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Gaz
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Aging feet...

Hi Graham,

I am not a medical practitioner but my understanding is that aging fee get longer, wider, flatter and thinner.

Over time, your feet become wider and longer and the natural padding under your heel and forefoot thins. Years of use also flatten your arches and stiffen your feet and ankles.   Excuse my frankness but it seems like the shoes that have served you well for the past 20 years needs updating.  As you have already had experience with a bespoke shoe maker, you will appreciate the process they go through.  However,  it may be in the interest of discussion for me to share the following information about shoe fit.  Apologies if you already know this.

To get a sense of the best fit for your feet, here are a few tips:

1. Try the fit of shoes later in the day.  Avoid fitting shoes in the morning since your feet swells during the course of the day. 
2. Fit to your largest foot.  Most people have a larger right foot, so fit it to this size.  In the event that you have a substantially smaller alternate foot, have both measured. 
3. Wiggle your toes.  When standing, you should have enough room in the toe box to wiggle your toes.
4. Ignore shoe sizes! Just because you are a 43 in one pair doesn't mean that you will be necessarily a 43 in another.  Shoe designs can impact this substantially.  Derbys with seperate quarters and vamps are more flexible than whole cuts or oxfords which have a more "restrictive" throat. 
Wear the right socks. Socks vary in thickness, which impacts fit.  Avoid wearing sports socks when fitting leather shoes.  Also, your sports shoes fit does not always correspond to your leather shoe fit (see 4). Get close to fit as possible. Don't buy shoes that feel too tight and expect them to stretch to fit.  Go for half sizes or expanded widths. Most good shoe stores should have a broad range of fits in half sizes and widths. Heel should be snug. Your heel should fit comfortably in the shoe with a minimum amount of slipping. The shoes should not ride up and down on your heel when you walk.  I have seen a John Lobb bespoke fitting where a pair of leather shoes are made specifically for the fitting and holes are cut in the heel is then cut up at the heel so the shoemaker can see how well the heel sits.  A brand new pair with the leather of your choice is then only made.
5. Don't rush or compromise.  Walk in the shoes to make sure they fit and feel right. Wear both shoes if required and test them in the range of your size and width. Take your time and enjoy the experience.  A good shoe store will understand that.  Ignore those who don't.

Gaz