Custom Orthotics: Are They Worth It?

Custom Orthotics –a topic often debated among those seeking relief from foot pain and discomfort. Are they truly worth the investment? As a podiatrist with 30 years of experience, I can confidently say that the answer is not a simple yes or no. Custom orthotics can be invaluable to some patients while not necessarily suitable for others. But far and away,  they are a great tool for me in alleviating a patient’s foot problems . Let’s delve into the intricacies to understand why.

What is an Orthotic? 

First and foremost, let’s define what an orthotic is. Orthotics are supportive devices, designed to be placed inside your shoes. They realign feet for better functionality and reduce stress or strain caused by malalignment.

They come in two main types: generic or over the counter (OTC) orthotics or custom molded orthotics that require a podiatrist’s evaluation and prescription.

While both can be referred to as arch supports, custom orthotics realign feet for better functionality and reduce stress or strain caused by malalignment of the foot bones from bad foot biomechanics.
Custom orthotics have a level of  precision and personalization that far surpasses generic OTC orthotics . 

What separates a custom orthotic from a generic orthotic?

Generic or over the counter orthotic is just an arch support and does not customize to affect individual deformities nor can aid in motion control to allow for optimal function. 

On the other hand, custom orthotics are a result of a mold of the foot in a neutral position optimizing function. Just like a car operating in the wrong gear can lead to various problems, a foot operating outside of its neutral position can result in pathology and functional issues. 

Beware of Orthotic Naysayers : 

If a foot issue is structural and bony, therapy or soft tissue manipulation cannot help as illustrated in the picture below. I mention this as there is a lot of online proponents advocating for therapy and barefeet-like shoes alone in solving various foot conditions. Although in certain situations this may be helpful under the guidance of your podiatrist, these barefoot proponents seemingly completely abandon this well established proven treatment of custom molded orthotics. 

Example of How an Orthotic Helps Abnormal Foot Alignment and Biomechanics:

A biomechanical exam revealing the above forefoot alignment can lead to the back of the foot compensating illustrated below.

This type of positioning can lead to strain and stress to tendons and structures on the outside of the foot. So a properly posted orthotic can alleviate this . 

Customization Process  of an Orthotic

A cast or an impression digitally of the foot in neutral position is captured .

The detailed orthotic prescription is written, and an orthotic lab constructs the device.

Because of the tedious labor and customization custom molded orthotics normally cost several hundred dollars . 

Conditions Treated with Orthotics

• Malalignment issues causing stress, strain, and pain 
  
• plantar fasciitis
• Ball of the foot pain ( metatarsalgia), neuromas, hallux limitus or big toe joint arthritis 

• Instability leading to tendinitis or joint issues

• Arthritis

• Offloading chronic painful areas

What to Do When You Can’t Afford Custom Orthotics:

*** To help my patients who cannot afford a custom orthotics, there are heat moldable OTC orthotics such as a spenco orthotic,  that can be DIY customized.  One can customize a Spenco OTC orthotic for ball of the foot pain with a metatarsal pad and to offload calluses with a callus protector pad . Check out my You Tube video on how to customize an OTC orthotic for calluses Also watch the YouTube video on how to apply a metatarsal pad on your insert or orthotic . 

Beware of DIY “custom orthotics” and store “custom orthotics “

Another reason I wanted to educate on this subject is that unsuspecting people are paying hundreds of dollars for so-called custom orthotics from doing their own foam box impressions for orthotics at home or from a store salesman with little to no training.
The untrained person, or the store salesman has very little training in foot mechanics, anatomy, and has no idea what neutral position is.

They do not have the comprehensive knowledge of the biomechanical issue that caused the current foot problem therefore, they don’t know how to fashion the orthotic to correct for it.
These store or online companies charge $200 for “custom orthotics
with no follow up and no way to get the device modified if you’re having problems.
Please know that part of the cost of custom orthotics is for the expertise of the podiatrist who has a doctorate +2 to 4 years of residency.
Plus, modifications are common after use and follow-ups are important.
Please see your podiatrist for an orthotic. Don’t try to use the at home foam box, impression , or the store salesman.

Cons of Custom Orthotics

1.Scientific studies are lacking 

Currently, the scientific studies show relative equal effectiveness between generic orthotics and custom orthotics . However, the quality of the studies have not been good and it is difficult to properly study orthotics.

While scientific studies may not conclusively prove the superiority of custom orthotics over generic options, the anecdotal evidence from countless satisfied patients speaks volumes. I have seen them transform patient’s lives.

2. Cost 

Due to the customization , expertise required for an effective orthotic and tedious labor cost will run $300-$500.

3. Adjustment period and modifications 

An adjustment period of about a month is normally required. Many times modifications are needed .

4.  A small percentage of patients cannot tolerate orthotics 

Unfortunately, custom orthotic intolerance is not known until one wears the orthotics. Plus custom molded orthotics are normally not refundable because they are customized for one individual .

I usually test to have more certainty that my patients can tolerate an orthotic with either first trying a generic orthotic or applying an arch strapping . See my YouTube video on how to apply a low dye strapping. If either of these two things help then usually a custom orthotic is helpful .

 

Pros or The Value of Custom Orthotics 

Despite the cost and potential drawbacks, custom orthotics offer several distinct advantages:

1. Individual Customization: Each pair of custom orthotics is tailored to the specific foot condition of the patient, ensuring optimal fit and functionality.

2. Longevity: The materials used in custom orthotic shells are durable, often lasting a lifetime. While the top cover may require replacement over time, the shell as stated by certain orthotic companies will last a lifetime . 

3. Transformative Results: I’ve witnessed firsthand the life-changing effects of custom orthotics on patients suffering from chronic foot pain. These devices offer superior functionality and can be adjusted to address specific issues, surpassing the capabilities of generic alternatives . 

Please also see my YouTube episode on custom orthotics.

The Decision Making Process 

It’s crucial to approach the decision with realistic expectations and an understanding of the potential drawbacks, including cost and adjustment periods.

Consult with a podiatrist to determine the most appropriate course of action for their specific needs. While custom orthotics may not be the answer for everyone, they have the potential to significantly improve the quality of life for those struggling with foot pain and discomfort. 

In conclusion, the decision to invest in custom orthotics is a based on an individual’s biomechanics, foot type and specific problem , guided by your podiatrist’s careful consideration of individual needs and preferences. While they may not be a panacea for all foot problems, the transformative effects they offer to the right patient cannot be overstated. So, if you’re considering orthotic intervention, consult with a podiatrist to explore your options and embark on the path to improved foot health and overall well-being.

 

Thanks for reading!

Melissa Gaffney, DPM

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Disclaimer: This post/ information on DrGaffneyBestFoot.com is not Intended to diagnose treat or prevent any disease disorder or condition. It is for informational purposes only and does not constitute medical advice nor is it intended to replace medical advice.  This blog / DrGaffneyBestFoot.com does not constitute a doctor patient relationship. See full disclaimer at  DrGaffneyBestFoot.com