Do I really need custom orthotics?

What do orthotics actually do?

An orthotic is a load management device. It changes where force goes as your foot meets the ground, and how fast it arrives. It does not correct posture, realign your skeleton or permanently reshape your foot, and any claim along those lines should make you suspicious.

A well made device does three things: it shifts pressure off irritated tissue, such as the plantar fascia insertion or a painful forefoot callus; it slows a motion happening too far or too fast, usually excessive pronation; and it gives the foot a more consistent surface to work against, which changes how the calf, knee and hip behave further up the chain.

That is a useful set of effects, and a narrow one. If your real problem is a training load that jumped sharply, an orthotic treats the symptom and leaves the cause untouched.

Prefabricated, semi-customised or fully customised?

There are three tiers, and the middle one is the most overlooked.

• Prefabricated (off the shelf). A moulded device chosen by size and shape. Modern prefabs are far better than the chemist insole most people picture, and for a straightforward pronating foot with recent, uncomplicated pain the research shows outcomes comparable to custom devices.
• Semi-customised. A prefabricated shell modified in the clinic with posting, wedging, cut-outs or top covers to suit your foot and symptoms. This is the tier we reach for most often: a fast fit with real individual adjustment, tunable again at your review.
• Fully customised. Made from a cast or scan of your foot, with prescribed shell material, stiffness, arch height and correction. Worth the extra time and cost when your foot falls outside what a stock shell can accommodate.

The right answer is often a trial: a prefab tells us whether changing load distribution helps you at all, before anyone commits to a customised pair.

When are custom orthotics genuinely worth it?

A custom device is sometimes the better clinical choice, not just the dearer one:

• Unusual foot shape. A high, rigid cavus arch, a severely flat foot, a forefoot at a marked angle to the rearfoot, or a foot that gaps on every stock shell.
• A significant structural difference between your feet. A leg length difference, an old fracture that healed with a change in shape, or a stiff arthritic joint needing accommodation on one side only.
• High or repetitive loads. Running volume, court sports, long days on concrete. More load means more benefit from getting distribution right. See sports podiatry.
• Diabetic offloading. With neuropathy, past ulceration or a high risk foot, a device built to take pressure off a specific area is protective, not cosmetic. The strongest indication of the lot. See diabetic foot care.
• Simpler measures have failed. You have changed shoes, strengthened properly for a couple of months, trialled a prefab, and are still limited.

When do you not need them?

Orthotics are often prescribed for problems that would settle without them. You probably do not need a custom device if:

• Your pain followed an obvious spike in activity and that load has already been corrected.
• Your shoes are worn out or wrong for your foot shape. Footwear is often the fastest win, and Bryce’s background managing a technical footwear store means brand and model level advice rather than “wear something supportive”.
• Your symptoms are skin or nail related — corns and callus, ingrown toenails or blisters — where friction and fit are the cause. Pressure related callus is the exception, since redistributing load is the point.
• You have flat feet but no pain, no fatigue and no functional problem. A flat foot is a shape, not a diagnosis.
• Your child has been told they need orthotics for what is a normal developmental stage. Most children’s arches develop without intervention. See children’s podiatry.

What does a proper biomechanical assessment involve?

The assessment is what makes a yes or no answer trustworthy. Ours starts with history — what hurts, when it started, what changed beforehand, what you need your feet to do — then examines joint range, muscle strength, foot posture and tissue tenderness, standing and non weight bearing.

From there we look at movement. Walking or running on a treadmill with video gait analysis lets us slow the footage down and see what the foot, ankle and knee actually do through the gait cycle, rather than inferring it from a static exam. We also read your shoes, because wear patterns are honest evidence of how you load them.

Only then does a device come up, alongside the alternatives, and you should hear which motion or pressure we are trying to change and why. Full detail is on the orthotics page.

The assessment is worth having even when the answer is no. Knowing your mechanics are not the problem sends your time and money to whatever is, and rules out conditions that need a different plan.

What can you claim back?

Orthotic therapy is claimable through all major Australian health funds, and we process claims with HICAPS on the spot at every clinic, so you only pay the gap. Cover varies between funds and policy levels, so ring yours with the item numbers first. We can give you those.

If you have a chronic condition such as diabetes, arthritis or vascular disease, your GP may write an Enhanced Primary Care plan, which attracts a Medicare rebate on a set number of podiatry visits each year. DVA Gold Card holders and WorkCover patients need a referral; nobody else does. We accept Visa, Mastercard and EFTPOS.

Common questions

This page is general information, not personal medical advice. Reviewed by Gideon Poratt, Principal Podiatrist (B.App.Sc (Pod), M.A.Pod.A), a member of the Australian Podiatry Association. Please book an assessment for advice specific to your feet.