In short: orthotics are devices worn inside your shoes to improve the way your feet function and to change how load travels through your lower limbs. They can help flat feet, heel and arch pain, shin pain, tendon problems, pressure lesions and some knee, hip and lower back complaints. At Podiatry Healthcare Group we assess first, then prescribe the simplest option that works, which may be a prefabricated insert rather than a fully customised device.
What orthotics actually are
An orthotic is a device worn inside your footwear to improve foot function. You may know them by their older names: arch supports, insoles or inserts. The language has changed because the job has changed. A modern orthotic is not simply a cushion under the arch. It is prescribed to alter how and when your foot loads, to shift pressure away from tissue that is being overworked, and to give the muscles and tendons around your foot and ankle a more efficient position to work from.
That distinction matters. Two people can have identically flat-looking feet, walk very differently and need two completely different devices. This is why we assess before we prescribe, rather than matching a foot shape to a product off a shelf. The device is also only half the equation, because it sits inside a shoe that has to be capable of holding it. Every orthotic consultation at our Melbourne clinics includes an honest conversation about footwear.
What orthotics can help with
Orthotics are prescribed as part of the treatment for a wide range of lower limb complaints, including:
- Flat feet and arch fatigue, where the foot rolls in excessively and tires quickly
- Heel pain, including plantar fasciitis and heel spur pain
- Shin pain and shin splints, particularly in runners and field sport athletes
- Tendonitis through the Achilles, tibialis posterior or peroneal tendons
- Corns and callus caused by repeated pressure in one spot
- Discomfort associated with bunions, where pressure needs to be redistributed
- Ankle pain and recurring instability after sprains
- Knee and hip pain, and in some cases lower back pain, where poor foot mechanics contribute to the load above
Orthotics for flat feet are one of the most common requests we see. Flat feet are not automatically a problem: plenty of people have low arches, no symptoms and no need for treatment at all. Orthotics become worth considering when the flat foot position is producing pain, limiting what you can do, or driving repeated skin problems from uneven pressure. The same applies to children, where growth, activity and shoe fit all matter. See our children’s podiatry page.
How we prescribe orthotics: three stages
Stage one: the biomechanical assessment
Nothing is prescribed until we understand how your foot works. We take a history of your symptoms, activity and work, then examine the joints of your feet, ankles, knees and hips for range of motion, strength and tenderness, and watch how you stand and walk. Where it is useful, the assessment includes walking or running on a treadmill while we record you with a video camera, so the footage can be slowed down and reviewed frame by frame. We also look at the shoes you arrive in, because wear patterns tell us a great deal.
Stage two: choosing the orthotic
There are three broad options, and the assessment decides which one suits you.
- Prefabricated devices are made in standard sizes and shapes. They suit straightforward presentations and are the quickest and least expensive way to test whether a change in foot position helps your symptoms.
- Semi-customised devices start from a prefabricated shell that we then modify, with additions, wedging or padding, to suit your foot and your specific problem.
- Fully customised devices are made from a cast or scan of your own feet and built to a prescription written for you. These are the right choice for complex foot types, significant deformity, high-load sport, or when simpler devices have already been tried without success.
Stage three: fitting, wearing in and review
When your orthotics are ready we fit them in the shoes you will actually wear, check the contact and pressure points, and adjust them on the spot if needed. You are then given a wearing-in plan, starting with short periods and building up so your feet and legs adapt gradually. We review you over the following weeks. Orthotics almost always need a small adjustment in that time, and the follow-up is part of the treatment rather than an optional extra.
Not everyone needs custom orthotics
We will tell you plainly if we do not think orthotics are the answer for you. A great deal of foot pain settles with a change of footwear, a strengthening program, a period of activity modification, or treatment aimed directly at the irritated tissue. Sometimes an orthotic is not the missing piece, and prescribing one would add cost without adding benefit.
Where orthotics do help, we still prefer to start conservatively. Trialling a prefabricated device tells us whether changing your foot position changes your symptoms. If it does and you need something more durable or more specific, we step up to a customised device knowing the approach works. If it does not, we have learned something useful and saved you the expense. For a longer look at that decision, see our article on whether you really need orthotics.
Rebates, referrals and payment
You do not need a referral to see a podiatrist. The exceptions are DVA Gold Card holders and WorkCover patients, who do need one.
If you have a chronic condition such as diabetes, arthritis or vascular disease, your GP may be able to put you on an Enhanced Primary Care (EPC) plan, which provides a Medicare rebate towards podiatry appointments. Ask your GP whether you are eligible. Patients managing diabetes should also read our diabetic foot care page.
We accept all major Australian health funds and process claims through HICAPS on the spot at every clinic, so you only pay the gap. Cover for orthotics varies between funds and levels of cover, so it is worth checking your extras limits first. We accept Visa, Mastercard and EFTPOS.
Common questions
Will orthotics fix my flat feet for good?
Orthotics change how your foot functions while you are wearing them. They are not a permanent structural change to an adult foot, and we would not claim otherwise. What they can do is reduce the strain a flat foot position places on particular tissues, which is usually what brings the pain down. Strengthening and appropriate footwear do the rest.
How long does it take to get used to orthotics?
Most people adapt over the first couple of weeks, which is why we give you a graded wearing-in plan rather than telling you to wear them all day from day one. Your review falls inside that window so we can adjust the device while you are still settling in.
Will orthotics fit in all my shoes?
Not always. A device built for a lace-up walking shoe will not sit properly in a flat pump or a slim dress shoe. Tell us at the assessment what you need to wear for work and for sport and we will prescribe accordingly. Sometimes the sensible answer is two devices, or a change of shoe.
Do I need a GP referral to get orthotics?
No. You can book directly with us. Only DVA Gold Card holders and WorkCover patients require a referral. To claim a Medicare rebate under an EPC plan, your GP needs to arrange that plan first.
Can children wear orthotics?
Yes, when they are indicated. Many childhood foot presentations are a normal part of development and need monitoring rather than a device. We assess, explain what we are seeing, and prescribe only when there is a clear reason. See our children’s podiatry page.
Do orthotics wear out?
They do, much as shoes do, and how quickly depends on your weight, your activity and the materials used. Top covers and padding usually go first and can often be replaced rather than rebuilding the device. Bring your orthotics to your reviews and we will check their condition.
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.