Custom vs. store-bought orthotics: what the research says

Custom orthotics can be excellent, and they can also be an expensive answer to a problem that a well-chosen off-the-shelf insert would solve. Here’s how to decide.

What the research says

For heel pain, a meta-analysis of trials in people with plantar heel pain found that foot orthoses reduced pain compared with sham inserts over 7 to 12 weeks (a modest effect), and that custom and prefabricated orthoses performed similarly at every time point.^[1]

For foot pain in general, a Cochrane review of custom-made foot orthoses found the strongest evidence for painful high-arched (cavus) feet, with supportive evidence for foot pain in rheumatoid and juvenile arthritis, plantar fasciitis and bunions, and limited evidence overall.^[2]

In other words: custom orthotics aren’t automatically better. They’re better for particular feet and particular problems.

When store-bought is a good first step

• Mild to moderate heel pain or arch pain.
• A normal foot shape that fits standard inserts.
• You want to see whether support helps before investing more.

Look for a firm, supportive arch (not just soft foam), a deep heel cup, and a fit that suits your shoe. Give it a fair trial of several weeks: in the heel pain trials, the benefit showed up at 7 to 12 weeks rather than in the first few.^[1]

When custom orthotics are worth it

• High-arched feet that absorb shock poorly and overload the heel or ball of the foot.^[2]
• Arthritis or other conditions where pressure needs to be carefully redistributed.
• Unusual foot shapes, a leg-length difference, or deformities that store-bought inserts don’t fit.
• Diabetes or neuropathy, where inserts must relieve pressure precisely to protect the skin.^[3]
• Store-bought inserts haven’t helped after a fair trial.
• Sport-specific needs, such as cleats or ski boots, where standard inserts won’t fit.

How we make them

We examine your feet, watch how you walk (and run, if you’re a runner), scan each foot in 3D to create a precise digital model, adjust the design for your diagnosis and footwear, and have a lab fabricate them. Then we check the fit and adjust as needed. See custom orthotics and what gait analysis shows.

Getting the most from either kind

• Break them in over a week or two, a few hours more each day.
• Make sure they fit your shoes: take out the shoe’s own insole if needed.
• Keep up the stretching and strengthening. Inserts support; they don’t replace exercise.
• Replace them when they’re worn or no longer feel supportive.

Common questions

Can orthotics make things worse?

Custom orthotics were safe in the trials reviewed by Cochrane.^[2] New inserts of either kind can cause soreness or blisters while you get used to them, which is why breaking them in gradually matters. Pain that is new or sharp, rather than mild aching, means the insert needs adjusting.

Does insurance cover custom orthotics?

Coverage varies widely between plans, so it is worth checking before they are ordered. For people with diabetes and significant diabetes-related foot disease, Medicare Part B covers therapeutic shoes and inserts each calendar year, when the certification and prescription requirements are met.^[4]

Are the inserts sold in pharmacy kiosks “custom”?

No. Machines that measure your feet and recommend an insert choose from a range of prefabricated designs. They can be a reasonable store-bought option, but they aren’t made from a model of your foot for your diagnosis.

When to see a podiatrist