Custom orthotics and gait analysis

What orthotics can and can’t do

Orthotics change how load is spread across the foot and can support or control motion. That makes them useful for redistributing pressure away from a painful spot, supporting a collapsing arch, cushioning a high-arched foot that absorbs shock poorly, or protecting the foot of someone with diabetes.

They don’t fix everything. A Cochrane review of custom-made foot orthoses found benefit for painful high-arched (cavus) feet, rearfoot pain in rheumatoid arthritis and some other conditions, with the evidence for plantar heel pain less certain.^[1] For heel pain specifically, a meta-analysis found that custom and prefabricated orthoses performed similarly.^[2] We’ll tell you which you’re likely to need.

How we make them

1. Evaluation. We examine your feet, ankles and legs, check joint motion and alignment, and look at wear on your shoes.
2. Gait analysis. We watch you stand and walk (and run, for runners) to see how your feet move and where they are overloaded. Our article on what gait analysis shows explains more.
3. 3D scan. Each foot is scanned to create a precise digital model, with no plaster casting.
4. Prescription. The design is adjusted for your diagnosis, your shoes and your activities, and sent to a local lab to be made.
5. Fitting and follow-up. We check the fit, explain the break-in period and adjust if needed.

Who may benefit

• Painful high-arched feet and feet that roll outward.^[1]
• Flat feet with pain, including early posterior tibial tendon dysfunction.^[3] See flat feet.
• Forefoot pain where pressure needs to move off a sore spot.
• Diabetes and neuropathy, where accommodating inserts and proper footwear help protect the foot from pressure injury.^[4] See diabetic foot care.
• Athletes and runners with recurring overuse injuries, as one part of a plan that also addresses training and strength.^[5]

Store-bought or custom?

For many problems, a good prefabricated insert is a sensible first step: it costs less and is available immediately.^[2] Custom orthotics make most sense when a foot’s shape or the problem is unusual, when a prefabricated insert hasn’t helped, or when precise pressure relief is needed. Our article custom vs. store-bought orthotics compares them.

Getting used to them

New orthotics feel different, and the body needs a little time to adjust. Start with an hour or two on the first day and add time each day, so that most people are wearing them all day within a week or two. Take out the shoe’s own insole so the orthotic sits flat, and wear them in the shoes you brought to the fitting. Mild aching in the arch or legs in the first days is common; blisters, sharp pain or new pain elsewhere are not, so call us and we’ll adjust them.

Common questions

How long do custom orthotics last?

It depends on the materials, your weight and how hard you are on them. We check them at follow-up visits. Replace them when the shell cracks or flattens, the top cover wears through, or your feet, your activities or your symptoms change.

Do I need a pair for every shoe?

No. Most people move one pair between shoes of a similar type, such as sneakers and walking shoes. Slim dress shoes and cleats often need a thinner design, and we can make a second pair for them if it helps.

Will I need them forever?

Not necessarily. Some people use orthotics while an injury settles and then stop; others, with a foot shape that keeps overloading one area, do best wearing them long term. We’ll tell you which is likely for you.

Can children have custom orthotics?

Yes, when they have a problem that orthotics help. Flat feet that don’t hurt usually don’t need them.^[6] See children’s foot care.

Insurance

Coverage for custom orthotics varies widely between plans. We’ll help you check your benefits before they are ordered.

When to seek care