Custom orthotics

What are custom orthotics, and how do they work?

Custom foot orthoses (custom orthotics) are shoe inserts made for one person's foot, rather than pre-made in standard sizes¹. They're made from a plaster cast, a digital scan, or a drawing or mould of your foot²³.

They're thought to work in two main ways: by changing how your foot moves, or by taking pressure off sore areas and spreading it more evenly⁴. Some also add cushioning for shock absorption².

Being custom-made doesn't, on its own, guarantee a better effect on how your foot is loaded, so the design matters as much as the label⁵. Ready-made (prefabricated) orthotics are pre-made, usually foam, and can be adjusted to fit¹.

What are custom orthotics used for, and how well do they work?

The strongest support is for adults with diabetes who are at risk of foot ulcers. Guidelines favour custom insoles in therapeutic footwear to help prevent ulcers coming back⁶. The Australian guideline recommends considering custom-made footwear or orthoses when there's a foot deformity or an early warning sign of an ulcer⁷. The certainty behind this is very low, so a firm conclusion can't be drawn⁸.

For flexible flat feet, adults had less pain with orthoses than without them, but results in children are mixed⁹. For heel pain (plantar fasciitis), orthotics may be a promising option that eases pain and disability¹⁰. Adults with a range of foot and leg problems had less pain and better foot function within 4 weeks, and this lasted to 12 weeks¹¹.

Orthoses are also listed for calluses, bunions, tendonitis and ankle sprains¹², but how well they work for these isn't clear yet. A benefit in one condition doesn't mean the same benefit in another.

Are custom orthotics right for me?

A podiatrist may prescribe orthoses if you have a long-standing foot or leg problem that's getting in the way of your foot health or function². They're most strongly recommended for adults with diabetes who have a foot deformity or an early sign of an ulcer⁷. They probably do little for rigid flat feet (feet where the arch stays low and stiff), because the joints can't move enough⁹.

People respond very differently, so the plan should be tailored to you¹². Book an assessment with a podiatrist rather than choosing a custom device yourself. If you have diabetes, reduced feeling in your feet or poor blood flow, make sure the orthoses are prescribed and fitted by a trained clinician. If you'd rather not use a recommended device, say so and ask about alternatives.

What happens when I get custom orthotics?

Expect an assessment first: your foot structure, joint movement, muscle strength and walking pattern, plus your usual shoes, work and lifestyle²³. Bring the shoes you wear most, and mention your work and sport.

Your foot is then cast, scanned or moulded. Insoles made from a direct scan are linked with greater satisfaction and more consistent wear than those made from foam-box casts¹¹. If you have diabetes, the plan should match your ulcer risk and any deformity, and be checked by a team⁶. There's no standard number of appointments, so ask when your review will be.

Wear them in gradually, following the schedule your podiatrist or orthotist gives you¹³. With diabetes, your feet and footwear should be checked before and after each use while you wear them in⁷.

What are the risks and side effects?

Mild discomfort is common at first, because orthoses change how your foot moves. It should ease as you wear them in¹³. Some minor aching in your feet, knees, hips or lower back is normal. If it becomes painful, take the orthoses out until it settles, then start the wear-in again from the beginning³. Discomfort in the arch can often be settled by a review and adjustment of the insole¹¹.

Discomfort is a common reason people stop wearing orthoses⁹. Tell your clinician early if comfort is a problem.

If you have diabetes, foot treatments can cause harm if they're not done properly, so they should only be done by an appropriately trained health professional. The benefits, risks and any reasons not to use a device should be talked through with you first⁷.

How do custom orthotics compare with other options?

Custom isn't clearly better than ready-made. In people with diabetes, a custom insole didn't reduce foot pressure more than an off-the-shelf one⁵. For most conditions it isn't clear yet whether custom devices ease pain or improve function more than ready-made ones. Custom-made footwear did lead to fewer ulcers than no special footwear in diabetes⁵.

Orthoses often work alongside other things, such as exercise or footwear changes. Before you commit, ask why a custom device is recommended for you, what else is in the plan, how much it costs and how long it takes to make.