Off-the-shelf orthotics

What are off-the-shelf orthotics, and how do they work?

Prefabricated orthoses (off-the-shelf orthotics) are pre-made insoles, usually made of foam, that can be modified to suit your foot¹. Custom orthotics, by contrast, are made for your individual foot¹. "Pre-made" covers both basic shop-bought insoles and off-the-shelf devices that a podiatrist adjusts for a specific problem³.

Insoles are designed to guide your foot so it works more efficiently¹, or to take pressure off a sore area².

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

Heel pain in adults is the best-studied use, and the benefit is small. Insoles may ease pain a little in the medium term, though that may not be enough for some people, and the full effect may take 7 to 12 weeks⁴. They don't seem to beat fake insoles or other simple treatments for pain and function⁵.

For children with flat feet the picture is mixed. Insoles may reduce pain, but the evidence is low quality⁶. For painless flexible flat feet they made little or no difference to pain after a year⁷. There's no strong evidence that long-term use changes the structure of a child's flat feet⁷. For children with painful flat feet, it isn't clear yet whether orthotics are worth it⁸.

Keep expectations realistic: people can expect a lot from insoles and be disappointed⁸. For most other foot and leg problems, how well pre-made insoles work isn't clear yet.

Are they right for me?

A podiatrist can assess how your feet and legs work, along with your footwear, work and lifestyle, to see whether orthotics are likely to help³. For heel pain, clinicians are advised not to give insoles to everyone, and to consider your preferences and how likely you are to wear them⁵. One advantage is that insoles take less effort to keep up than exercises or stretching⁵.

For children with painless flexible flat feet, there's no support for expensive custom orthoses⁷. A child with ongoing foot pain should be assessed by a health professional, because flat-foot pain is often put down to growing pains⁸.

What happens when I get them?

A podiatrist will usually start by assessing your feet, legs and footwear³. A pre-made device can be fitted on the day². Prescribing commonly includes advice and some adjusting of the insole¹⁰. Your podiatrist can tell you how many visits you'll need.

Wear the insoles in supportive shoes that have a removable insole and fasten securely with laces, a buckle or a strap¹¹. Follow the wearing-in schedule your clinician gives you. For heel pain, give them several weeks before deciding whether they help.

What are the risks and side effects?

Side effects are usually mild. Aching in your feet, legs, thighs or lower back, a lump felt in the arch, or muscle tiredness can happen at first as your body adjusts, and should settle within a few days¹²¹³. Insoles shouldn't cause pain, redness or rubbing¹¹.

After taking them out, look for redness or pressure marks that don't fade within 30 minutes, blisters, cuts, rubbing areas, or swelling or pain in your feet or ankles¹². If you notice any, stop wearing the insoles, then build up wear time slowly again and wait for blisters to heal¹².

How do they compare with other options?

For adults with heel pain, pre-made and custom insoles gave similar pain and function results¹⁴⁴, and well-contoured pre-made ones may cost less⁴. The shape of the arch support may matter more than whether it's custom-made¹⁵. If a custom device is recommended for heel pain, it's reasonable to ask why, given the extra cost.

No commonly used heel pain treatment, insoles included, comes out clearly ahead of the others¹⁴. Insoles weren't effective on their own but were mostly effective combined with shockwave therapy¹⁴, so ask whether they should be paired with another treatment. This evidence is mostly about heel pain in adults and may not apply to other conditions or to children.