What Are Custom Molded Orthotics?

Orthotics are foot supports designed to be worn inside the shoe. Scientific research has demonstrated that both over-the-counter and custom molded orthotics, or orthopedic insoles, are effective in treating lower-extremity injuries and pain. Insoles can also help correct biomechanical irregularities in your feet, and they solve many foot problems such as flat arches and plantar fasciitis.

Sports podiatrist and Doctor of Podiatric Medicine (DPM) Richard Braver considers orthotics a “cure-all” for many lower-body injuries and pain. According to Braver, “orthotics can prevent and cure a problem by reducing and eliminating the stress that caused it.” Clearly, orthotics are important additions to our shoes. But what are custom orthotics?

Over-the-Counter Versus Custom-Molded Orthotics

There are two types of orthotics: over-the-counter and custom-made orthopedic insoles (also called custom molded orthotics). What are the differences between the two?

1. Over-the-counter inserts encompass a variety of different foot products including arch supports, insoles, heel liners, and foot cushions. Not all pre-fabricated insoles are made alike, however. Here at Tread Labs, we have outlined the types of over-the-counter insoles available to help you understand the best option for your feet.
2. Custom molded orthotics are insoles that have been prescribed by a doctor and constructed for your specific foot. A podiatrist must conduct a thorough evaluation of your feet, ankles, and legs. Only then will the custom-made insert accommodate your individual foot structure.

While scientific research has proven that that insoles help treat and prevent lower-extremity injuries, studies have not found a significant difference between pre-fabricated versus custom orthotics.

In fact, Dr. Braver believes that for most people, orthopedic or custom-made orthotics should be a last option. Think of it this way. If you have a headache, you rest, take an anti-inflammatory, and drink water. You probably don’t immediately rush off to get an MRI. It’s the same with orthotics. With prices from $300 to $500, prescription insoles are not necessarily the best option for everyone.

So who may be a good candidate for custom orthotics?

People Who May Need Custom Orthopedic Insoles

1. Diabetics - Diabetes and poor circulation increase the risk of foot ulcers and infections. You might want to see a podiatrist if you have diabetes.
2. High-performance athletes - Running an ultra-marathon is different than a completing a 5K. If you engage in sustained, high-level activities (particularly weightbearing ones like running), you could benefit from an orthopedic insole.
3. People with recurring injuries that don’t go away with over-the-counter versions - Have you tried every single over-the-counter version available and you still suffer from plantar fasciitis or other issues? A podiatrist can help determine if you would benefit from prescription orthotics.

The Types of Custom Orthotics

1. Functional orthotics - As William R. Olson, DPM, and former President of the American Academy of Podiatric Sports Medicine (AAPSM) writes, “The purpose of the functional orthotic is to accurately and precisely position the foot throughout the gait cycle so as to promote proper function.” These orthotics control abnormal motion. They also treat foot pain and injuries such as tendinitis and shin splints. Functional orthotics are often crafted of semi-rigid materials like plastic and graphite.
2. Accommodative orthotics - Accommodative orthotics are designed to provide cushion and support. They are often custom-fitted for people suffering from diabetic foot ulcers or painful calluses on the bottom of their feet.

What To Expect When Getting Fitted for Custom Molded Insoles

If you’ve decided you might be a good candidate for custom molded insoles, it’s time to see a podiatrist. Here is what you can expect when getting fitted for your orthotics.

1. A Range of Motion Test - Your podiatrist will measure the motion of all your lower-extremity joints (such as your hips, knees, and ankles) in order to identify any irregularities in joint motion like excessive flexibility or extreme limitation. Your doctor will also establish the weightbearing and non-weightbearing functional positions of these joints. This means he or she will test your joints both when you are standing and walking on them (weightbearing) and when you are lying down (non-weightbearing).
2. A Muscle Examination - Your podiatrist well next test the lower-extremity muscle groups like the quadriceps and calves to identify any overly weak or tight areas. This will allow him or her to assess muscular contributions to your injury, symptoms, or biomechanical problems.
3. A Non-Weightbearing Neutral Position Cast of the Foot - Your podiatrist will then cast your foot to provide a model for the orthotic laboratory. As Dr. Olsen says, “The specific method of casting is critical and must be done accurately in order to achieve an accurate impression of the foot in its neutral position.” This is also why stomp-box moldable orthotics are ineffective in treating biomechanical problems, as they take an impression in a weightbearing position, thus incorporating any biomechanical issues into the build of the orthotic.

FIND YOUR BEST SEMI-CUSTOM INSOLE FIT

Questions Your Podiatrist May Ask

Your podiatrist should perform a thorough examination that includes all the elements listed above as well ask you questions about your pain and foot problems.

A good podiatrist will ask you to explain the type, frequency, and duration of all the activities you engage in as well as your overall lifestyle. Are you on your feet all day at work, lifting heavy loads? Your podiatrist should know this. Have a long history of plantar fasciitis or stress fractures? This is important information.

Your podiatrist should also ask to look at the wear pattern of your shoes. This will help him or her understand your gait mechanics. Podiatrists look for the following patterns:

• Symmetry - Is the wear equal and in the same location on both shoes?
• Tipping at the Heel - If you place the shoes on a table and look at them from the back, do the shoes tip in at the heel (pronation) or out (supination)? Does one shoe tip in a different direction than the other? That can be indicative of leg-length discrepancies.
• Toe Wear - Are there holes in the mesh part of the shoe where your toes have popped up? Do the toe creases run straight across the front of the shoe? If they aren’t, this can demonstrate poor fit.

A thorough examination is the foundation for effective, reliable custom-made orthopedic insoles.

Well-made, custom molded orthotics (a pair of orthotics made for a particular individual) are quite expensive ($300 and up). There is a small group of people that will benefit from this kind of custom solution. Custom molded orthotics have the goal to control pronation and increase the comfort and performance of footwear. There are many providers for custom molded orthotics, and some are better than others. Here are a few considerations for finding a great provider.

Finding The Right Custom Molded Orthotics Provider

1. Hands-On Evaluation – Great custom molded orthotics cannot be made without a face-to-face visit. There are a variety of providers who will send out a "Stomp Box," a piece of impression foam in a box. You are instructed to step into the box with each foot and send the resulting impressions off to make your orthotics. Unfortunately, without an experienced provider to position your foot as it makes the impression, your dysfunctional biomechanics may be built into the design of your orthotics.
   
2. Type of Provider – A certified Pedorthist (C. Ped) diagnoses foot problems and prescribes orthotics. I have found that C. Peds often have the most hands-on experience with orthotics and functional biomechanics. A C. Ped would be my first choice for a provider. Podiatrists are doctors who specialize in feet. They can diagnose foot problems and prescribe orthotics as well as perform surgery to fix problems. Because they are more focused on surgery, they would be my second choice.  A chiropractor is involved with the diagnosis and treatment of musculoskeletal disorders. Some provide custom orthotics, but because orthotics are a subset of what they do, chiropractors would be my last choice. 
3. Years of Experience – Getting custom molded orthotics right is a challenging mix of art and science. It takes years of experience to learn the subtleties of making custom orthotics that meet both the functional and the comfort needs of the client. Choosing someone with a long history of success will increase the chances that the orthotics will be right – the first time.
4. Hands-On Fabrication – Some practitioners evaluate a client's needs, then transmit the info to a lab that creates the actual orthotics. While this system can work, having the orthotics made at the place of the diagnoses prevents errors in communication and insures that modifications can be easily made if necessary. 

Finding a great provider for custom molded orthotics can be challenging. If Tread Labs can help in any way, please reach out to us for assistance. Healthy, comfortable feet are our goal.

Do you own custom-made orthotics? Tell us your thoughts about the process.