Do I Need 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 prefabricated insoles are made alike, however, especially when it comes to the level of support they offer.
2. Custom molded orthotics are insoles that have been prescribed by a doctor, often a podiatrist, sports medicine physician, or orthopedic surgeon after conducting a thorough evaluation of your feet, ankles, and legs. They are built for your specific foot and gait, and accommodate your individual foot structure.

While scientific research has proven that that insoles help treat and prevent leg, foot and lower-extremity injuries,  studies have not found a significant difference between prefabricated 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 weight-bearing ones like running), you could benefit from an orthopedic insole.
3. People with serious biomechanical issues and recurring injuries that aren’t addressed with over-the-counter versions - Have you tried every single over-the-counter version available and you still suffer from plantar fasciitis, pain or other issues? Prescription orthotics may be a good option. However, you also need to rule out other causes of foot pain such as tight muscles and improper footwear. Seeing both a podiatrist and a physical therapist can help you determine the true cause of lower-extremity pain.

If you don't fall into these three categories, aftermarket insoles might be a better option.

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 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 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 why stomp-box moldable orthotics are ineffective in treating biomechanical problems. They take an impression in a weightbearing position, thus incorporating any biomechanical issues into the build of the orthotic.

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 look at the wear pattern of your shoes to 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 not, it could be a sign of 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), and there is a  small group of people who will benefit from them.

Custom-molded orthotics are designed 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. You’ll want to consider a few factors when searching for a 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. C. Peds often have the most hands-on experience with orthotics and functional biomechanics.Podiatrists are doctors who specialize in feet. They can diagnose foot problems and prescribe orthotics as well as perform surgery to fix problems.  A chiropractor is involved with the diagnosis and treatment of musculoskeletal disorders. Some provide custom orthotics.
3. Years of Experience – Getting custom 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.

If you’ve decided that custom orthotics aren’t right for you, or that it makes sense to try over-the-counter insoles first, you’ll find you have a lot of choices.

How To Choose Over-The-Counter Insoles

The most important thing to consider is that not all over-the-counter inserts are made alike. Their quality and effectiveness varies greatly. And understanding the difference between inserts and insoles is helpful.

Think about arch supports, feet, and walking the way you think about eyeglasses, eyes, and seeing. Most people (especially as they get older) benefit from some kind of corrective lenses to improve vision. In the same way, most people benefit from arch supports to optimize their stride.

Shoe Inserts

Depending on your eyesight, you might need a specific prescription or a simple pair of generic reading glasses found at the drugstore. Generic reading glasses are similar to shoe inserts that don't have much variety in sizing and fit.

The basic cushioned inserts you find at the drugstore may be cheap, but they lack any structure and they won't provide the needed support.

Shoe Insoles

If you require more than drugstore reading glasses, you will need an eye exam, after which you get a prescription for lenses. The prescription is written in a detailed scale because added precision enables better sight.

Like with glasses, having precision sizing withinsoles enables a higher level of support and better biomechanics. For many people, an eye exam and simple prescription is enough, much like aftermarket insoles with precision sizing works for most people in relation to arch support.

There are different types of insoles:

• Heat-moldable insoles and stomp-boxes – These “do-it-at-home” models seem to provide a custom fit for your feet. Remember, however, that because these inserts take weightbearing casts of your feet, they build the biomechanical issues you are trying to correct into the very structure of the insert supposed to correct it. Moreover, if the materials are soft enough to heat, they are not going to provide the firm structure your feet need.
• Structured insoles – Brands like Superfeet or the electronically-fitted Dr. Scholls line provide more structured inserts with deep heel cups and arch support. But, unlike Tread Labs, neither brand provides sizing options that accommodate every foot.

When you’re considering  over-the-counter insoles, look for proper fitting medical-grade arch supports that provide comfort as well as support. They should control overpronation and prevent and relieve plantar fasciitis. But most importantly, they should support your active life so you can walk better, feel better, live better.

FIND YOUR FIT