Custom orthotics cost big money and typically insurance doesn't cover them, so before you hand over the $200 to $800 they cost, make sure you really need them. And if you do, find out how to get the most for your money.
If you're thinking about spending the money on custom insoles, you'll want to know exactly what you’re paying for so you can decide whether it’s a good fit for you. To help you along, we'll review:
After prolonged use, the plastic or EVA foam material used in the orthotic will wear out, which means you'll need to buy another pair of custom orthotics. Over a lifetime, those costs add up to a big number.
Also, ask yourself if you really need them. A 2009 study came to the following conclusion: "At two to three months and at 12 months, prefabricated orthoses were as effective as custom orthoses ... There is no evidence that custom orthoses are more effective than prefabricated ones."
Some people absolutely do need custom orthotics. Dr. James Ioli, DPM, Chief of Podiatry at Brigham and Women's Hospital in Boston, says people with certain conditions like the following do need custom orthotics:
However, the majority of people, including those suffering from Achilles tendinitis, plantar fasciitis, arch pain, heel pain, and kinetic chain pain, over-the-counter orthotics will work well and are significantly less expensive.
The actual manufacturing cost of custom orthotics (including materials) is normally $100 or less, so why are custom orthotics so expensive? It's because you're paying for the exam, casting of your feet and a hefty mark-up.Here's what goes into the total cost of prescription orthotics:
As podiatrist Dr. Robert Eckles of Manhattan notes, “It's hard to see the value in the plastic.” But he reminds us that we’re “paying for a comprehensive diagnosis of present and future problems” and not simply the orthotic itself.
It is helpful to ask your podiatrist to break the cost down for you, so you can understand the exact cost of each element. A reputable podiatrist will be able to provide this for you. If the price of your custom orthotic insoles is high but your podiatrist isn’t thoroughly examining your feet or even taking a cast, be wary.
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 do they need to be custom to work?
Some sports medicine doctors aren’t convinced they are worth the cost. Dr. William O. Roberts, a sports medicine physician in St. Paul, Minnesota says, "If your main business is feet, and part of your income is prescribing orthotics, then you might prescribe them 90, 100 percent of the time. It’s a financial issue, and I don’t think there's a huge need for custom orthotics.”
Orthopedic surgeons often agree with this line of thinking about custom insoles for shoes. Dr. John G. Kennedy, an orthopedic surgeon in Manhattan contends, "There is a big problem with orthotics out there and people are not aware of it. The number of orthotics that I see prescribed in this city is far greater than is warranted by the number of pathological reasons.”
One factor in this difference of opinion between medical doctors (MD) and podiatrists (Doctors of Podiatric Medicine, DPM) is their training:
When you're finding a provider to make your custom orthotics, there are a few things you'll want to think about:
Creating quality, custom-made orthotics is a detailed and involved process. As Richard M. Olsen, DPM, states, “The manufacture of functional foot orthotics is thus a multi-step process involving detailed and intricate cast correction, orthotic fabrication and application of additional items prescribed by your podiatrist for the treatment of your specific condition.”
When you see your podiatrist for custom orthotics, you can expect to start with a thorough examination that includes:
You can also expect your doctor to take measurements, ask about your lifestyle and inspect your shoes for a specific wear pattern to better understand your gait mechanics. Podiatrists look for the following patterns:
Once your exam is complete, you'll have your feet casted. You're podiatrist should:
The most common method of taking this cast is by using plaster. Wet plaster strips are wrapped around the foot. The hollow, “negative foot mold” is then sent off to the orthotics lab. The lab will fill in the cast and discard the shell. The resulting “positive cast” looks like your foot.
While the plaster hardens (it usually takes 5-10 minutes), your podiatrist will watch your foot position to make sure it doesn't change. The plaster usually takes a full 24 hours to harden completely, so after your podiatrist removes the cast, it will be stored before being sent to the lab.
After your podiatrist takes the proper non-weightbearing cast of your feet, the negative foot mold and your custom prescription are sent to an orthotics laboratory.
Your prescription will include not only the materials, dimensions, and accessories to be used in the orthotics' manufacturing, but also the specifications for the correction of the cast. These measurements are taken from the in-depth exam your podiatrist conducted before casting your foot.
Once the positive cast has been constructed, the lab constructs the orthotics through the following steps:
For your custom made orthotics to provide optimum results, they must be constructed from materials that can resist the various forces and motions you put on your feet. Materials need to be rigid enough to control for irregular injury-producing motion, while still flexible and comfortable enough to be compatible with your activities.
There are two main types of materials used for the rigid foundation of your orthotic:
Cushioning materials such as Neoprene and open- and closed-cell forms are often used to complement the harder plastics or graphite and provide added comfort. Remember, these softer materials should never form the core structure of your orthotic.
The most common materials used to cover the plastic or graphite arch-support and heel cup come from the polyethylene foam family. These are closed-cell forms best for total-contact, pressure-reducing orthotics. Individual materials include:
A good podiatrist will take your lifestyle and body type into account when choosing materials for your orthotics. According to podiatrist Simon Spooner, PhD, the patient’s weight and activity level are important. “I work with professional rugby players who weight about 280 lbs and can sprint nearly as fast as Usain Bolt. Trying to provide foot orthoses that can cope with those kind of forces is a challenge. You’ve got to pick the right horse for the right course.”
Your individual foot requires individual attention. Materials that work well for one person might not be good for another.
As the American Podiatric Medical Association explains, 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.
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.
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 and custom orthotics. If you've decided that you don't need custom orthotics or want to try over-the-counter insoles before spending the money on custom, you'll find you have a lot of choices.
The most important thing to consider is that not all over-the-counter inserts are made alike. Their quality and effectiveness varies greatly. Understanding the different types of over-the-counter insoles available is helpful.
Heat-moldable insoles and stomp-boxes are a "fit-at-home” option. However, 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 like those from 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 a choice of arch heights like Tread Labs.
When choosing your over-the-counter insoles, there are some specific features to look for to make sure you're getting the support you need.
Whether you choose to invest in custom orthotics or start with over-the-counter insoles, getting the proper support for you feet will help control pronation issues, prevent and relieve foot pain you may have, and most importantly, support your active life.
Questions? Drop us a line at firstname.lastname@example.org. We're here to help.
Mark has always believed exceptional footwear can change lives. He's been in the footwear industry for over 30 years, working with podiatrists, pedorthists, foot care experts, and footwear makers. Mark started Chaco sandals in 1989 and developed a game-changing sport sandal that delivered comfort and durability. After Chaco sold in 2009, Mark ultimately started Tread Labs to continue transforming people's footwear so they can walk better, feel better, live better.
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