How Much Do Custom Orthotics Cost & Are They Worth It?

Custom orthotics are 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.

THE BASICS ---

• Custom orthotics are expensive, running anywhere from $200 to $800. Additionally, the office visits from initial evaluation to follow-up can add to the total quickly.
• Making custom orthotics is a multi-step process that includes a thorough exam by a podiatrist, taking a cast of your foot, and the manufacture and fitting of your orthotics.
• Lots of people think they need custom orthotics to solve their foot issues, but the truth is most people don't need them. Unless you have a complex foot disorder or diabetic issues, the right pair of over-the-counter insoles will solve your foot issues. 
• Over-the-counter insoles that are the most like custom orthotics have a firm arch support that matches the contour of your arch as closely as possible. Tread Labs insoles come in four different arch heights and are made with medical-grade support for a close-to-custom fit.
• We recommend Tread Labs Pace Insoles for firm support and a semi-custom fit.

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WHAT YOU NEED TO KNOW ---

The first step is knowing exactly what you’re paying for, so you can decide whether it’s a good fit for you. In this article, we’ll go over:

• all of the expenses to consider before purchasing
• what you’re paying for
• what doctors have to say about them
• and whether they’re worth the price

How Much Do Custom Orthotics Cost?

While the sticker price for custom orthotics runs from $200 to $800, you should also factor in additional costs. While these devices can last for years, the top surfaces will wear out and have to be replaced. This can cost $50 to $100.

Additionally, the plastic or EVA foam material used in the orthotic will give way after prolonged use. When that happens, you'll have buy another pair of custom orthotics. Over a lifetime, those costs add up to a big number.

Does Insurance Cover Custom Orthotics?

If you're health insurance covers the cost of custom orthotics, you'll usually only have to pay 10-50% of the total price. However, it's important to know that insurance often doesn't cover them. Before you consider having custom orthotics made, you'll want to check to see if your insurance plan will cover the cost.

Why Are Custom Orthotics So Expensive?

The manufacturing cost of custom orthotics (including materials) is normally $100 or less. So where does the hefty price tag come from, and are custom insoles worth it?

What You're Paying For When You Buy Custom Made Orthotics

Here's what goes into the total cost of prescription orthotics:

• Examination – Remember, the podiatrist is doing a thorough analysis of your lower extremities, gait, and lifestyle. This can include X-Rays, gait analysis on a treadmill and other tests.
• Casting – A podiatrist takes a non-weight bearing cast of your feet.
• Mark-up – Feet, after all, are still a business.

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.

What Physicians Have To Say About Custom Insoles

While podiatrists often promote the need for custom orthotics, 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:

• Physicians attend school for four years, where they learn many general concepts before doing three years of highly-specialized residency.
• Podiatrists go to four years of school, learning specifically about the foot and ankle before doing one more year of podiatric residency. While this can make them experts at anything foot- and ankle-related, they might miss other larger structural problems that a sports medicine or orthopedic physician will consider. Nevertheless, a good podiatrist will consider the overall picture before prescribing custom orthotic inserts.

What's The Difference Between Custom vs. Over-The-Counter Orthotics?

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."

With so many doctors and studies questioning the need for custom orthotics, you're probably asking yourself if you actually need them. The truth is, there are some people who absolutely do need custom orthotics. Dr. James Ioli, DPM, Chief of Podiatry at Brigham and Women's Hospital in Boston, says this population includes those with:

• Complex foot disorders
• Diabetes who have loss of feeling in their feet
• Poor circulation
• Severe foot deformities caused by arthritis 

But for the majority of people, particularly those suffering from Achilles tendinitis, plantar fasciitis, arch pain, heel pain, and kinetic chain pain, over-the-counter orthotics are the option that makes sense.

How Are Custom Orthotics Made?

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.”

Step One: Casting the Foot

After your podiatrist has completed a thorough exam of your legs and feet, taken the required measurements, looked at your shoes, and asked you about your lifestyle, you'll have your feet casted. 

When you're getting casted for custom foot orthotics, it is crucial that your podiatrist:

• Take a non-weightbearing cast of your foot. You should be sitting or lying down.
• Place your foot in a neutral position. Your podiatrist will need to see your knee in relation to your foot and set your foot into the desired position.

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.

Step Two: 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.

This is where custom-made insoles differ from a stomp-box model. Your podiatrist will specify exactly how the orthotic should be designed to correct for the biomechanical irregularities of your feet (shown in the neutral cast). A stomp-box will simply build those bio-irregularities into the orthotic itself.

Once the positive cast has been constructed, the lab constructs the orthotics through the following steps:

1. Under extreme heat, your individual cast is pressed against a sheet of graphite or plastic material.
2. A cover made of comfortable yet durable material is attached to the harder heel and arch structure.

Step Three: Materials

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:

• Plastics – Most plastics come from the polyolefin family. Polypropylene is the most common plastic used.
• Material thickness often ranges from 1/8” to 1/4”
• Flexibility of plastics have a wide spectrum, ranging from very flexible to relatively rigid

• Graphite – The graphite family is lighter and thinner than plastics.
• Material thickness is half that of plastic (1/16” to 1/8”)
• Also has a wide range of flexibility and rigidity

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:

• Ethyl-vinyl cetates (EVAs)
• Crepes/neoprenes
• Silicones

A good podiatrist will take your lifestyle and body type into account when choosing materials for your orthotics. According to podiatrist Simon Spooner, PhD, two important factors are the patient’s weight and activity level. “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 are optimal for one person could be detrimental to another.

What To Look For In Over-The-Counter Orthotics

If you've realized you don't fall into the small group of people who do require custom orthotics, and you're considering buying over-the-counter orthotics instead, there are some specific features you'll want to look for to make sure you're getting the support you need.

• Multiple Arch Heights - Arches are not one size fits all, so it makes sense that your insole shouldn't be either. The arch of your insole should match the contours of your foot and provide full contact from one end of your arch to the other whether you're a low arch or an extra high. 
• Medical-Grade Support - High-quality, durable arch support comes from strong, firm support that holds up against the pressure you put on it. Cushy foam and gel do not provide the support your arch needs to address the foot fatigue or pain you're experiencing.
• Deep Heel Cups - Your foot has a fatty pad under the heel bone that helps cushion each step you take. Look for an insole that has a deep heel cup that will help enhance your foot's natural shock absorption. You'll get greater comfort and stability from it.

As you're shopping around for over-the-counter insoles, check out Tread Labs selection. Our insoles offer a Million Mile Guarantee so you're arch supports are covered for life.

And, because our insoles come in two parts - the molded arch supports and the interchangeable top covers - you'll only ever have to replace the top covers when you need. Not having to replace the entire insole will save you lots of money over a lifetime.

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Questions? Drop us a line at hello@treadlabs.com. We're here to help.