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As a recreational runner for over 30 years I can attest to the stress relieving and posture enhancing impact of custom foot orthotics. I credit these shoe inserts for alleviating my chronic heel pain (Achilles tendinitis), improving my athletic performance and for being instrumental in allowing me to be like the Energizer Bunny, “still going…”  As a Chiropractic Physician, the profound personal benefit I have experienced wearing Custom Foot Orthotics have made me a passionate proponent of their use; encouraging me to develop an expertise in their proper use. My profession is uniquely qualified in understanding the relationship of how faulty foot mechanics impact the entire body. We commonly prescribe Custom Foot Orthotics as an effective pain remedy for people who suffer from metatarsalgia, foot neuromas, plantar fasciitis, heel spurs, Achilles tendinitis, shin splints, reoccurring knee, hip, back or neck pain. Athletes of all types have long understood their performance enhancing impact. For the past 17 years I have successfully assisted hundreds of patients to achieve a more pain-free lifestyle from the ground up through the application of Custom Foot Orthotics.

From my experience most people are in the dark when it comes to choosing the foot orthotics that will work best for them. Most are blind to the fact that there is a science and art to prescribing, fitting and dispensing corrective foot appliances. Those seeking the improved comfort and support provided by orthotics may be overwhelmed and confused by the diversity of types and prices. The seemingly endless variety can range from prefabricated off-shelf inserts purchasable at local retail store kiosks to laboratory created “custom” versions prescribed by clinicians. This article was written to shed light and aide those consumers searching for foot orthotics to make a more informed decision about which version would best suit their health needs.
Custom foot orthotics work on feet the way braces work on teeth; exerting gentle pressure to mechanically reposition the foot muscles, joints, and ankle into a more ideal alignment. They are purposely applied to the body’s foundation to minimize stress forces (excessive pronation or supination), improve structural support (fallen arches) and balance weight distribution from the ground up; ultimately serving to improve whole-body posture and relieve pain. Unlike the prefabricated store bought inserts, Custom Foot Orthotics must be prescribed by a clinician. The most accurate custom foot orthotics should be meticulously crafted in a laboratory from a mold of each foot. To create the most corrective custom appliance available, the prescribing doctor provides the orthotic lab with a cast (impression) of each foot, taken with the feet held in the most ideal foot-ankle alignment. This casting method called Non Weight Bearing Sub-talar Neutral, corrects for the negative foot-ankle postural effect of gravity and body weight.  Orthotics made in this way provide the most therapeutic benefit because they are posted (pitched or tilted) a few degrees to correctively align each foot at the ankle (neutral alignment). By supporting a more ideal alignment of the body’s foundation these custom foot appliances have the broadest impact.

It should be noted that many clinicians fit custom foot orthotics by using a less precise casting method, known as Step-In-A-Box. This method requires that the standing patient step each gravitationally misaligned (non-neutral) ankle-foot into a box of foam. Next, these weight bearing foot impressions are sent to a laboratory where the orthotics are usually hand-picked from a collection of pre-made off-shelf templates. The step-in-a-box variety of custom foot orthotics are less precise (not truly custom) because they are not formed directly from a mold of each foot and depend upon guess work regarding contour and corrective posting. With foot orthotics of this nature, the right and left inserts are commonly just mirror images, thus not accounting for the unique requirements of each foot.   Prefabricated “custom” foot orthotics, whether chosen off-shelf from a store kiosk or selected from a batch of pre-manufactured models in a lab should not qualify as “truly” custom foot orthotics. Unfortunately, in this manner many unsuspecting consumers may waste money as they are deceived into purchasing overpriced “custom” orthotics that in reality may not provide the best therapeutic result.

The standard of care for prescribing, fitting and ultimately creating the most efficacious Custom Foot Orthotics is all about the clinician taking the necessary time to attain the most therapeutically wearable cost-effective inserts. Practical and utilitarian concerns such as the size and types of footwear (i.e., sport, dress, heel height) typically worn should be addressed. Unfortunately, many people are misguided into wastefully purchasing orthotics that are mismatched or ill fitted to their footwear; often “throwing away good money after bad.”  In my practice we request orthotic candidates to report with a shopping bag of their typically worn shoes to best ensure the inserts chosen are a qualified match. Consideration must be given to those who possess sensitive feet. In my practice we weed out the “princess and the pea” types by allowing those who may be potentially sensitive, to test drive sample inserts. A thorough health history (i.e., diabetes, joint pains, etc.), foot exam (i.e., Achilles/ heel problems, hammer toes, bunions, foot arches, calluses, etc.), shoe preferences (i.e., dress or sport varieties) and postural distortions (i.e., unleveled hips, scoliosis, etc.) are important considerations for choosing the style and specifications for orthotic construction. In order to achieve optimal comfort and utility, customization also includes determining the orthotics’ length (i.e., 1/2, 3/4, or full), firmness of construction material (i.e., EVA, Plastazote, Leather & Cork, Polypropylene Thermoplastics, etc.), type of cover (i.e., Spenco), and heel cupping (flanging).  Other accommodations such as metatarsal padding, neuroma bar, Morton’s extensions, heel lifts, heel spur hole-pad, etc. may be added as needed. Attention to these details often requires a close working relationship with the laboratory pedorthist (a licensed professional, trained to manufacture foot orthotics). We even consult with the lab pedorthist about each cast and provide him with a video of the patient’s foot alignment and gait to ensure even more accuracy and comfort. A custom orthotic clinic should be questioned about the laboratory practices and processes involved in their manufacture. Because of the clinical decision making and meticulous steps involved in creating the best custom appliances one can expect them to be priced from $400.00 to $500.00 per pair.

In summary, corrective insoles can be transformational in their ability to improve posture and alleviate pain throughout the body. However, it is important to understand that just like feet, not all foot orthotics are created equal. Those seeking the health benefits of appliances which so intimately hug and support our feet are advised to make a knowledgeable decision. In order to achieve the best outcome, my advice is to become an educated consumer and consult with a skilled foot orthotic clinician.