Weighing The Pros And Cons Of Pre-Made Orthoses And Custom Orthoses

In 1976, as a 19-year-old college distance-running athlete, I sought help from a local podiatrist for my recurrent running injuries. His treatment plan for me, custom foot orthoses, not only healed my running injuries but also impressed me so much with podiatry that I decided to apply to podiatry school a few years later. Foot orthoses have always been a very large part of my clinical practice and I still wear them in my shoes daily.

However, I need to make an important admission. I recommend pre-made foot orthoses much more than custom foot orthoses as a first-line therapy in the treatment of symptoms due to mechanically-related foot and lower extremity pathologies. Why? Pre-made foot orthoses have distinct advantages to custom foot orthoses in certain clinical situations.

There are numerous pre-made foot orthoses with wide-ranging designs and arch heights that are readily available for immediate purchase at specialty sports stores in my community. Patients greatly appreciate the ability to purchase relatively inexpensive pre-made foot orthoses and start using them, literally on the same day as their initial office visit in my practice.  

If patients have never tried a pre-made or custom foot orthosis to treat their injuries, I send them to one of the specialty running shoe stores in my community with a list of recommended pre-made foot orthoses. I then ask the patient to return to my office within a week or two for a follow-up visit with the orthoses. On this follow-up visit, I modify their pre-made orthosis by grinding or adding padding in an attempt to relieve their pain, and improve their gait function.

I take time during my custom modification process of their pre-made orthoses to educate patients on exactly how and why the orthoses will likely work better after making the orthosis modifications. I use a brief “layperson-friendly” biomechanical explanation to describe how these orthosis modifications will reduce the stress on patients’ injured tissues, allow faster healing, reduce their pain and help improve their gait function. More importantly, I use this time to emphasize that, even though pre-made foot orthoses and custom foot orthoses may superficially look the same, they are quite different in many ways.

One of the analogies I often use to better instruct my patients as to the differences between pre-made and custom foot orthoses is to compare foot orthoses to eyeglasses. When a patient asks me, “How are your custom orthotics different from the ones I can buy at the store?” I take off my $15 Costco reader eyeglasses and then ask the question: “Do you think my eyeglasses are cheap, pre-made glasses or do you think my eyeglasses are made from a prescription, costing hundreds of dollars?” When the patients say they can’t really tell the difference, I inform them that, in much the same way, custom foot orthoses and pre-made foot orthoses may look very much alike, but they are indeed quite different from each other.

I tell patients each custom foot orthosis is made from a three-dimensional image of the unique structure of both of their feet whereas pre-made orthoses are made as perfect mirror images of each other and without the exact custom fit of prescription orthoses to their plantar foot morphology. In addition, I inform patients that custom orthoses are made with materials that are far more durable than pre-made foot orthoses with many patients happily wearing their plastic orthoses for over 10 to 20 years. I tell patients that even though prescription foot orthoses are more expensive than their pre-made alternatives, custom foot orthoses have the important benefit of allowing an unlimited potential for design modifications that we can use to customize their orthosis prescription for their specific injures. These options may include using multiple materials of different stiffness and cushioning characteristics that will most likely resolve their painful symptoms, improve their gait function and prevent new symptoms from occurring.  

All in all, there is simply no “best” foot orthosis treatment option for all patients. Patients need to receive both an orthosis treatment recommendation and an orthosis treatment choice that is based on their immediate and long-term needs, and their financial ability to pay for treatment. Podiatrists with the proper training and skills in foot orthosis therapy will be able to offer their patients either pre-made or custom foot orthosis therapy, treatment options that, in many cases, are the best podiatric treatment options available for treating many foot and lower extremity pathologies.

Dr. Kirby is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is in private practice in Sacramento, Calif.