Prefabricated (Over-the-Counter) Orthotics versus Custom Orthotics

After a detailed review of the peer-reviewed literature, understanding how foot orthotics are purported to work, and the cost of producing custom orthotics, the following conclusions can be drawn:

  1. There is evidence to support the use of orthotics (either OTC or custom) compared to no orthotics, as part of the treatment plan for certain existing foot and ankle conditions (ex. Plantar fasciitis, acquired adult flatfoot deformity with posterior tibial dysfunction, etc.)

  2. There is very little evidence to support the use of orthotics (either OTC or custom) compared to no orthotics for prophylaxis against developing overuse injuries (ex. Tendonitis, stress fractures, etc.)

  3. Rigid orthotics (such as the UC Berkeley Laboratory) can partially control the foot position during gait, however, to do this they must exert a force against the plantar aspect of the foot, equivalent to 3-4x body weight. This force creates significant patient discomfort and explains why rigid orthotics have fallen out of favor.

  4. The common foot orthotics used today (either OTC or Custom) are either semi rigid or accommodative, and have NOT been shown to adequately control hindfoot motion. They essentially function like a bed for your foot to allow more even dispersion of force over the surface of the foot.

  5. There is NO significant evidence in the peer reviewed literature to support the use of Custom Orthotics over appropriate Over the Counter (OTC or prefabricated) orthotics, for the treatment of common foot and ankle problems (ex. Overuse injuries).  There is good evidence in the literature (see references) and based on how orthotics are purported to work (see conclusions #3 and #4) to conclude that appropriately selected OTC orthotics and custom orthotics will provide equivalent results, except in cases where there is a markedly abnormal foot deformity (metatarsal fractures that have healed with marked displacement or a marked Charcot midfoot deformity).

  6. To be optimally effective, OTC orthotics need to be appropriately selected. For example, patients with flatfoot related problems should have a medial arch support, high arched foot patients should have a recessed area under their first metatarsal head (not an excessively high arch), and patients with 2nd and 3rd metarsalgia should use an orthotic with a metatarsal pad.

  7. Manufacturing of custom orthotics is close to a billion dollar a year industry in the United States, and quite often the individual prescribing the orthotoic is also profiting from the orthotics.

  8. If the idea of spending $300-$350 for a custom orthotic rather than $30-60 for an OTC orthtotic does not bother you, then by all means go for the custom orthotic.

  9. No orthotic (Custom or OTC) will be able to adequately treat all foot problems and depending on their particular problem many patients will still have some symptoms after obtaining appropriate orthotics.


References


(These references where taken from Foot and Ankle International (FAI) the leading orthopaedic peer-reviewed journal devoted to Foot and Ankle Problems.)"The routine prophylactic use of orthotics in flat-footed athletes to prevent future injury may therefore not be justified based on the data available."

— Michelson FAI July 2002


"Since prescribed orthoses are expensive and replaced regularly as the child grows, this therapy may represent a substantial financial burden to families with young children. The use of ready-made orthoses would reduce costs, but to date there has been little evidence comparing the effectiveness of these two types of orthoses. Our trial demonstrated that there was little difference between the two types of orthoses with respect to the outcomes measured."

— Michelson FAI July 2002


"This study found no evidence to justify the use of in-shoe orthoses in the management of flexible excess foot pronation in children."

— Whitford et al. FAI June 2007: A Randomized Controlled Trial of Two Types of In-Shoe Orthoses in Children with Flexible Excess Pronation of the Feet


"These findings suggest that if a foot orthosis is being dispensed as prophylaxis for overuse injuries in an active, healthy population, there is little justification for prescribing semirigid biomechanical orthoses. Their cost is high compared to other types of orthoses, without an advantage in comfort or a reduction in stress fractures, ankle sprains, and foot problems."

— Finestone et al. FAI July 2004: A Prospective Study on the Effect of Orthoses Composition and Fabrication on Comfort and the Incidence of Overuse Injuries.


"A particularly interesting finding from this review was the lack of any differential efficacy between custom and prefabricated foot orthoses, both from pooled data and individual study data that could not be pooled."

— Collins N. et al. FAI March 2007: Foot Orthoses in Lower Limb Overuse Conditions: A Systematic Review and Meta-Analysis


Edited September 24, 2015

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