Do you really need orthotics? An honest guide.

What an orthotic can and can't do

An orthotic supports. It does not strengthen. It has limited ability to improve mobility in a stiff joint, retrain the way you move, or change what is happening at your hip or spine.

If the underlying cause is weakness, stiffness or a movement habit, an orthotic may reduce your symptoms while the cause carries on untouched. For some people that is a reasonable trade. For many it means the pain returns when the insole wears out, or shows up somewhere else.

A scan finding is not a diagnosis

It is also worth knowing that many people have feet that look "abnormal" on a scan and never have pain. Flat feet and high arches are common variations, and studies find little or no link between arch shape and foot pain.¹ A finding on a scan only matters if it explains your symptoms.

Custom, 3D-printed or off the shelf?

Off the shelf

Off-the-shelf insoles cost little and, for many common problems, research shows they perform about as well as custom devices in the short term.^2,3 They are often a sensible first step.

Semi-customised and custom

Semi-customised and custom orthotics are made to a prescription written for your foot and your problem. They earn their price when your foot shape is unusual, when you need a precise correction, or when a simpler device has helped but not enough. The difference in price between a semi-customised and a customised orthotic can be significant.

3D-printed

3D-printed orthotics, such as those designed directly from dynamic scan data, are a manufacturing method. They can be light, durable and consistent. The printing does not make the prescription right. The assessment behind it does.

Seven questions to ask before you pay

1. What is the diagnosis, in plain words?
2. What is causing it, and how do you know?
3. Did you examine me above the ankle?
4. What will the orthotic change, and how will we know it is working?
5. What happens if I do strength and mobility work instead, or as well?
6. Would a cheaper off-the-shelf insole be a fair trial first?
7. How long should they last, and what do reviews and adjustments cost?

A clinician who is confident in the prescription will be glad to answer all seven.

How we approach it

At Porch House Clinic an orthotic is one option among several, and never the automatic outcome of a scan. An assessment looks at your foot, then at the rest of you: ankle, knee, hip, pelvis and spine. Where the picture is unclear, our DIERS 4D motion lab measures foot pressure together with spine and pelvis movement, so we can see whether the foot is the cause or the messenger.

Sometimes the answer is a semi-custom or custom orthotic. Sometimes it is a simple insole and a strength programme. Sometimes it is different footwear and nothing else. You will be told which, and why.