Are you feet giving you grief? You may need an orthotic, such as a shoe insert, brace, splint, or custom-made device. "Orthotics don't change the shape of your foot, they change the way your foot functions," says Dominic J. Catanese, DPM, FACFAS, director of podiatric medicine and surgery in the department of orthopaedic surgery at Montefiore Medical Center in the Bronx, NY. "Orthotics hold your foot in the position that allows it to function more normally, and with less pain."

Foot Problems Orthotics Can Treat

Orthotics can be used to treat the following conditions:

  • Plantar fasciitis (heel spur syndrome) is a common problem that occurs when the tissue that supports the arch of the foot becomes irritated and inflamed. According to the American Academy of Orthopaedic Surgeons, it is the number one reason people feel pain on the bottom of the heel. Two million patients are treated for the condition annually.
  • Flat, or very highly arched feet.
  • Sesamoiditis. This is a type of stress fracture characterized by the irritation or inflammation of the tendons surrounding the sesamoids. There are two sesamoids in each foot and they are connected to tendons or embedded in muscles.
  • Arthritis in either the joints of the big toe or the rear of the foot.
  • Tarsal coalitions, which are also known as an abnormal union of the bones in the foot typically happen during childhood.

If you suspect an orthotic could help you, see a doctor. "A doctor can look at the motion of major joints and observe the position of the foot's arch and heel in respect to the leg to see how they line up and observe the way you stand," explains Catanese. "This can determine what kind of help you need."

Custom Made Or OTC?

Orthotics are available as both prescription and over-the-counter devices; the latter are usually known as inserts. "Orthotics can be expensive," admits Catanese, who notes that although custom-made designs (which require a prescription) are generally superior, "over-the-counter orthotics are better than none at all. If you have a normally shaped foot, you should fit into one, and it can work very well." He adds that plantar fasciitis patients may find that "over-the counter orthotics work particularly well, decreasing strain on the plantar fascial ligament (the tissue that supports the arch), and resolving the condition." Some patients may want to try an over-the-counter orthotic before investing in a custom device.

But be warned: Over-the-counter devices are mass-produced and designed to fit as many people as possible, so "they usually don't have great arch support, or deep enough heel cups," Catanese says. (Heel cups provide stability and heel support.) He suggests avoiding products made with gel and foam. "Choose inserts made with plastic reinforcement of the arch instead."

It's also important to note that over-the counter products are not for everyone. For example, "A flat-footed patient might need an orthotic to support the arch and take the pressure off the tendons and the ligaments," Catanese says. "But the patient's feet may not fit into an over-the-counter device." The same problem would apply to people with very highly arched feet. Such patients—and many others—require custom orthotics.

Still, just because the orthotic fits doesn't mean you should wear it, points out Ben Kittredge, MD, an orthopaedic surgeon with Commonwealth Orthopaedics in Alexandria, VA who believes—along with other experts—that orthotics are over prescribed. "A third of the population has flat feet but that doesn't mean a third of the population needs orthotics. It really depends on the specific problem," explains the doctor who is an avid runner and a fan of cushioned shoes. "Sometimes all you need is a good, supportive shoe," he says adding that runners should keep track of the mileage in their shoes. "The lifespan of a running shoe is 300 to 400 miles. I tell my patients to write the date of their first run on the sneaker to help them keep track. Good shoes are really important."

Making and Breaking in Custom Orthotics

Should you need a custom orthotic, your doctor will likely take a plaster cast or foam imprint of your foot. A lab technician will use this imprint to create a mold filled with hard plaster; the orthotic is built around this plaster model. The orthotic will be contoured to comfortably fit the patient's foot, but thanks to custom features like deep heel cups or phalanges that raise or lower the foot, the orthotic will also align the foot in the exact position the doctor prescribes.

Once you've received your custom orthotic, allow a break-in period of about three weeks, and expect to feel results in three to five weeks, according to Catanese. Patients typically get a lot of wear from their custom orthotics—lasting five years or more. Wear and tear is more likely to affect the orthotic's cushioned top cover, which can be replaced.

Are Orthotics Worn All the Time?

In some cases, like foot pain stemming from inflammation, the temporary use of an orthotic may allow the patient to fully recover. However, Catanese warns, "For the majority of conditions requiring a custom device, it should be worn constantly since if you're not in the orthotic, it's not working."

Dominic J. Catanese, DPM, FACFAS, reviewed this article.


Dominic J. Catanese, DPM, FACFAS, director of podiatric medicine and surgery in the department of orthopaedic surgery at Montefiore Medical Center in the Bronx, NY. Phone interview 6 December 2013.

Ben W. Kittredge, IV, MD. Commonwealth Orthopaedics. Phone interview. 7 January 2014.

"Plantar Fasciitis and Bone Spurs." American Academy of Orthopaedic Surgeons.
Web. Reviewed June 2010. Accessed 12 December 2013.

"Sesamoiditis." American Academy of Orthopaedic Surgeons. Reviewed June 2010. Web. Accessed 12 December 2013.

Santa Rosa Medical Center. "Foot & Ankle Surgery. Patient Information: Tarsal Coalition."
Kaiser Permante. Web. Accessed 12 December 2013.