Spoiler: You (likely) do not need them. Good Prefabricated inserts for a fraction of the cost can work just as well.
Biomechanics and the study of how we walk is very nuanced. You have 28 bones in the foot, which absorb force which then travels up the entire body. This is an extraordinarily complex ordeal which needs to be fully appreciated when dealing with foot pain. Unfortunately, many people "prescribe" orthotics when they are interested in "selling" custom orthotics.
It is the end of 2022 and I can count on one hand the amount of custom orthotics that I made for my patients. Why is this? Let me share with you my methods, thoughts, and approaches for prescribing custom orthotics.
Custom orthotic quality varies greatly
In my experience, over 60% of custom orthotics are inferior to high quality prefabricated orthotics. If you include the hefty price tag of around $400 to $600 dollars for customs, it is hard to justify. "Sole Support" orthotics are (in my opinion) the best widely used custom orthotic to date due to the technology they employ and what they call "MASS" theory. I currently use a pair of custom orthotics from Sole Support
Pre-Fabricated Inserts work as a low-cost template
I can modify prefabricated orthotics to act in a similar fashion to custom orthotics by altering structure or adding rearfoot/forefoot changes. If my patient needs a custom pair, what better than a good prefabricated orthotic trial run in preparation for the more expensive alternative? If you're going to spend a lot of money on orthotics, then make it worthwhile!
Intentions
For me, I want the best outcomes for my patients. To keep my bias in check I never cast a pair of custom orthotics before modifying a pair of non-customs. The result is that I seldom need to have custom inserts fabricated.
Transparency
I would say about 85% of my patients do great with high quality prefabricated orthotics. My favorite brand is "Power Steps" which has been my favorite brand of over-the-counter orthotics for a decade.
In summation
You can acquire a $30 to $60 pair of pre-fabricated orthotics and do about as good as a pair of custom orthotics. The last thing I would mention is that any pair of arch supports need to be "broken in" slowly - if you wear new arch supports all day the first day you get them, you will probably be in a lot of pain. Breaking in new inserts gradually by wearing them one to two hours a day and then increasing that time by an additional hour or two for each subsequent day is paramount to success.
Last but not least, I have to say that I do NOT consider Dr. Scholl's to be arch supports. They are "arch-pads." The only time I recommend them is for people who need padding instead of supports.
Unsure of what you need? Disagree with my opinions? Leave a comment below!
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