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Orthotics vs Insoles...What's the difference?

Orthotics, insoles, arch support, shoe inserts, custom orthotics. All these terms get thrown around quite loosely, and there are no rules governing the use of these terms, which doesn’t make it any easier for consumers to understand. You’ll see these products sold at doctors’ offices, pharmacies, sporting goods stores, and shoe stores and it’s difficult to know which one to choose. What’s the difference? Which product is right for you and your feet? Which option will provide you with the best results?

Let’s take a moment to clarify the terminology.

Insoles, arch support and shoe inserts, and orthotics are often used interchangeably. The main difference is who makes them, how they are made, and where you get them.  The products that are available to purchase from most retail stores do not need to be prescribed by a doctor or foot specialist and are NOT custom made.  They may offer some mild, temporary help but they won’t specifically address your individual foot conditions nor will they perfectly fit your feet because they’re mass produced.  Orthotics, or custom made orthotics, are a more specialized product. They are made specifically for a patient, based on a prescription and hopefully a foot specialist’s

Biomechanical Assessment (how your foot and ankle moves when manually manipulated) and Gait Analysis (how your foot moves while walking).

If you have mild, occasional foot pain, off-the-shelf insoles can be helpful as a short-term solution.  These off-the-shelf insoles will offer some temporary relief and won’t cause any harm, however, most only provide extra cushioning and don’t address the underlying causes of your foot-related pain or discomfort.

If you have chronic or serious foot conditions, insoles made of gel or other soft materials can potentially do more harm than good because the soft, flexible material creates an unstable surface underneath your feet. In these cases, custom orthotics are a better option, especially considering that they would be made specifically for your feet according to the specifications of a Chiropodist or Podiatrist.

Pros: These off-the-shelf insoles are mass produced which means they are inexpensive and readily available to anyone.

Cons: You get what you pay for. A cheaper insole is a result of cheaper materials, mass production, and a generic design. The cheaper the insole, the faster it tends to breakdown, and the more often it will need to be replaced.

What if you don’t wear a standard shoe size, or if your feet differ in size (feet often differ in size by as much as ½ a shoe size!)? What if you have a specific foot condition that requires additional modifications? In these cases, orthotics that are custom-made for your feet are the better option.

What’s the difference between orthotics vs custom orthotics?

3-D plaster cast for custom orthotics

Not all orthotics are created equally. As mentioned above, the term ‘orthotics’ can be used by anyone to describe something that is inserted into your shoe for pain relief or added comfort. A custom orthotic is one that is made from scratch, specifically for your feet, foot conditions, activities, lifestyle, and footwear based on the findings of the assessment done by a Chiropodist or Podiatrist. These are often made of more robust, technical materials, so they tend to last longer. Because they are custom made for your foot, they can provide proper arch support and alignment.

There are a variety of different types of orthotics available, to suit your footwear and activities. Custom orthotics can only be prescribed by a healthcare practitioner, ideally by a foot specialist such as a Podiatrist or Chiropodist.

What about the ‘orthotics’ we see in retail stores, pharmacies, and even infomercials?  The short answer is this: if they weren’t constructed based on a 3D cast of each of your feet in a neutral, non-weight bearing position, they are NOT custom made!

Remember, two dimensional measurements such as digital pressure maps can NOT be used to create accurate, three-dimensional orthotics … think about it, where is the measurement data coming from for the 3rd dimension (arch height/depth/shape)?

How do I know if my orthotics are REALLY custom-made?

A lot goes into a pair of truly custom-made orthotics, and the more steps and more people involved, the greater the chance of something not going according to plan.  

When you’re looking at being assessed for custom-made orthotics you’ll need to ask your clinic some important questions:

1.    Who is doing the assessment and taking the cast?

2.    What casting method are they using?

3.    What lab are the casts being sent to for fabrication?

4.    Does that lab make a new positive mold for each cast received?

1.     Who is doing the assessment and taking the orthotics cast?

All HealthCasa practitioners are fully vetted, certified, licensed and insured Chiropodists and Podiatrists. We take great care in training our practitioners on the proper casting techniques and they use only HealthCasa-provided materials, so we can maintain consistency of quality.  There are a few different methods of taking 3D casts, but the tool is only as good as the person using it. You want to be sure you are working with a foot specialist such as a Chiropodist or Podiatrist who has had extensive training in the assessment, casting and design of custom orthotics.  

While many Chiropractors and Physiotherapists also sell orthotics, Chiropodists and Podiatrists are the only regulated healthcare professionals that can prescribe custom orthotics. They are foot specialists that are trained specifically in diagnosing and treating conditions that affect your feet and ankles. For the same reason that you would see a dentist if you had tooth ache, seeing a Chiropodist or Podiatrist is the logical choice for your feet.

2.     What casting method are they using?

The basis for a truly custom-made orthotic starts with a properly made 3D cast, with the patient’s foot in a neutral (not moving) and non-weight-bearing (not standing, pushing, etc.) position. This is the natural position of your foot where you don’t experience any sort of pain or discomfort, and the position that custom orthotics attempt to maintain for the patient. The primary preferred casting methods that maintain the proper position of the patient’s foot are plaster of Paris and some 3D digital scanners.

There are many other methods of taking a cast for orthotics such as foam boxes, digital pressure mapping, digital walking mats, and more. Unfortunately, these methods don’t keep your feet in a neutral, non-weight bearing position. This means that your feet will be casted in the same position they’re in when you’re experiencing pain … so if your orthotics are made according to a cast in THAT position, at most all they’re going to do is prevent your feet from getting any worse.Basically, those orthotics will be a waste of your time and money with little health benefit. This is why most insurance companies require proof that your orthotics were made based on a 3D cast of your feet in a neutral and non-weight-bearing position in order for you to qualify for reimbursement.

3.     What lab are the casts being sent to for fabrication?

We spent a couple months speaking with, interviewing, vetting, and doing other due diligence on most of the orthotic manufacturing labs across Canada.  We insisted on using a lab that could prove to us that they only made custom-made orthotics, had great communication and customer service protocols, used high quality materials and whose technicians are highly trained. We’ve personally visited many of these labs and have actually seen first-hand what their orthotic manufacturing processes look like.

4.      Does that lab make a new positive mold for each cast received?

Unfortunately, some labs use pre-fabricated orthotic shells and choose the ones whose shape and size are the closest match to the casts they receive. Close enough IS NOT good enough for HealthCasa.

These labs will often call these orthotics “custom”, but in essence, what you’re getting is an orthotic that is only slightly better than one of the cheaper off-the-shelf options you can buy online or in a store.   And you’ll probably be paying a price that is comparable to a really custom-made orthotic. Insurance companies will not accept claims where pre-fabricated orthotics have been used, however those labs are not exactly forthcoming with their dishonest practices.  Insurance companies are trying to crack down on this practice, but it’s also important for you as the patient to choose practitioners and clinics that can demonstrate where their orthotics will be manufactured and how.

If your foot clinic can’t readily answer these questions to your satisfaction, ask yourself why they don’t know this vital information or why they won’t tell you.  If the casts aren’t taken correctly by a certified foot specialist such as a Podiatrist or Chiropodist, if they are using substandard casting methods, if they have not thoroughly vetted their lab, and/or the lab is not making a new positive mold for each cast received, then chances are your orthotics will NOT be fully custom made.


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