Custom Orthotics vs. Over-the-Counter Inserts: Which Are Best for Your Feet?

The right shoe support can go a long way in relieving foot pain or preventing calluses and other developing foot conditions. But sometimes – whether due to grueling schedules or a genetic predisposition – the standard built-in shoe cushioning is not enough to prevent more serious conditions from developing. 

When this happens, orthotics or shoe inserts are a common solution. Nowadays, many podiatrists – ourselves included – offer custom orthotics that are specifically built for particular foot shapes. But what’s the difference between custom orthotics and the over-the-counter (OTC) inserts you can find at the drugstore? Are the results different for custom orthotics vs. store-bought ones?

Custom Orthotics vs. Over-the-Counter Inserts

What are orthotics?

Technically speaking, “orthotics” are prescription-only devices, while any ready-made versions bought over the counter should only be called “inserts.” But because many people use the terms interchangeably, when we refer to “orthotics” here, we may be referencing custom or OTC, but “inserts” will only refer to OTC devices. 

Orthotics are any device worn inside the shoe for the purpose of preventing or alleviating a foot condition, such as bunions, Achilles tendonitis, or microfractures. Many orthotics force us to modify our gait and posture as we walk and stand. As a result, they can also affect other biomechanical issues, such as knee or back pain. When well-fitted, they may make an ongoing ache disappear.  

However, if you wear the wrong size or type, they can force you into an awkward position that will leave your back sore or your knees at risk. 

Common types of orthotics include: 

  • Gel cushioning, for pain or stress fractures in the front of your feet. 
  • Arch pads, which can be rigid or soft, for people with flat feet or high arches. 
  • Shoe inlays (a firmer variant of insoles that extend both under and around the foot) to alter pronation(the way your foot rolls when it lands as you walk). 
  • Toe separators, for bunions or calluses. 
  • Bunion shields. 
  • Heel inserts that specifically absorb shock under the heel. 

What’s the difference between custom and store-bought orthotics?

The price difference between custom and store-bought is what’s most obvious to consumers. Custom orthotics can cost 10 times as much as over-the-counter orthotics, so it’s important to understand the functional difference between the two. 

Over-the-counter orthotics are prefabricated and mass-produced. As a result, they are generally manufactured in a few common foot sizes, and some budget-friendly brands even have “one-size-fits-all” models. 

Of course, product price affects the types of materials that can be used for orthotics. Adaptable, all-purpose inserts that are able to fit many types of feet also need to be softer and more accommodating. This means there’s a bit more leeway if they’re not sized properly, but they also won’t provide the same amount of support as a firmer, custom-sized orthotic. Consequently, OTC orthotics often use gel and memory foam instead of firmer silicone or plastic. 

In contrast, custom orthotics are made to order and as unique as our patients. Typically, each piece follows the imprint and instructions sent by a podiatry specialist who has examined and diagnosed the patient’s specific foot problem.  

To make sure you’re getting the best orthotic support, one of our podiatrists will first perform a physical evaluation of your feet. During this inspection, we’re checking for any unique foot deformities and taking into account an orthotic’s likely impact on the knees, ankles, and spine.  

This specialized consideration and personalized fitting is why custom-made orthotics are usually the most successful option for treating serious problems such as flat feet or plantar fasciitis. 

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Do OTC foot orthotics work?

While experience has shown us that custom orthotics produce better results in a wide assortment of instances, prefab inserts can still be of some use. They have a more limited range of function, but if used properly, they can help diminish or prevent some types of foot pain related to overexertion. 

For example, OTC inserts may be enough to keep your feet well-rested during an intensive week of sightseeing, when you’ll be walking significantly more than you’re used to. They can also keep you comfortable when using heavier work shoes or when ramping up the intensity of your workouts. 

For example, one study showed that “prefabricated” commercially available arch support inserts could help prevent the foot and knee pain associated with bunions. They can also be useful if you are looking to prevent a problem that hasn’t happened yet, such as corns, or falls among the elderly.  

One important caveat is that both studies examine the results of well-selected orthotics. However, in order to choose the right model or size, you may need to consult a professional anyway: what seems like regular heel pain may be tendonitis or a sprain may be confused with a microfracture. Without professional input, patients may end up treating the wrong problem. 

Inaccurate sizing also poses an extra risk. Often, “one size fits all” really means “one size fits most,” and even when there’s a large array of sizes, many people will not get a perfect fit. The wrong size can cause someone to unconsciously adjust their gait, which increases pain rather than prevents it. 

Pros and Cons of Custom Orthotics

Finally, let’s take a closer look at custom orthotics. 

Custom-made orthotics have the following benefits and advantages over OTC inserts: 

  • Greater durability: made from firmer materials, custom orthotics will keep their shape longer. 
  • More therapeutic options: custom orthotics can treat less common conditions more successfully than mass-market inserts can. 
  • They can support general foot function better, without jeopardizing ankle or knee alignment. 
  • High-quality custom orthotics don’t usually require a break-in period, as they’re already adjusted to the foot’s shape. 
  • The custom measurement and manufacturing process includes podiatrist follow-up and monitoring. 
  • Prescribing professionals can help if something is wrong as far as fit, problems arising from the manufacturing process, or something similar. 
  • Custom orthotics may be covered by health insurance (depending on your specific plan). 

You may need to wait a couple of weeks for custom orthotics, in between the initial appointment, scans, or X-rays, and the time it takes to manufacture them. We’re hoping that you’ll find the results well worth any wait. 

Looking for orthotics near Los Angeles? UFAI has your back

The foot specialists, podiatrists, and surgeons at the University Foot and Ankle Institute have vast experience with all manner of foot problems, from metatarsalgia to fractures and foot ulcers. 

In addition, we have ample experience with custom orthotics, braces, and minimally invasive surgery of the foot and ankle. 

Request an appointment with a UFAI podiatrist today!  

We are convenient for all Southern California patients with offices in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia. 

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