Custom Vs. off the shelf foot orthotics, which should you buy for the best relief of back and neck pain?

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[caption id="attachment_3103" align="alignright" width="300"]superfeet Superfeet off the shelf orthotic[/caption] by William D. Charschan D.C., I.C.C.S.P. A common question patients ask is; Which is better, off the shelf or a custom made foot orthotic? This is a difficult question because we are all built differently and have different needs. Years ago, custom foot orthotics were the only choice most of us had to choose from, however, now there are a number of off the shelf options that you can choose from that may meet your needs. Off the shelf insoles are much less expensive than custom ones, however, they are not going to last as long either and are not designed to. If you wear off the shelf insoles, you should replace them every 6 months if used daily. If you use them with less frequency, they will last longer. How do you know when your off the shelf insoles are no longer corrective? An easy test is to take the insole out of your shoe and press down on it with your hand. If the insole is worn out, it will flatten out and it should be discarded. If you are beginning to experience symptoms in the legs or back that have not been experienced for a while, it may be a sign your orthotics are worn out and replacement is necessary. Since off the shelf insoles are relatively inexpensive, it is a good idea to have them in different pairs of shoes so you are corrected from shoe to shoe. Wearing an orthotic, any orthotic in just one type of shoe and not in another makes little sense since they only help when you wear them, so always remember to either move them from shoe to shoe or have a second pair laying around. There are different styles of off the shelf and custom for different types of shoes. In general, females because of the variety of styles they wear may require one for a sneaker and their Uggs, and a smaller set for their pumps or dress shoes. If a woman is wearing a shoe that has a heel greater than 2 inches, a foot orthotics is not needed because their feet cannot turn out naturally and those shoes will level out the pelvis, similar to the way the foot orthotics may. A custom insole can cost from $300 - $400 in our office. An off the shelf, depending on the brand can cost up to $75. Custom insoles, while potentially more corrective and more durable, are also subject to the inconsistencies of casting which can render an expensive device ineffective. In our office, we regularly see new custom insoles that are under posted which means they are not corrective enough because the patient was not cast in neutral correctly. For those who are unfamiliar with neutral positioning, it is the most mechanically efficient position the foot can be in (foot orthotics are designed to help you achieve neutral for maximum effect when you are walking or running) to affect the leg enough the level the pelvis and achieve symmetry in gait. While podiatrists and other healthcare providers are well trained in how to caste in neutral; if not done carefully, a positioning error will result in an under corrective caste which affects the final product; your orthotic. While the cast can be adjusted in our office by adding a posting to either the front or the back of the orthotic, it should be done right the first time. It is also essential that whoever is going to fit you for a custom insole understands your lifestyle, types of shoes, etc. so that the device that is made will work with what you wear. A huge mistake made by many offices is to not qualify the patient first to make sure the devices that are made will work with your lifestyle. Imagine being told to only wear an ugly orthopedic shoe while they hand you a device that barely fits in it and is uncomfortable while paying hundreds of dollars for the privilege. This is a common complaint we hear in our offices, and it makes the device unusable for the patient. If the orthotics are not worn, they are not helpful and a waste of money, no matter who pays for it (insurance or you). Sometimes, it is helpful just bringing your shoes in with you, and having the healthcare provider look at them first can avoid big and costly mistakes. for both you and the provider. Accommodating custom orthotics into your lifestyle should be relatively easy, but long term usage can be life-changing.

What should you expect your foot orthotics to do?

Foot orthotics serve one purpose; to create symmetry and level out your hips which allows the core to function better. Some of us have been told that it is for plantar fasciitis, shin pain, knee pain, back pain etc. and may use them because these areas feel better when you wear them. If this is what you were told or believe, you may be disappointed since someone with tight myofascia that has become dysfunctional (myofascia is formed according to the forces placed upon it so if you are built asymmetrically, the fascia will reflect that and distort your hips, even with an orthotic). In other words, it takes more than just a foot orthotic for most people to feel better. Also, many patients who were told that they were for a symptom such as plantar fasciitis stopped wearing them when the symptom seemed to go away, but years later may have permanent joint damage in the knees or hips orthotics which may have been prevented. With tight myofascia comes pelvic distortion, compensatory upper body distortion (think scoliosis without the curve with just the tightness acting on your structure) and chronic pain. To understand this more fully, read Cheating Mother Nature, what you need to know to beat chronic pain which will give you an understanding of how and what postural compensation does to create chronic pain (available through If a foot orthotics works, but the fascia is distorted in your core, you cannot run as efficiently as you should, will have pain even with foot orthotics in place, so please remember that foot orthotics is just part of the management of problems in the knees, shins, ankles, and back. A chiropractor is most likely going to look at you, not just the pain you are in and use foot orthotics as part of long term management which may be a reason to seek out a chiropractic opinion if you are considering having orthotics made first. Basically, foot orthotics change the rules of the game for chronic pain sufferers. By leveling the pelvis, an orthotic which is only a brace rather than a treatment will help you engage your core better, and feel better too. Treatments that help the myofascia include myofascial release (Active Release Technique is a style of this), Graston or instrument-assisted soft tissue treatment, and chiropractic manipulation which will restore motion and resilience to movement of the body that tight fascia has affected. Basically, orthotics help things stay looser by creating symmetry. This is why having them in your shoes all the time is essential, and during the summer, foot orthotics with good arch support can replace your foot orthotic. If you are planning on having foot orthotics made for you, speak with us first. Getting custom orthotics right the first time is essential because there is no bigger disappointment than having to spend your hard-earned dollars on a concept that potentially can help you avoid knee, hip and back pain and have it fail because you cannot or would not wear it for whatever reason. We will help you get this right the first time. Some may wonder about walking barefoot. A Barefoot walking gait has a different mechanism than walking shod (in shoes). It is this authors opinion that some of us may actually do better minimalist, some may need some correction and some of us will most benefit from well-constructed shoes with foot orthotics in them. Basically, no one size fits all and unfortunately, many opinions abound. For an interesting study I did, check out my series in the blog posts below on Going Barefoot Almost. It is food for thought. In my case, foot orthotics are essential for my gait style. Your mileage may vary. If you are not sure about what is best for you, ask us. The process of elimination may be the best way to help you figure that out. See a chiropractor first for advice on how to best fit a foot orthotic into your lifestyle, and how you can resolve the problems caused by gait related problems.