Do I need orthotics? Signs, types and how they help foot, knee and back pain

Signs you might need orthotics

You may benefit from orthotics if one or more of these sounds familiar:

1. Stabbing heel pain with your first steps in the morning or after sitting, the classic sign of plantar fasciitis.
2. Flat feet or very high arches that ache after standing or walking.
3. Repeated overuse injuries, such as shin splints, Achilles tendinitis or ankle sprains.
4. Shoes that wear out unevenly, for example on the inside edge of the heel.
5. Pain under the ball of the foot or big toe.
6. Store-bought inserts that helped, but not for long.
7. Sore feet at the end of every workday, even in good shoes.

If several apply, it’s worth having your feet and your walk checked by a podiatrist.

Store-bought inserts vs custom orthotics

Types of custom orthotics

• Functional orthotics have a firmer shell that controls how your foot moves, for example limiting how far the arch rolls in. They’re common for sports, long days on your feet and overuse injuries.
• Accommodative orthotics are softer and cushion sore spots. They’re used for arthritis, painful bumps, calluses, thinning heel pads and diabetes.
• Hybrid designs combine a supportive shell with a cushioned top layer.

Heel cups, metatarsal pads and heel lifts can be added for specific problems.

What orthotics can and can’t do

Orthotics are a useful tool, but they work better for some problems than others.

Heel pain and plantar fasciitis

This is where the evidence is strongest. Arch support and a cushioned heel take strain off the plantar fascia. Good prefabricated supports often work about as well as custom ones, so many people start there. See our guide to heel pain in the morning.

Flat feet and high arches

For flat feet that ache, arch support can reduce strain and tiredness. High arches don’t absorb shock well, and a cushioned orthotic spreads pressure across more of the foot. Flat feet that don’t hurt usually don’t need treatment. See flat feet: when to worry.

Achilles tendinitis and shin splints

Orthotics and heel lifts can take some load off the Achilles tendon and the shin muscles. They work best alongside a strengthening program and a gradual return to running.

Ball-of-foot pain and big toe stiffness

Metatarsal pads and forefoot changes can take pressure off the ball of the foot and a stiff big toe joint. See ball-of-foot pain.

Knee pain

For pain around the kneecap (runner’s knee), arch-supporting orthotics have helped in the short term in studies, especially in people whose feet roll in. For knee arthritis, wedged insoles haven’t been shown to help and aren’t recommended. Supportive shoes, strengthening exercise and weight loss help more.

Hip and lower back pain

Your feet, knees, hips and back work as a chain, so how your feet land can affect the joints above. If back or hip pain is linked to your foot mechanics or a difference in leg length, orthotics or a heel lift may help. But research on orthotics for back pain is limited, and most back pain has other causes. Physical therapy and exercise are the main treatments, and orthotics are a possible extra.

Arthritis and thinning heel pads

With age, the fat pad under the heel thins and joints stiffen. Cushioned, accommodative orthotics relieve pressure and make walking more comfortable.

Diabetes

For people with diabetes and numb feet, accommodative orthotics spread pressure away from high-risk spots and help prevent ulcers. They’re often paired with diabetic shoes. See our guide to diabetic foot care.

Try this first

Before custom orthotics, many people get relief from simpler steps:

• Supportive shoes with a firm heel, a sole that doesn’t fold in half and a removable insole.
• A good store-bought arch support. Give it a few weeks.
• Daily calf and arch stretches.
• Easing back on the activity that hurts, then building up gradually.

If you’re not improving after a few weeks, or your pain keeps coming back, see a podiatrist.

Getting custom orthotics: what to expect

1. Evaluation. Your podiatrist asks about your pain, your activities and your goals, examines your feet and ankles, checks movement and strength, and watches you walk.
2. Shoe check. Bring the shoes you wear most, so the orthotics can be designed to fit them.
3. Scan or mold. Your feet are scanned or molded to capture their exact shape.
4. Making them. A lab builds the orthotics to your podiatrist’s prescription.
5. Fitting. You try them in your shoes, stand and walk. They should sit flat, feel supportive and not pinch.
6. Break-in. Start with an hour or two on the first day and add an hour or two each day. Most people adjust within one to two weeks.
7. Follow-up. Small adjustments, such as adding a pad or changing the top cover, fix most comfort problems.

Learn more about custom orthotics at Evolve Health.

Shoes that work with orthotics

• a removable insole, so the orthotic can go in its place
• enough depth that your heel doesn’t slip out
• a firm heel and a stable sole
• room for your toes

Sneakers, walking shoes and many work boots work well. Slimmer orthotics can be made for dress shoes, and if you wear very different shoes, a second pair may be worth it. Our guide to the best shoes for plantar fasciitis has more tips.

How long they last and how to care for them

Most custom orthotics last two to five years. Replace them, or have them checked, if:

• the shell cracks or the arch flattens
• the top cover wears through or bunches up
• your foot shape or shoe size changes
• your pain comes back after months of relief

Wipe them with a damp cloth, let them air dry, and keep them away from heat, such as a hot car or a radiator.

Cost and insurance

Coverage varies a lot between plans. Some pay for custom orthotics prescribed for a diagnosed foot problem, and others don’t cover them. Medicare usually doesn’t cover foot orthotics on their own, except for inserts that go with diabetic shoes. Check your plan before your fitting, and see which insurance plans we accept.

When to see a podiatrist

See a podiatrist if foot, heel or arch pain lasts more than two to three weeks, keeps coming back, or changes the way you walk, or if store-bought inserts haven’t helped. See one sooner if you have diabetes, numbness or a sore on your foot. You can find a podiatrist near you and book online.