Custom orthotics sit in an awkward place in health care. They genuinely help a lot of people, they are widely covered by extended health plans, and they are also one of the most over-prescribed items in musculoskeletal care. Insurers know this, which is why claims for them are scrutinised more closely than almost anything else in a paramedical benefit.
This article is the honest version: what orthotics do, who they help, who they do not, and how to tell whether the pair you are being offered is a sensible part of your recovery or simply a use of your benefits. We provide orthotics at our Woodbridge clinic, so we have a reason to be candid about where they fit.
What an orthotic actually does
A foot orthotic is an insert that changes how load passes through your foot and up the leg. Depending on its shape and stiffness it can support the arch, cushion the heel, shift pressure away from a painful area, limit how far the foot rolls in, or alter the timing of how the foot moves as you walk.
What it does not do is permanently reshape your foot. An orthotic works while you are wearing it. That is not a criticism — glasses do not change your eyes either — but it does mean the useful question is whether changing how load passes through your foot will meaningfully reduce your symptoms, not whether your foot looks the way a textbook foot is supposed to.
The research on orthotics reflects this. For several conditions, especially plantar heel pain, they reduce pain in the short to medium term. The effects are real but often modest, and they tend to be largest when combined with exercise rather than used on their own.
Flat feet are not a diagnosis
The single most common reason people ask about orthotics is that someone once told them they have flat feet. This is worth addressing directly, because it drives a great deal of unnecessary spending.
Arch height varies enormously in healthy people. Plenty of people with low arches run, play sport and work on their feet for decades without a problem, and plenty of people with high arches develop foot pain. Foot shape alone is a poor predictor of who will get injured.
If your feet are flat and nothing hurts, you almost certainly do not need orthotics. If your feet are flat and something does hurt, the flat foot may or may not be relevant — and finding out is the job of the assessment, not an assumption made from looking at you standing still.
When custom orthotics are worth it
There are situations where custom-made orthotics genuinely earn their cost over a prefabricated insert. They share a common thread: the foot needs something an off-the-shelf shape cannot provide.
- Persistent plantar heel pain that has not settled with footwear changes, a prefabricated insert and a few weeks of strengthening.
- Significant structural differences, such as a markedly high arch, a rigid foot, a leg length difference or a foot that has changed shape after injury or surgery.
- Inflammatory or degenerative arthritis in the foot and ankle, where shifting pressure away from painful joints matters.
- Diabetes or reduced sensation, where redistributing pressure helps protect the skin — usually alongside care from a chiropodist or physician.
- Posterior tibial tendon problems, where the arch is collapsing progressively and needs firm support while the tendon is rehabilitated.
- Someone who has tried good prefabricated inserts properly and had partial benefit, suggesting the idea works but the fit does not.
When an off-the-shelf insert is enough
For a great many people with mild or recent foot, heel or knee pain, a decent prefabricated insert does much of what a custom one would, at a fraction of the price. Several trials in plantar heel pain have found little difference between custom and prefabricated orthotics in pain outcomes.
That makes a prefabricated insert a reasonable first step in many cases. If it helps, you have learned that changing load through the foot is useful. If it helps partially, that is a good argument for something more specific. If it does nothing at all, a more expensive version of the same idea is less likely to be the answer.
A good clinician will tell you this. If the only option you are offered is a custom pair, at the first appointment, before anything else has been tried, it is reasonable to ask why.
| Prefabricated insert | Custom orthotic | |
|---|---|---|
| Made from | A standard shape in a range of sizes | A cast or scan of your foot |
| Typical cost | Low | Considerably higher |
| Usually covered by benefits | Rarely | Often, with conditions |
| Best for | Mild or recent symptoms, a first trial | Persistent problems, unusual feet, arthritis, diabetes |
| Lifespan | Months to a year | Often several years, with refurbishment |
What a proper orthotic assessment includes
A footprint on a pressure mat is not an assessment. It shows one moment of standing, and most foot problems appear when you move. A worthwhile orthotic assessment looks at the whole chain.
Expect questions about where and when it hurts, what you do for work and exercise, what footwear you wear for most of the day, and what you have already tried. Expect the clinician to watch you walk — and, where relevant, run, squat or step down — and to check the mobility and strength of the foot, ankle, knee and hip.
The cast or scan comes last, once there is a clear reason for an orthotic and a clear idea of what it needs to do. If the casting comes first and the questions come afterwards, the order is backwards.
Orthotics work best with exercise
Orthotics change load; exercise changes capacity. For most foot and lower-limb problems you want both: the orthotic to reduce irritation in the short term, and the strengthening to make the tissue better able to tolerate load in the long term.
For heel pain that usually means calf strengthening and slow, heavy heel raises. For knee pain it usually means hip and quadriceps strength. For tendon problems around the ankle it means progressive loading of that specific tendon. None of these are replaced by an insert.
The best outcomes we see are from patients who use orthotics as a bridge — something that makes walking comfortable enough to do the rehabilitation — and then often find they need them less, or only in certain shoes, as their capacity improves.
Getting used to new orthotics
New orthotics, especially firmer ones, take some getting used to. Wear them for an hour or two on the first day and add an hour or so each day over one to two weeks. Mild awareness of them is normal at first; new pain somewhere else is not, and is worth reporting rather than pushing through.
They also need to go into shoes that can hold them. A supportive orthotic in a soft, collapsing shoe loses much of its effect. Most orthotics fit best in shoes with a removable insole and a firm heel counter, and many people end up with a second pair, or a slimmer version, for dress shoes.
Expect a review appointment after a few weeks. Small adjustments are common and part of the process, not a sign that something went wrong.
Questions to ask before you buy
Whether you get orthotics from us or anywhere else, these questions separate a considered prescription from a reflexive one.
- What specifically is this orthotic meant to do for my problem?
- Have we tried a simpler option first, and if not, why not?
- What exercises should I be doing alongside it?
- How will we know in six weeks whether it is working?
- What does my insurance require, and who will be signing the paperwork?
- Is there a follow-up for adjustments included?
Orthotics at our Woodbridge clinic
At Med Wellness in Woodbridge we assess before we prescribe. That means a look at how you move and load, a conversation about what you have already tried, and a straight answer about whether an orthotic is likely to help — including when the answer is that you do not need one.
When an orthotic is the right tool, we pair it with the strengthening and load advice that addresses the cause, and we help you understand what your extended health plan needs before you commit. Patients come to us from Woodbridge, Vaughan, Maple, Concord and Kleinburg, and no referral is required to book an assessment.
References
Written by Sandeep Sharma, Clinic Director · Clinically reviewed by Paramjeet Kaur Bassi · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
