In short, the answer is no, not all custom orthotics are made the same. There are many different factors to consider.
Who is taking the cast/impression/scan of the feet?
As I stated in a previous blog, Custom Orthotics Frequently Asked Questions, education level varies between those who fabricate orthotics. Some only complete a weekend course to become certified, while others have spent 1000’s of hours training such as a typical Doctor of Podiatric Medicine.
It is important to know who is going to be taking the foot impression. This step is critical and unfortunately is sometimes passed off to an assistant. Position is critical as it not only affects the shape of the device but also the function. One typically needs to know the initial position of the feet when making any adjustments as well.
Also, will he/she be available when you need an adjustment? Is the adjustment done in house or will it be sent back to a fabrication lab where you may have to wait weeks before receiving it back?
The position of the foot when the cast/impression/scan is taken affects the fabrication as well. If a foot is not balanced enough, changes must be made before fabrication.
Who is making the custom orthotic?
This is important as well. I believe, one can send a cast/scan/impression to 3 different labs and there will be 3 different results. Labs may “fill” in some of the arch(s) randomly, so it is not exactly to your feet. Some will scan the cast of the feet and the computer will pick out a premade device off the shelf that closely matches your feet. This is not a truly custom orthotic in my opinion. Some may use a file to flatten the bottom of the cast and all that is left is a simple medial arch! Again, who, how and where your orthotic is designed is critical.
Regarding computer scans that claim 3d scans, this is not exact as some think. There are many soft tissue factors involved in weightbearing that are not considered with such scanning. Also, when “corrections” are needed, such as adding an arch pad, metatarsal pad or wedge, the 2-D computer screen cannot accurately do this. The cast is 3-D but when one is using a 2-D computer screen, it is impossible to accurately produce some of these corrections.
What about guarantees? Some will say lifetime warranty. Is your body the same shape as it was 5, 10 years ago? Probably not. Those that are familiar with biomechanics, will typically agree that most should replace their custom orthotics about every 5 years. Eye glasses may last a lifetime, but you most certainly will not see well with the same ones your entire life.
What about those 90 Day money back guarantees? This is typically done to attempt a volume business. Studies have shown that a good percentage will not take advantage of this, so the company wins.
How your body responds to orthotic treatment is not an exact science. So how can one guarantee you results? Surgery and medicine are not exact and therefore cannot be guaranteed.
Material selection. Many who are not extensively trained will typically fabricate “soft” orthotics as they have a wider standard deviation of acceptance. However, they are less functional and typically do not last as long. Further, many times a combination of material is needed and who chooses what, where and how to apply affects results as well.
At ArchMasters, we apply all the most advanced biomechanical theories to provide individual care. What is done for one is not done for all. We also have extensive education. I take the foot impression and complete the fabrication process myself, including all critical stages from design, position, material selection, dispensing and follow-up. When I learned to fabricate orthoses, I learned of the other theories and apply/combine/take into consideration all the theories when needed.
What about those “Hard Orthotics?” I have had patients come in and say, “Hard ones do not work for me.” Well…Who made them? What position did they hold your feet? How flexible? All these things matter when fabricating an orthotic. Many times, they do not follow the principles we use. I once had an 82-year-old man ask me to trade his soft orthotic for a hard one like his other two pair!