Obviously, if orthotics helps you then you may think they are worth it. If they do not help you, then you may think they are not worth it. Like all medical care, no provider is 100% successful with the results of orthotic treatments. However, there are many complex reasons why some may fail. While some can be avoided, some cannot.
First, the reason most custom orthotics cost more is not necessarily the cost of the material but rather the knowledge, experience and time put forth in the creation, fabrication, dispense and follow up of the device themselves. As previously blogged, there are real differences to premade and custom orthotics.
For a higher chance of success on custom orthotics, I would look for a provider who has extensive education in biomechanics. Not just with the traditional podiatric “Root” theory or the “Pedorthist” or “Orthotist” theory but rather one who is knowledgeable of all the theories that are in the literature.
Everyone is different and should be treated individually. Therefore, one cannot completely rely on evidence studies of orthotic devices. How one individual reacts to the treatment may vary from individual to individual. Further, how much anatomical, pathological and surgical knowledge do they have? Many factors should be taken into consideration to give the best individual attention.
For those really involved in biomechanics, a lot of time is put forth to ensure the most advanced knowledge is provided. This, along with experience, really counts. I was told that I had to give up surgery in order to be really good bio-mechanically, so I did and I see why. There is so much information out there; it takes time to discern the good from the bad.
Position is critical. Is the provider positioning the foot or their assistant? I shrug when I hear that “they had their assistant take the impression rather than the prescriber. This is especially true today with computerized scanning. It is not just a simple scan or impression of the foot. And, if there is a problem, then how does one know the starting point if they did not take the impression themselves?
Types of Material
The types of materials used are critical as well. Orthotics are much more complex than soft or hard. It is again, the combination of knowing the materials but also how you’re responding to such and determining if changes need to be made. This is where follow-up is critical. For example, sometimes one returns and says they think the arches need lowering. Reality, they have about a 30% chance of being correct. I have sometimes raised the arch or not even touched the arch but did a wedge or post here or there and they relate it feels much better. Did you lower the arch? No, I didn’t touch it!
Who is Making the Device?
Who is making the device matters as well. One can send an impression, scan, or cast to a fabricating lab and if you send it to 3 different labs, you will get 3 different results. Why? Different theories are applied in fabrication. This is why long ago I took it upon myself to learn all the theories available and fabricate them myself.
Now days, there are many types of providers dispensing foot orthotics but not fabricating them. In the U.S., I believe this is so due to the lower medical insurance reimbursements. That is, providers are looking for other monetary avenues to make up for the losses. Unfortunately, with that, the amount of knowledge and experience in providing is going to vary greatly. For example, a provider may have taken a one day course from a fabrication lab and is now “Certified” to provide such a device.
Knowing the providers education, experience, 100% involvement in the exam, prescription, fabrication and follow up will lead to a higher chance of success. If needed, custom orthotics are worth it as they are helping many people not only with foot problems, but whole body issues as well. They typically will last significantly longer than an over the counter and provide improved function as well.
David J. Sables, D.P.M., C.Ped