Do Foot Orthotics Work? What the Evidence Actually Says
Orthotics are one of the most requested — and most misunderstood — treatments for foot and heel pain. They can be genuinely useful, but they are not magic insoles, and more expensive is not automatically better. Here is a balanced look at what the research shows.
A foot orthotic is a device worn inside the shoe that changes how load is spread across the foot. It doesn’t permanently “correct” a foot or rebuild an arch. What it does is redistribute pressure and reduce the demand on a painful or overloaded tissue — for example, easing strain on the plantar fascia or offloading a sore area under the forefoot. Thinking of orthotics as a way to change load, rather than to fix posture, explains both what they can and cannot do.
What the evidence supports
For plantar heel pain (plantar fasciitis), orthotics — whether custom-made or good-quality prefabricated — can reduce pain and improve function in the short to medium term, with few side effects. They tend to work best as part of a plan that also includes calf and foot stretching, load management and appropriate footwear, rather than on their own. Orthotics are also commonly used to settle symptoms in conditions such as forefoot pain and some cases of flexible flat foot.
Custom vs prefabricated: the surprising part
Many people assume a custom device moulded to their foot must outperform an off-the-shelf one. The research doesn’t clearly support that. Reviews comparing custom-made and prefabricated orthoses for plantar heel pain have generally found no meaningful difference in pain or function at short, medium or long term. Prefabricated devices are cheaper and often work just as well. Custom orthoses still have a place — for unusual foot shapes, specific pressure problems, or when off-the-shelf options have failed — but they are not automatically superior.
When orthotics are worth considering
- Pain that is clearly load-related (worse with standing, walking or running).
- A specific tissue to offload, such as the plantar fascia or a painful area under the foot.
- As a short-to-medium-term aid while you build strength and adjust footwear and training.
Key points
- Orthotics change load and pressure — they don’t permanently reshape the foot.
- They can reduce pain in plantar heel pain, especially alongside exercise and footwear advice.
- Custom devices are not reliably better than well-fitted prefabricated ones for most heel pain.
- They work best matched to a clear clinical goal, not prescribed for a “flat foot” alone.
At Flow Clinic we assess your symptoms, footwear, strength and how you load the foot before recommending anything — and we’ll be honest about whether a prefabricated option, a custom device, or no orthotic at all is the better fit for you.
Evidence & sources
CADTH. Custom-Made Foot Orthoses versus Prefabricated Foot Orthoses: A Review of Clinical Effectiveness and Cost-Effectiveness. 2019. ncbi.nlm.nih.gov/books/NBK549527
Rathleff MS, et al. Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial. ncbi.nlm.nih.gov/pmc/articles/PMC6052580
This article is general information, not a substitute for individual assessment. Foot pain has many causes; see a qualified health professional for advice specific to you.
Not sure if orthotics are right for you?
Book a biomechanical assessment at Flow Clinic in Wairau Valley for honest, tailored advice.