Custom Orthotics or Pharmacy Insoles: How to Decide Before You Spend

Standing in a pharmacy aisle in front of a wall of insoles, with a quote for something custom-made sitting at the back of your mind, is a very ordinary kind of stuck. You’d like your feet to stop hurting, you’d rather not waste money, and almost everyone you ask seems to be selling something. It’s okay to not know which way to lean.

For common foot pain, especially pain under the heel, the best trials and reviews find that custom-made and prefabricated orthoses perform about the same. So a sound first spend is an assessment by a registered podiatrist, which is also what the Australian Podiatry Association advises, and then, if a device is indicated, a prefabricated one. Custom devices have a clearer case in a few specific conditions, and where a prefabricated one has been tried and hasn’t worked. This is general information, not a diagnosis, and it can’t tell you what is happening in your own feet.

What you are really choosing between

“Orthotics versus insoles” sounds like two options. In practice there are three.

• A custom-made orthosis is made for you, usually from a cast or scan taken after an assessment of how you stand and walk.
• A prefabricated orthosis is made in standard sizes, but it is firm and shaped to support the arch.
• A cushioning insole is soft and mostly flat. Its job is comfort, not control of the foot.

This matters because the Australian heel-pain trial described below compared custom with a firm prefabricated device, not with a soft cushion. In the benchmark Australian trial on heel pain, the “sham” device was soft, thin foam, and the prefabricated device was firm foam. So the claim “a pharmacy insole does as well as a custom one” is only supportable for firm, arch-supporting prefabricated products. The evidence described in this article does not cover a soft shelf cushion, so it cannot tell you how one compares. Pages that rank for this question tend to describe custom devices as better made and longer lasting, and they often don’t name a trial or review behind that.

What head-to-head research finds

A Cochrane review of custom-made foot orthoses for foot pain, published in 2022, pooled 11 trials with 1,332 participants, covering plantar fasciitis, rheumatoid arthritis, a high-arched foot (pes cavus), bunions and juvenile idiopathic arthritis. Its authors put the limit plainly: “There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain.” The devices were safe in every study. For plantar fasciitis, the review found the benefit unclear.

A 2018 systematic review and meta-analysis from La Trobe University on plantar heel pain looked at 19 trials and 1,660 participants. On the question you are probably asking, it says: “A comparison of customised and prefabricated foot orthoses showed no difference at any time point.” Against a sham device, orthoses reduced pain a little more in the medium term, but the authors were uncertain whether that change is big enough to matter, and in the short and longer term the (very low-quality) evidence showed no reduction in pain or function.

The 2006 Australian randomised trial followed 135 people with plantar fasciitis, split between a sham, a firm prefabricated device and a semirigid custom plastic one. The benefit at three months was small and was no longer significant at 12 months. The authors concluded that the custom and prefabricated devices had similar effectiveness.

A US physical therapy guideline from 2023 points the same way. It advises against using orthoses, prefabricated or custom, as the only treatment for short-term pain relief in plantar fasciitis, and it allows them as one part of a combined plan.

“About the same” does not mean orthoses are useless or that custom ones are a scam. It means that when researchers measured pain and function, the custom version did not buy a measurable extra benefit on average for heel pain.

Where custom devices have the better case

Custom-made orthoses are a legitimate tool. The Cochrane review found them effective for several specific problems, and the Australian diabetes guideline gives them a place too.

• A painful high arch (pes cavus). Custom devices reduced pain at three months compared with a sham. This is the only finding the review rates at its highest certainty.
• Rear-foot pain from rheumatoid arthritis. Custom devices reduced pain at three months compared with no treatment. The picture for pain in the big toe joint was less clear.
• Juvenile idiopathic arthritis. Custom devices beat supportive shoes, but prefabricated neoprene inserts looked just as effective.
• A painful bunion. Custom devices reduced pain compared with no treatment in the trial reviewed, but surgery did better, so they shouldn’t be oversold as a fix.
• Diabetes-related foot problems. The 2021 Australian guideline on diabetes-related foot disease says that when a foot deformity or a sign of impending ulcer is present, clinicians should consider custom-made footwear or orthoses. This is a clinical pathway through a podiatrist or similar professional, not a retail decision.

The other side has a fair point. The evidence is limited, many trials are short, and the Cochrane review rates its certainty at the top level only for the painful high arch. People also respond differently, and a podiatrist can adjust a custom device in ways a shelf product can’t be. “No difference on average” is not “no difference for you,” which is a good reason to have the conversation with a podiatrist rather than decide from an article.

What the research does not show

Some claims that travel with orthotics are not backed by the sources above.

• That they correct your foot mechanics for good, or prevent future pain. The heel pain research shows no long-term benefit over a sham for either type.
• That they fix posture, or back and knee pain. A 2007 Cochrane review found strong evidence that insoles are not effective for preventing back pain, and that the evidence on insoles as a treatment for low back pain does not allow any conclusions. It is dated, but it counts against the posture claim.
• That they are the answer for flat feet. A 2014 paper by Australian podiatrists on adults with symptomatic flexible flat feet noted that there are no clinical guidelines for prescribing custom orthoses for that group, so their recommendations rest on expert agreement, not trial results.
• How long a device lasts, or how quickly it works. No authoritative source for either turned up, so the numbers you see quoted come from sellers. If you are quoted a lifespan, ask how long the shell is expected to last and what happens when it wears out.

None of this means you’ll get no relief. It means the honest summary is modest and depends on the condition.

A decision order that does not waste money

One manageable way through puts the cheaper and better-evidenced steps first.

Take a hypothetical example. Say someone has had sore heels for a few months and is torn between a custom quote and a firm shelf product. They book the assessment first. If the podiatrist finds ordinary heel pain and recommends a device, a prefabricated one is a reasonable place to begin, and if it doesn’t help after a fair trial, the case for custom is stronger because a simpler option has been ruled out. If the pain drags on despite everything, the next conversation may be about wider options, which this look at when foot or ankle surgery is worth asking about walks through.

Paying for it

Private health extras differ by policy. On some, orthotics sit under their own sub-limit with a longer waiting period than ordinary podiatry visits, while others combine them. The Australian Podiatry Association says podiatrists are the only health professionals whose prescription of orthotics may be eligible for a fund rebate, which is worth knowing before you buy elsewhere. The place to check is the Private Health Information Statement for your own policy, and reading one is the same skill as in this guide to private health and laser eye surgery.

Medicare needs a closer look. Under a GP chronic condition management plan, eligible patients can use up to five individual allied health services a year, and podiatrists are among the professions listed. Services Australia’s page describes services, though, and says nothing about orthotic devices, so don’t assume the device itself is covered. The arrangements changed from July 2025, so check current details with your GP.

Questions people ask

Are custom orthotics better than over-the-counter ones? For heel pain, trials find no difference between custom and prefabricated at any time point. For a few conditions, such as a painful high arch, custom has the clearer evidence. A soft pharmacy cushion is a different product again, and the evidence described here does not cover it.

What kind of insoles do podiatrists recommend? There’s no single answer. The Australian Podiatry Association’s advice is to see a podiatrist, so the recommendation fits your condition, and it notes that a plan may or may not include orthotic therapy.

Do I need orthotics at all? Not necessarily. Many foot problems are treated with several measures together, and an insert is one possible part. The assessment tells you whether it belongs in your plan.

Where the money is worth spending

If you take one thing from this, let it be the order: assessment first, device second, custom third unless the condition or the history points there. The best-spent money is on a proper look at your feet by a registered podiatrist, because that decides whether you need a device and which kind.

After that, the evidence is kind to the cheaper path. A firm prefabricated orthosis has done about as well as a custom one for common heel pain, and custom is easiest to justify for a painful high arch, certain arthritis-related foot pain, diabetes-related foot problems, or after a prefabricated one hasn’t worked. If your pain is persistent or worsening, or you have diabetes, please see your GP or podiatrist rather than waiting for an insole to settle it.

You don’t have to decide everything this week. Book the assessment, jot down where and when it hurts, and take your usual shoes along. That one step makes every later choice easier.

Sources: Custom-made foot orthoses for the treatment of foot pain, Cochrane Database of Systematic Reviews 2022, Issue 3, CD006801 (https://www.cochrane.org/evidence/CD006801_custom-made-foot-orthoses-treatment-foot-pain); Foot orthoses for plantar heel pain: a systematic review and meta-analysis, British Journal of Sports Medicine 2018 (https://pubmed.ncbi.nlm.nih.gov/28935689/); Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial, Archives of Internal Medicine 2006 (https://pubmed.ncbi.nlm.nih.gov/16801514/); Heel Pain, Plantar Fasciitis: Revision 2023, Journal of Orthopaedic and Sports Physical Therapy 2023 (https://www.orthopt.org/uploads/content_files/files/Heel_Pain_Plantar_Fasciitis_revision_2023_1_.pdf); Australian Podiatry Association public statement on retail orthotics, 15 October 2019 (https://www.podiatry.org.au/documents/item/2104); Australian guideline on prevention of foot ulceration, part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease, Journal of Foot and Ankle Research 2022 (https://jfootankleres.biomedcentral.com/counter/pdf/10.1186/s13047-022-00534-7.pdf); Services available under a GP chronic condition management plan, Services Australia (https://www.servicesaustralia.gov.au/services-available-under-gp-chronic-condition-management-plan?context=20); Insoles for prevention and treatment of back pain, Cochrane Database of Systematic Reviews 2007 (https://pubmed.ncbi.nlm.nih.gov/17943845/); Consensus-based recommendations of Australian podiatrists for the prescription of foot orthoses for symptomatic flexible pes planus in adults, Journal of Foot and Ankle Research 2014 (https://pubmed.ncbi.nlm.nih.gov/25558287/)