Orthotics Explained: What They Are, What They Cost, and Who They Help
Updated: Sep 19
Orthotics are one of the most commonly recommended and most commonly misunderstood things in podiatry. Some people are told they need them for life. Others are told they are a waste of money. Both statements are too broad to be useful.
What an orthotic actually is
An orthotic is a device worn inside the shoe that changes how load is distributed through the foot and lower limb. That is the whole job. It does not correct the shape of your foot, and the effect lasts only while you are wearing it.
What it does is reduce how much work particular structures have to do on every step. If your plantar fascia is being overloaded, an orthotic can take some of that load. If your midfoot collapses under body weight and your muscles are working hard to control it, an orthotic can reduce how much control they need to supply.
That is a modest description on purpose. Orthotics are useful when the problem is a load problem. They are less useful when it is not.
Custom versus off-the-shelf
This is the question most people arrive with, and the honest answer is that both have a place.
Off-the-shelf orthotics are pre-made in a range of sizes and arch profiles. They are cheaper, available straight away, and for a good number of people they are enough. If your feet are broadly typical in shape, your symptoms are mild or recent, and you mainly need a bit more support than your shoe provides, an off-the-shelf device may do the job.
Custom orthotics are made from a scan or cast of your own foot, prescribed to your specific foot shape, symptoms and activity. They cost more and take longer to make. They are worth considering when your foot shape sits outside the typical range, when off-the-shelf devices have already been tried without much change, when symptoms are long-standing, when you have a condition such as diabetes or significant hypermobility that changes the stakes, or when you need the device to do something quite specific.
The comparison people often expect is that custom is better. A more accurate framing is that custom lets us prescribe something particular. If nothing particular is needed, the extra cost may not buy you anything.
Custom devices also differ in what they are made from, and that is part of the prescription rather than an afterthought. We use both EVA and TPU depending on what the foot needs. EVA is lighter and more cushioning, which suits people who want shock absorption and all day comfort. TPU is more durable and holds its shape better under higher loads, which suits heavier patients, higher mileage runners and anyone who needs a device to keep behaving the same way for years. Where a foot genuinely needs rigidity, we can incorporate materials such as carbon fibre to increase stiffness without adding bulk.
Conditions orthotics are commonly used for
Orthotics are most often prescribed for load-related problems including:
Plantar fasciitis and other causes of heel pain
Flat feet and arches that collapse under load
Forefoot pain, including Morton's neuroma irritation and metatarsal overload
Shin splints and other lower limb overuse injuries
Knee pain related to how the foot behaves during gait
Foot fatigue with prolonged standing or walking
Diabetes, where pressure redistribution reduces risk in high-pressure areas
Hypermobility, where joints move further than expected and muscles work harder to control them
Bunions. An orthotic will not correct a bunion, but it can reduce pressure across the big toe joint
Achilles tendinopathy, where reducing load through the calf and Achilles can support tendon rehabilitation
Posterior tibial tendon dysfunction and other medial ankle pain, where supporting the arch lowers the demand on the tendon
They are one part of a plan rather than the plan itself. Footwear, strength, activity load and sometimes other treatments matter as much or more.
A note on flat feet
Flat feet are one of the most common reasons people go looking for orthotics, so it is worth being clear.
Having flat feet is not in itself a problem. Plenty of people have low arches, no symptoms, and no need for anything at all. Arch height alone is a poor predictor of pain.
What matters is whether the foot is causing symptoms and how it behaves when you load it. A flat foot that is stable and not causing symptoms needs nothing. A flat foot that collapses further under load, with aching arches by the afternoon, is a different situation, and that is where support can help.
Orthotics for children
Most children are born with flat feet, and an arch usually develops through childhood. In most cases nothing needs to be done, and the arch appears on its own.
It is worth having a child looked at if they complain of foot or leg pain, avoid activity they used to enjoy, tire quickly on walks, walk with an obvious limp or a marked in-toe or out-toe, or if one foot looks clearly different to the other. Where a device is appropriate, children usually need it reviewed more often than adults, because their feet are still growing.
Orthotics as you get older
The fat pad under the heel and forefoot thins with age, so the foot has less natural cushioning than it once did. Joints stiffen, and conditions such as arthritis change how load is shared across the foot. An orthotic can redistribute that load and add cushioning where it has been lost.
There is a second reason this matters. Foot pain changes how people walk, and walking less has knock-on effects on balance, strength and general health. Keeping someone comfortable on their feet is about more than comfort alone.
What an orthotic assessment involves
A prescription without an assessment is guesswork. Ours involves:
History covering your symptoms, activity, footwear and what you are trying to get back to
Examination of foot posture standing and moving, joint range, and how the midfoot behaves under load
Gait analysis, barefoot and in your shoes
Strength and balance testing where relevant
Footwear review, which is why we ask you to bring the shoes you actually wear
3D scanning of the foot when a custom device is appropriate
Diagnostic ultrasound when a tendon, plantar fascia or bursa needs a closer look
The output should be a clear explanation of what we found, whether an orthotic is likely to help, and what else needs to happen alongside it.
What orthotics cost in Australia
Costs vary between clinics and by device, so treat these as general ranges rather than a quote.
Off-the-shelf devices typically run from around fifty to a couple of hundred dollars. Custom orthotics generally sit in the several hundred dollar range, and the price usually includes the assessment, the scan, the manufacture and follow-up reviews.
On funding:
Private health insurance. Many extras policies include orthotics, though limits, waiting periods and how often you can claim vary a great deal between funds and policies. Worth checking your specific cover before you commit.
Medicare. A GP care plan can provide a rebate towards allied health consultations for eligible patients with a chronic condition. The device itself is generally not covered.
DVA. Eligible veterans can access podiatry and orthotic provision with the appropriate referral.
NDIS. Orthotics can be funded for eligible participants where they relate to the participant's goals and plan.
Ask any clinic what the quoted price includes. A figure that covers the assessment, manufacture and reviews is not comparable to one that covers the device alone.
Do orthotics work?
Orthotics have reasonable support in the research literature for several conditions, particularly plantar heel pain, where they are widely used as part of management. The evidence is stronger for symptom relief than for changing foot structure, which fits the description at the top of this article. They are a load management tool.
The more useful question is usually not whether orthotics work, but whether your problem is a load problem. If it is, an orthotic is a sensible thing to try. If your symptoms are driven by something else, an orthotic on its own is unlikely to be the answer, and you should expect your clinician to say so.
We would rather tell you an orthotic is unlikely to help than sell you one that does not.
Wearing them in
New orthotics usually feel odd at first. That is normal and expected.
The usual approach is to build up wear time gradually over the first week or two rather than wearing them all day from the start. Some aching in the arch or calves as things adjust is common. Sharp pain, rubbing, blistering or numbness is not, and it means the device needs adjusting rather than persevering with.
Custom orthotics can and should be adjusted. If something is not right, come back. A device that sits in a drawer because it was uncomfortable has helped nobody.
They also need the right shoe. An orthotic in a shoe with no depth, a soft heel counter or a flimsy sole will not do its job. Bring your shoes to the fitting.
How long do they last?
Custom devices generally last several years depending on your weight, activity and how hard you are on them, though the top cover usually needs replacing sooner than the shell. We have written about this in more detail in our article on how often orthotics need replacing.
When orthotics are not the answer
Worth saying plainly. Orthotics are less likely to help when:
The problem is primarily a strength or control issue that needs loading, not offloading
Footwear is the actual culprit and changing shoes would solve it
Activity load has increased too quickly and needs managing
The diagnosis has not been established, and an orthotic is being used in place of working out what is wrong
A good assessment should be able to tell you which of these applies.
Getting assessed
If you are wondering whether orthotics would help, the useful first step is a biomechanical assessment rather than buying a device and hoping. You can read more about custom orthotics at our Albany Creek clinic, or book an appointment online.
We see patients from across Brisbane's north, and we will tell you if we do not think an orthotic is the right call for you.
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