CUSTOM ORTHOSES VS. STORE BOUGHT INSOLES

By: Alexandra (Dax) Hooper CPed(c)

When weighting the option between Custom Orthoses vs a pair of Store Bought Insoles there are many avenues to consider.  
              Firstly is knowing how each device is defined is important. Store Bought Insoles or Over the Counter Foot Orthoses, are defined as mass-produced devices that are not unique to the patient. PAC Website, Pedorthic Terminology 2011. Where as The Pedorthic Association of Canada defines a custom foot orthoses as “an internal foot appliance which is manufactured from a three dimensional image of the foot, and made from raw materials. A custom foot orthoses can accommodate bony deformities, and/or modify the movement pattern of the foot and lower limb.” (Pedorthic Association of Canada, Pedorthic Terminology, 2003)
 
            It is very important to note that although SBOI’s can be heat-moldable and modifications can be applied to the existing insole is possible, i.e., additions of metatarsal pads and posting, a SBI can never be classified as a “Custom Device” because the device is not made from a negative cast capturing the exact 3 dimensional shape of the patient’s foot.  Therefore most insurance companies do not cover SBI’s.
 
There are many basic differences between Store Bought Insoles (SBI) and Custom Fit Orthoses (CFO) with advantages and disadvantages that go along with that!
 
STORE BOUGHT INSOLES:
SBI products tend to be made with more cushioned materials

• Advantage: For a patient with a lack of padding on their feet i.e. fat pad dystrophy or migration. Or a patient with normal biomechanics who is subjected to hard surfaces regularly cushion might be all that is necessary!
• Disadvantage: Cushion materials such as PPT or poron break down faster than firmer materials such as EVA or Plastics used in custom orthoses.

SBI products can provide some biomechanical or motion control (see point 4 in summary for definition) but due to their material cushioned properties the support is minimal. What the patients needs are will determine if Store Bought Insoles will have sufficient control.

SBIs are usually shaped for a “general” or “average” foot shape, though some are heat moldable.

• Advantage: If heat moldable then some extra control and accommodation can be achieved.
• Disadvantage: If the patient’s foot is not the same or similar to the shape of the SBI then the level of comfort and support will be minimal if any is achieved at all.

 
Tend to be less expensive 

• Advantage: The upfront payment is not as difficult to deal with.
• Disadvantage: Most insurance companies will NOT cover the costs associated with SBOs and due to wear and tear of materials they usually require replacement every 3-6 months actually increasing the patients yearly cost with no reimbursement options  

 
CUSTOM FOOT ORTHOSES:
CFOs provide more material options for rigid or semi rigid shells, top covers, etc.

• Allows the provider to customize orthotics based on not only patient biomechanical control needs and the patients foot specifically but also on the type of shoe the CFO needs to fit in, the activities of the patient, and any material allergies or discomforts the patient may have.
  

CFOs provide more biomechanical or motion control (see point 4 in summary for definition). A more functional and supportive orthoses can be made for the patient depending what the patient needs.

• i.e : a patient with rearfoot instability a using semi-rigid or rigid materials a deep heel-seat and high borders can be put into the orthotic design for more control and support.

CFO products are made from a direct 3D cast of a patient’s foot using either a foam box cast, plaster cast, or computerized casting methods.  By directly casting the patients foot it allows the provider to capture the most desired position of the patients foot, reflect the anatomy of the foot, and establish a good starting point for the fabrication of the CFO.

Tend to be more expensive

• Disadvantage: It is recognized that custom orthotics do have a rather large upfront cost that can be difficult to manage sometimes but there are solutions!!
• Advantage: At this time when custom orthoses are made by the properly licensed professionals insurance companies will cover a portion if not the entire cost of the orthotics. 
  

Lifespan 1-2 years depending on amount of daily use. Although the cost of an orthotic appears substantially more than store bought orthoses the replacement needs are much less in the run of a year or two.

In Summary Key Factors to Consider SBI vs CFO

• Durability: The “lifespan” of a SBI is typically shorter than a CFO product due to the inevitable wear and tear on the materials used. Therefore although SBI’s initially cost less they must be replaced more frequently, and there is no option for insurance re-imbursement.
• Cost: In cases where the cost of a CFO is not at all feasible a SBI can provide the patient with some relief at a lesser cost.  But remember insurance companies do not cover SBIs and usually need to be replaced more often herefore in the long run your patient may end up paying less by going with the CFO option.
• Time Sensitive: Because CFOs are custom made there is time needed to manufacture them. In moments of urgency a SBI for immediate relief in for example a diabetic who requires offloading right away a SBI can be modified to allow the patient comfort until their CFO arrives.
• Biomechanical Control: When discussing biomechanical control we’re really talking about the goals of motion control coming from the orthoses when considering accommodative vs functional orthoses. An Accommodative orthotic can be sufficiently effective when control of motion is not a concern. Conversely a Functional orthotic would be considered more effective with more motion control is necessary.
• Minor vs. Major Abnormalities: In some situations of minor biomechanical abnormalities where simply cushion is necessary a SBI can be very effective for a patient. Where as for a foot with moderate/severe abnormities a custom orthoses would be a more effective method to address the foot problems with success.