Custom orthotics for plantar fasciitis

January 9, 2024 8:23 AM

This was me a few months ago. By now, though, the cortisone shot has worn off and, when getting another shot yesterday, the podiatrist suggested I get custom orthotics. The cost ($500+) doesn't concern me if they really will make a difference, but *will* they make a discernible and worthwhile difference? A few more details inside.

If it matters:
-I've been wearing successive pairs of Asics Gel Kayano shoes for years, but could be talked into a change if it will really help.
-I have been walking, and will continue to walk, 4-5 miles every day. I cannot be talked out of this, so don't try.
-I am not by any measure really young (69 years).

posted by DrGail to Health & Fitness (29 answers total)

I'm not sure about custom orthotics, but even good recovery sandals (oofos) helped a lot.
posted by slidell at 8:25 AM on January 9 [3 favorites]

Yes, they help. Please note that good orthotics should not cause you any pain - the modern computer gait analysis ones tend to average things out and often need tweaking, so make sure you order from a place where tweaks are possible. My best ones were old school handmade from plaster casts of my feet.
posted by I claim sanctuary at 8:34 AM on January 9 [4 favorites]

Orthotics worked for me for plantar fasciitis. YMMV. One other thing is that once I got the orthotics, I switched to a more neutral shoe when I used to wear the Kayanos. I now wear Brooks - the orthotic provided greater stability for me. I have found them well worth the price and just had my 5 year old orthotics examined by the pediatrist yesterday and he said they looked great.
posted by turtlefu at 8:46 AM on January 9

Opinions vary, but in my experience, anything that supports your foot is a crutch, whether that be a custom orthotic, a store-bought orthotic, an insole, a heel-pad, or arch support. Like all crutches, they make you weaker and the goal should be to strengthen yourself so that you can do without them. This cannot be done while you continue to use them.

It's great that you walk a good distance every day. However, if you're doing that with supports of any kind, your foot is not getting stronger.

I had plantar fasciitis in my late 30s and early 40s. I wore custom orthotics for 6 or 7 years. My feet got worse as I got older.

It wasn't until I embraced the ideas in my first paragraph, and stopped using those crutches, that my feet were able to become stronger. I did exercises daily and threw the $700 (Canadian) orthotics away and now wear exclusively flat shoes with no support (like Feelgrounds and Vivobarefoot). I walk pain-free 15KM a day in the winter and 22+ a day in other months and have been doing so for about 7 years. I'm 55.
posted by dobbs at 8:47 AM on January 9 [2 favorites]

Yes, they will definitely help. If you want to try something else first, you might consider an over-the-counter insole -- but make sure you get a hard one. It's counter-intuitive, but the hard insoles help more with PF than the soft ones. I personally use the Superfeet black insoles (I use black because I have "high volume" feet and need a lower profile -- I think other people have had good luck with the green/sport ones.
posted by OrangeDisk at 8:48 AM on January 9 [4 favorites]

I use Superfeet, too. The podiatrist recommended the blue ones for me. They solved the problem.
posted by pangolin party at 8:50 AM on January 9 [3 favorites]

Definitely worked for me. I can walk comfortably for hours again and haven't had a PF flare since I started using them about 2 years ago. And I don't even remember the insoles are in my shoes. The only drawback is that I've had to give up some favorite shoes because there wasn't enough room in them.
I had several pairs of Lenz custom insoles made at a winter sports specialty store in Austria for a fraction of the cost of the pricy pair prescribed by the orthopedic surgeon and they've been just as good. And they didn't cost more than the OTC insoles like Superfeet (which helped a bit when I tried them, but I could definitely feel they were in my shoes when I used them).
posted by pendrift at 9:00 AM on January 9

They definitely helped me. As dobbs said, opinions may vary and mine do; take the crutch and use it for as long as you need it but you should also do the exercises that are recommended because they are just as important as the orthotics.
posted by ashbury at 9:08 AM on January 9 [3 favorites]

Yeah, pretty solid advice above. I had PF a few years ago, that eventually went away after switching shoes.

My big advice is even though its just walking, if you have a store nearby that specializes in running shoes, they can help immensely in recommendations.

The place near me had a treadmill with a video camera that analyzed my stride and I could see with my own eyes how I was turning my right foot.

I bought running shoes that had much stiffer soles than I would have chosen myself, and it was uncomfortable for a week, but then I adapted and never looked back.
posted by jeremias at 9:18 AM on January 9 [1 favorite]

I have a collapsed arch, and custom orthotics have definitely helped me, along with exercise. After wearing out the pricey pair I was prescribed, I discovered ArchCrafters and have been using their insoles ever since.
posted by May Kasahara at 9:21 AM on January 9

I’ve been dealing with plantar fasciitis again (after recovering from a bout several years ago). I read a lot on here and realized I needed to strengthen my feet rather than finding shoes or orthotics to accommodate them. Have you gone to a physical therapist?
posted by bluedaisy at 9:29 AM on January 9 [3 favorites]

Okay I see you went to a physical therapist early on. Did they give you exercises to ease the pain (like rolling your foot on a ball?) or foot strengthening exercises, like doing toe raises? Having said all this: given the amount you walk, custom orthotics seem like an okay idea anyway. I have some and they’ve been helpful for my weird foot arthritis.
posted by bluedaisy at 9:34 AM on January 9 [1 favorite]

Have you looked into systems focused more on rebuilding strength, such as this one?
posted by papergirl at 9:41 AM on January 9 [2 favorites]

They've helped me, more than over the counter ones.
posted by kbuxton at 9:59 AM on January 9

I'm on team Dobbs, blue daisy, and paper girl.

I don't know if everyone can strengthen their foot architecture rather than shoring it up with orthopedics, but what helped for me was PT and on my own foot exercises.

I went from agony and using a crutch to zero pain and able to walk like crazy. I had spent years fiddling with inserts and other supports. I did stop running and walk now instead, so that is probably part of it...but even walking back then was incredibly painful.

Good luck.
posted by rhonzo at 10:29 AM on January 9 [1 favorite]

Night splint even if you don't think that you can sleep with them, wearing them during your evening relaxing time will make a noticeable difference. This helped me more than custom orthotics.
posted by notned at 10:44 AM on January 9 [4 favorites]

I have tried a variety of over the counter inserts and none do as good a job as my custom ones that I got when I broke my foot. My only regret is I didn't take advantage of the buy-one-get-second-half-price because by the time I tried to get the second pair they had apparently lost my mold.
posted by terrapin at 10:48 AM on January 9

When I was really suffering with plantar fasciitis a combination of custom orthotics and using a night splint (for much longer than I thought I would have to) did a great job of resolving it. The orthotics helped a lot immediately.
posted by Well I never at 11:13 AM on January 9

I would recommend this book if you're interested in strengthening your feet.
posted by dobbs at 11:22 AM on January 9 [2 favorites]

They help tremendously. I got a pair last year after years of issues in my right foot (and I also did all the foot strengthening stuff and transitioned to all barefoot shoes and whatnot, which worked for a decade until it didn't). 100% worth the money.
posted by anderjen at 11:37 AM on January 9

I had terrible plantar fascitis for about 8 months. While searching Google I came across Altra zero drop shoes. I switched and my PF was gone in a month. I wore them for both running and everyday use. I am not alone in this experience. I have now switched from Altra to Hoka with no further PF.
posted by Xurando at 11:42 AM on January 9

Also this.
posted by Xurando at 12:02 PM on January 9

if they are good, made-by-a-podiatrist orthotics, they will almost certainly help. i wore mine for many years when i had PF and they helped immensely.

also try different shoes. i wore asics gel kahana (or something) for YEARS and then they got shittier in quality so i tried some brooks. these brooks shoes are so good i have bought 6 pairs to future guard me against them also getting shitty. they're adrenaline gts 22. like honestly i might buy a couple more if i see them on sale.
posted by misanthropicsarah at 12:53 PM on January 9

Orthotic insoles help my feet immensely, especially when I want to wear shoes that look a little nicer than sneakers but still don't want to be in so much pain at the end of the day. However, the one time I spent the money on custom ones, I didn't find them much better than off-the-shelf Superfeet, which still cost less than what I paid for the orthotics even after the insurance covered part. Your feet may vary, of course!

And yes, strengthening exercises, stretching, ice massage, and wearing the right shoes for my particular feet also helped a lot -- I don't even consider myself as having PF anymore and I attribute it mostly to doing those things. But the insoles helped me not hate my life while I was getting to that point. And as I said above, there are times in most people's lives where we would like to wear shoes that aren't perfect sneakers, y'know? I still use insoles in my work boots and fun boots.
posted by rhiannonstone at 1:18 PM on January 9

Yes, but only if good one. I had one pair that was measured by a computer and they did nothing. One pair done by an old-school podiatrist drawing with a pensil did wonderes.
He also recommended that I walked barefoot in the house a couple of hours a day and that I alternated shoes as much as possible to keep the foot moving in different ways every day, even if supported.
posted by thegirlwiththehat at 4:14 PM on January 9

I have a similar but different foot issue, where people are often helped by PF treatments and vice versa.

I have had a lot of success with using toe-spreading socks at night. Get a pair eg like these and try them for a a week or two. You have to kind of build up to wearing them all night but for me the benefits were obvious pretty quick. They can complement orthotic inserts, and I will agree and reinforce the notion that orthotics are often not a great long-term aid. They are best used to get you over a rough patch, which is what I did for a year, until I figured out they were holding me back. Studies show that orthotics do reduce pain for many people; but they can also increase pain for people who are more active and put extra load on their feet. Also I have felt better after taking turmeric daily as an anti-inflammatory, in case that's of interest.

Good luck, and feel free to memail me if you'd like to hear more about these.
posted by SaltySalticid at 4:19 PM on January 9

Have you tried acupuncture? When I had my (hopefully) one and only experience with plantar fasciitis, it was relieved and resolved by acupuncture. It took 3 visits a week for 3 weeks.
posted by Scout405 at 7:00 PM on January 9 [1 favorite]

I am evangelical about my custom orthotics - my problem is hypermobility, not plantar fasciatis though. Mine were fitted by initially taking a plaster cast of my feet, and then by carefully adjusting them using little foam wedges until the physio was happy with the way I was walking and, crucially, I had spent a few weeks walking on the final adjustment and reported back. They are not at all symmetrical - one has about half an inch more wedge - and I use them whenever I am not barefoot.

Re: orthotics being a crutch. I have two thoughts here.

First, my orthotics allow me to use my foot and ankle more normally and thus prevent pain, which means I can walk literally five or six times further, all the while building the muscle in the right places to support that normal walking. The shape of my of my sole and my calf muscles dramatically transformed, and I walk so much better barefoot than I used to. Perhaps if I transitioned away from using the orthotic now I would maintain this, but I suspect that I would need to completely switch over to barefoot style shoes at a minimum, which I don't really want to do. In this regard, yes, they might be a crutch, but they are a mobility aid and I am super grateful to have them.

Second, because my orthotics are compensating for problems that cannot be solved via physio/exercise, I am much less concerned by them being a crutch. I am never going to produce normal connective tissue in my ankles, or grow an extra half inch on my left leg, or untwist my femurs such that my hips have more outward motion naturally.
posted by In Your Shell Like at 5:48 AM on January 10 [1 favorite]

I got myself some Oofos slides this summer as a birthday gift to myself and omg they are amazing. I have relatively mild pain usually, although air travel and certain shoes definitely exacerbate it. My mom has it much worse and never goes barefoot at home anymore, which I absolutely can’t stand. I take my shoes off first thing when I get home, but got the Oofos on her recommendation. I had some house slippers but none of them had any support and if I wore them for doing chores around the house my feet would hurt terribly, particularly standing to wash dishes in the sink (I think it’s the leaning over shifting my weight for sustained periods causing it.) Anyway, I keep my Oofos slides right by the kitchen door and when I have foot pain upon waking I put them on while the water boils for my tea. Usually a couple hours in them sorts things out for a few days! So even if you go for the custom orthotics for your other shoes, look at Oofos for around the house wear or if you do water activities.
posted by Mizu at 6:24 AM on January 10