Custom orthotics can look very appealing if you're looking for a tool to help your patients address specific issues. But are they truly better than pre-fabricated orthotics?
Since most patients don't know foot anatomy, and some barely look at their feet, getting them to understand the need for orthotics is challenging. But, knowing when a cost-effective solution is best and when to go full out for custom orthotics can help make a big difference in patient compliance.
What's Going On In Your Foot That Could Require Orthotics?
As we know how complex the foot is, we also know some of the simplest things can throw the foot out of alignment. And once the foot is out of alignment, the knees, hips, back, neck, and the whole body structure can come out of alignment as well. High heels, dress shoes, sandals and flip-flops, and many decorative and sporty shoes people wear can cause problems.
Orthotics are one way to solve the health issues of wearing poor shoes. They can address things from simple calluses to severe structural issues.[1] Some of the most common reasons people get custom orthotics is to address complications with bunions, hammer toe, protonation, or structural defects[2]. Some people obtain these inserts to help knee, back, and neck issues that stem from how they walk.
Yet many other things can call for orthotics but might not need custom orthotics. Things like simple arch support, simple protonation, or correct walking patterns can be addressed with pre-fabricated orthotics.
But, the orthotics could allow a problem to perpetuate if the root of the problem is not addressed. For example, most pre-fabricated arch supports only focus on the inner arch, but could allow the outer arch and ball of foot arch to lack support. Prescription foot orthotics usually have a rear foot post or wedge that tapers outward underneath the heel, which helps reduce the pronation of the ankle and abnormal placement of the knees and hips.
All orthotics, whether store-bought or custom, should be treated as a tool to promote healing, not as a patch or a crutch. Orthotics should be used as part of a comprehensive treatment plan.
Pros & Cons of Different Foot Supports
Those custom orthotics and pre-fabricated ones have their benefits and attractions. So, let's take a look at them.
Custom orthotics
| Custom Orthotics - PROS | Custom Orthotics - CONS |
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Pre-Fabricated Orthotics
| Pre-fabricated Orthotics - PROS | Pre-fabricated Orthotics - CONS |
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When it comes to custom orthotics, many people fear spending hundreds of dollars to create them. They tried cheap orthotics in the past and threw them out after a month because they were uncomfortable or couldn't get used to them.
Yet, pre-fabricated orthotics are easy to integrate into your practice. They can be utilized in that same appointment and you can help your patients find ones that are comfortable enough to wear regularly.
I've used both types personally and professionally for my patients. Keeping both types of orthotics available for use will give you the most options possible.
How To Get Insurance Reimbursement For Your Orthotics
Insurance can be one of the hardest problems when attempting to get custom orthotics for your patients. Many companies will not cover custom orthotics unless it's related to specific conditions. Not only will you have to review the patient's insurance plan, but you also have to match the proper coding.
The code L3020 is most often used, and L3030 follows that. It must be stressed the orthotics are custom-made for the patient, not pre-fabricated. However, certain carriers will lump orthotics in with other DME, so you need to check prior to submission.
Most insurance companies will not cover custom orthotics unless it's part of the treatment plan for the specific issue being treated. Checking prior can answer many questions prior to recommending custom orthotics.
So, What's Better – Pre-Fabricated or Custom Orthotics?
It's really up to you, the practitioner, to ultimately decide, but at the end of the day, these are the reasons I would choose a pre-fabricated orthotic versus a custom one:
- Type of condition
- Price
- Immediate Usage
- Patient Compliance
- Long-term use
- Ease of switching between shoes
Education is key to patient compliance, whether you used pre-fabricated orthotics or custom ones. If your patients don't know why they are using the orthotics, they might not wear them. Patient compliance involves knowing the ultimate goal of the treatment plan and what the patient is supposed to be experiencing while using the custom orthotics.
Properly fitting and being comfortable will ultimately decide whether your patient is going to use them or not. In some cases, you may start with a pre-fabricated orthotic and then move to a custom orthotic as your patient becomes used to wearing the support but this process is both patient and condition dependent as well.
The education of your patients is the priority. From there, you can help your patient choose the most cost-effective orthotic for their particular condition and treatment goals.
1: Tran K, Spry C. Custom-Made Foot Orthoses versus Pre-fabricated foot Orthoses: A Review of Clinical Effectiveness and Cost-Effectiveness [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Sep 23. PMID: 31714699. 2: Eng JJ, Pierrynowski MR. Evaluation of soft foot orthotics in the treatment of patellofemoral pain syndrome. Phys Therap 1993; 73:62-70. 3: Trotter LC, Pierrynowski MR. Changes in gait economy between full-contact custom-made foot orthoses and pre-fabricated inserts in patients with musculoskeletal pain: a randomized clinical trial.J Am Podiatr Med Assoc. 2008 Nov-Dec; 98(6):429-35.