You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what whether you need custom orthotics means and what actually works. Call (810) 206-1402 for a same-day appointment at our Howell or Bloomfield Hills office.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Do I Need Custom Orthotics isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Related Conditions
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Quick Answer
Do I Need Custom Orthotics? A Podiatrist’s Guide Mich relates to orthotic fitting — typically caused by biomechanical foot needs. Most patients improve in 2 weeks to break in with conservative care. Same-week appointments in Howell + Bloomfield Hills: (810) 206-1402.
✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
Do I Need Custom Orthotics? A Podiatrist’s Guide
“Do I need custom orthotics?” is one of the most common questions patients ask Dr. Tom Biernacki DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. The honest answer: custom orthotics are one of the most effective tools in podiatry for specific conditions — but they’re not necessary for everyone, and they’re not a substitute for proper diagnosis. Here’s exactly who benefits and who doesn’t.
Conditions Where Custom Orthotics Have Strong Evidence
Custom orthotics show consistent clinical benefit for: plantar fasciitis (reduces loading on the plantar fascia origin), posterior tibial tendon dysfunction / adult flatfoot (offloads the failing tendon), diabetic foot ulcer prevention (redistributes plantar pressure away from ulcer-prone areas), running-related injuries associated with overpronation (patellofemoral pain, iliotibial band syndrome, medial shin splints), hallux valgus / bunion slowing progression (reduces first ray hypermobility), Achilles tendinopathy (reduces tensile load via heel lift), pediatric flexible flatfoot causing pain or fatigue, and sesamoiditis (offloads the first metatarsophalangeal joint). For these conditions, multiple randomized controlled trials support custom orthotics as a primary treatment.
Conditions Where Custom Orthotics Have Weaker Evidence
OTC insoles may work as well as custom for: mild metatarsalgia in younger active patients, mild cavus foot without significant pain, shin splints where arch control is a contributing factor (though biomechanical assessment determines this). Custom orthotics are unlikely to help with: established hallux rigidus with significant arthritis (joint is already rigid), acute fractures or ligament tears (requires immobilization, not orthotics), neurological conditions causing foot drop, and conditions where the primary problem is systemic (rheumatoid arthritis without biomechanical component).
Custom vs. OTC Orthotics: When Does It Matter?
OTC orthotics (Dr. Scholl’s, PowerStep Pinnacle) cost $20-60 and work well for patients with average foot shape and mild biomechanical needs. Custom orthotics cost $400-600 (partially covered by many insurance plans) and are made from a 3D scan or cast of your specific foot. Custom is significantly superior for patients with: significant foot deformity (moderate to severe flatfoot, cavus foot), specific conditions requiring precise pressure redistribution (diabetic ulcer prevention, sesamoiditis), patients who have failed OTC orthotics for documented conditions, and patients with significant limb length discrepancy. At Balance Foot & Ankle, we use 3D scanning technology for custom orthotic fabrication — the most precise method available.
Signs You May Benefit from Evaluation
Consider a podiatric evaluation for potential orthotic prescription if: you have recurring heel pain, arch pain, or ball-of-foot pain that hasn’t resolved with stretching and rest, your ankle or foot rolls excessively inward when walking (overpronation visible in your shoe wear pattern), you’ve worn out the inside edge of multiple pairs of shoes, you’re an athlete with recurrent lower extremity injuries, you’re diabetic and have peripheral neuropathy, or you’ve tried OTC insoles without adequate relief.
The Evaluation Process at Balance Foot & Ankle
A complete custom orthotic evaluation at Balance Foot & Ankle includes: standing and walking assessment, 3D foot scan, biomechanical examination of ankle and subtalar joint range of motion, assessment of shoe wear patterns, gait analysis, and review of your activity demands. This hands-on exam plus imaging when needed determines whether custom orthotics are appropriate for your specific situation — we don’t prescribe orthotics unless the evidence supports them for your condition. Insurance coverage check included. Call (810) 206-1402.
Medical References & Sources
- American Podiatric Medical Association — Orthotics
- PubMed Research — Custom Orthotics Clinical Evidence
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, #208
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
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👟 Dr. Tom’s Complete Footwear Library
Podiatrist-Approved Guides for Every Foot Type & Condition
Clinically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist
🦶Podiatrist Recommended Orthotics
👟Best Shoes for Plantar Fasciitis
👟Best Shoes for Bunions
👟Best Shoes for Flat Feet
👟Best Shoes for Neuropathy & Diabetic Feet
🏃Best Running Shoes
🚶Best Walking Shoes
🚶Best Womens Walking Shoes
🏃Best Womens Running Shoes
👡Best Sandals with Arch Support
👡Best Sandals for Plantar Fasciitis — Arch Support
🦶Best Insoles for Flat Feet
🦶Best Orthotic-Friendly Shoes
📏How to Find Your Perfect Shoe Fit
🧦Best Podiatrist Recommended Compression Socks for Real Relief
🏠Best House Shoes & Slippers
↔️Best Wide Width Shoes for Men and Women in
👔Best Dress Shoes for Foot Pain
👟Best Shoes for High Arches
👟Best Shoes for Metatarsalgia Ball of Foot Pain
👟Best Shoes Achilles Tendonitis
👟Best Podiatrist Shoes for Supination
All guides are written and reviewed by licensed podiatrists. Schedule an appointment →
More Podiatrist-Recommended Orthotics Essentials
PowerStep Pinnacle
The podiatrist-recommended OTC orthotic — arch support + heel cup.
CURREX RunPro Insole
Performance insole for runners — reduces fatigue and prevents injuries.
Tuli’s Heel Cups
Shock-absorbing heel cushion — adds lift and relief under painful heels.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Off-the-shelf inserts help 70% of patients — but if you’ve tried several without relief, custom orthotics molded to your specific foot mechanics are usually the next step. Balance Foot & Ankle makes custom orthotics in-office and most major insurance plans cover them. We’ll cast or scan your feet and have them ready in about 2 weeks.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Pros & Cons of Conservative Care for orthotics
Advantages
- ✓ Custom orthotics 80%+ improvement
- ✓ Most insurance covers
- ✓ Lasts 3-5 years
Considerations
- ✗ 2-week break-in
- ✗ Custom can be $400-700
- ✗ OTC limits effectiveness
Dr. Tom’s Recommended Products for orthotics
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
PowerStep Pinnacle Maxx Dr. Tom’s Pick
Best for: High-arch + severe plantar fasciitis
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Hills. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Hills, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
This single insole eliminates plantar fasciitis pain in 60% of patients within 2 weeks. The lateral wedge is the active ingredient — it stops the overpronation that causes the fascia to overstretch with every step. Pair with a max-cushion shoe for compound effect.
CURREX RunProDr. Tom’s #1 Brand
4.4
(4,000+ reviews)
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Choose your arch height from a wet-foot test (low/med/high). Wrong arch = re-injury. For runners, athletes, or anyone who failed standard insoles — this is the closest you can get to custom orthotics without paying $500. The carbon heel is what professional athletes use.
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
4.6
(5,500+ reviews)
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Doctor Hoy’s Natural Pain Relief Gel.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Doctor Hoy’s Natural Pain Relief Gel
- Pricier than Doctor Hoy’s Natural Pain Relief Gel
- Strong menthol scent at first
Apply to plantar fascia + calves before bed. Combined with stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
What is Custom orthotics?
Custom orthotics is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of custom orthotics include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of custom orthotics respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from custom orthotics varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
Dr. Tom’s Clinic-Recommended Products
The OTC orthotic I recommend most in our clinic. Medical-grade arch support at a fraction of custom orthotic cost. Holds shape 12+ months.
Natural topical pain relief — arnica + menthol + magnesium. What I use in our clinic. No greasy residue. FSA-eligible. Plant-based.
As an Amazon Associate and Foundation Wellness affiliate I earn from qualifying purchases at no extra cost to you.
Ready to fix this for good?
Reading goes only so far. The fastest path to relief is a 30-minute office visit with Dr. Biernacki — same-day Howell or Bloomfield Hills. Call (810) 206-1402 or use our online booking.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot pain, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.
What is the difference between a podiatrist and an orthopedic surgeon?
Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.
How do I know if my foot pain is serious?
Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.
Can foot problems cause back and knee pain?
Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.
Are orthotics worth it?
For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.
How do I choose the right running shoes?
Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.
What is the difference between a sprain and a fracture?
A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.
How do I prevent foot and ankle injuries?
The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.
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Or call: (810) 206-1402
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.