✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

How to Know If You Need Orthotics (And Which Ones to Buy)

Not everyone needs orthotics. But when they’re indicated, the right orthotic can be life-changing — eliminating pain that’s been present for years in a matter of weeks. The problem: most patients either buy ineffective $15 drugstore insoles or assume they need $400 custom orthotics before trying anything else. Here’s how to know which you actually need.

5 Signs You Might Need Orthotics

1. Heel pain first thing in the morning that improves after walking — classic plantar fasciitis, almost always helped by orthotics
2. Flat feet or significantly low arches — without support, your arch collapses with every step, causing pain from the foot up to the hip and back
3. Knee pain that gets worse with walking/standing — overpronation at the foot causes excessive internal tibial rotation, loading the medial knee
4. Frequent ankle sprains — supinated (high-arched) feet are unstable laterally; orthotics with lateral posting improve stability
5. Uneven shoe wear — look at your old shoes. Excessive wear on the inner heel? Overpronation. Outer heel? Supination. Either pattern indicates an orthotic could help.

Custom Orthotics vs. Over-the-Counter: When Each Makes Sense

Start with quality OTC orthotics if you have mild to moderate symptoms, a relatively normal foot structure, and no diagnosis requiring specific accommodations. Quality OTC options like Powerstep Pinnacle, PowerStep Pinnacle Total Support provide significant improvement for 60-70% of patients at a fraction of custom cost.

Move to custom orthotics if you have: significant structural deformity (severe flat feet, high arches, leg length discrepancy), failed 6-8 weeks of quality OTC orthotics, a specific diagnosis requiring prescription correction (posterior tibial tendon dysfunction, Charcot arthropathy), diabetic foot complications, or pediatric foot deformities.

Best OTC Orthotics for Common Conditions

• Plantar fasciitis: Powerstep Pinnacle (firm arch, deep heel cup) or PowerStep Pinnacle (women’s version)
• Flat feet / overpronation: PowerStep Pinnacle (maximum support) Polysorb Cross Trainer
• Ball-of-foot pain: Metatarsal pads or PowerStep Ball of Foot relief insoles
• General daily use: Total Support — excellent all-day support at reasonable price

How Custom Orthotics Are Made

Modern custom orthotics start with a 3D scan of your foot — we use a digital scanner that captures your arch height, heel width, and pressure distribution in milliseconds. From this scan, a lab mills a custom device from polypropylene or carbon fiber, ground to specific prescriptive angles. The entire process takes about 2 weeks. Custom orthotics typically last 3-7 years with proper care.

Frequently Asked Questions

How long do OTC orthotics last?

Quality OTC orthotics typically last 6-12 months with daily use. Custom orthotics last 3-7 years. Replace them when the cushioning feels flat or the arch support is no longer noticeable.

Can I use orthotics in any shoe?

Most lace-up shoes with removable insoles can accommodate orthotics. Remove the original insole first. Heels, dress shoes, and very slim shoes are often incompatible with full-length orthotics — in those cases, a 3/4-length device works better.

Do kids need orthotics?

Not all flat-footed children need orthotics — flat feet are normal in toddlers. But if a child complains of foot pain, fatigues easily, or has significant in-toeing or out-toeing beyond age 6-7, an evaluation is warranted.

Expert Podiatric Care for Michigan Patients

Michigan patients dealing with foot and ankle problems benefit from evaluation by a board-certified podiatrist who can provide an accurate diagnosis and evidence-based treatment plan. At Balance Foot & Ankle, we combine clinical examination, advanced imaging when indicated, and a comprehensive understanding of foot biomechanics to identify the underlying cause of the patient’s symptoms. Our podiatrists are fellowship-trained in foot and ankle surgery and provide the full spectrum of care. Michigan patients can call Balance Foot & Ankle at (810) 206-1402 for same-week appointments at our Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208) locations.

Expert Podiatric Care for Michigan Patients

Related Treatment Guides

• Plantar Fasciitis & Heel Pain Treatment
• Custom 3D Orthotics
• Sports Foot & Ankle Injury Treatment
• Bunion Treatment

Michigan patients dealing with foot and ankle problems benefit from evaluation by a board-certified podiatrist who can provide an accurate diagnosis and evidence-based treatment plan — rather than relying on symptom management alone. At Balance Foot & Ankle, we combine clinical examination, advanced imaging when indicated, and a comprehensive understanding of foot biomechanics to identify the underlying cause of the patient’s symptoms and design a treatment plan that addresses it. Our podiatrists are fellowship-trained in foot and ankle surgery and provide the full spectrum of care — from conservative treatment and custom orthotics to minimally invasive and reconstructive surgery. Michigan patients can call Balance Foot & Ankle at (810) 206-1402 for same-week appointments at our Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208) locations.

Medical References & Sources

• American Podiatric Medical Association — Orthotics
• PubMed Research — Custom Orthotics Clinical Evidence

Clinical References

1. Landorf KB, et al. “Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial.” Archives of Internal Medicine. 2006;166(12):1305-1310.
2. Banwell HA, et al. “Foot orthoses for adults with flexible pes planus: a systematic review.” Journal of Foot and Ankle Research. 2014;7:23.
3. Collins N, et al. “Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome.” BMJ. 2008;337:a1735.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.