Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Quick answer: How Orthotics Are Made 3 is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
The most important clinical decision with How Orthotics Are Made 3 isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Step 1: Evaluation and Prescription Writing
The custom orthotic process begins with a comprehensive biomechanical evaluation. Dr. Biernacki assesses: standing foot posture (arch height, heel alignment, forefoot position), gait analysis (pronation pattern, heel-to-toe progression, push-off mechanics), joint ranges of motion (subtalar neutral, ankle dorsiflexion, first MTP motion), and the specific pathology being addressed.
The orthotic prescription is a clinical document specifying the biomechanical corrections needed: posting (adding material to the medial or lateral heel or forefoot to address alignment), extensions (full-length vs. 3/4 length, Morton’s extension to the toe tip for first MTP immobilization), cutouts (first metatarsal depression for plantarflexed first ray), shell material, and top cover material.
The prescription is customized to both the clinical diagnosis and the intended footwear: a running orthotic prescription differs from a dress shoe orthotic in length, flexibility, and profile even for the same patient with the same diagnosis.
Step 2: Foot Impression
Three impression techniques are used at Balance Foot & Ankle: foam box impression (most common for rigid orthotics), 3D optical scanning, and plaster casting.
Foam box impression: the patient steps into a foam box in subtalar neutral position (the joint position that most accurately captures the true foot shape). The impression captures the three-dimensional plantar surface of the foot. The depth and weight-distribution of the impression encode foot shape precisely.
3D optical scanning: a camera captures the full foot surface in 3D in seconds. The digital file is sent directly to the orthotic laboratory. Increasingly used for sports orthotics where turnaround time is critical.
Plaster casting: wrapping the foot in plaster strips while held in subtalar neutral. The most labor-intensive but produces the most detailed impression. Preferred for complex deformities and surgical orthotics.
Step 3: Laboratory Fabrication and Fitting
The foot impression and prescription are sent to an orthotics laboratory. A technician pours the impression to create a positive model of the foot, then vacuum-forms a polypropylene shell over the model. The shell is ground and smoothed to the exact specifications of the prescription.
Top covers (EVA foam, leather, or microfiber) are applied over the shell for patient comfort. Total fabrication time: 3–10 business days depending on laboratory and complexity.
Fitting appointment: Dr. Biernacki evaluates the orthotic in the intended footwear. Patients walk in them for 5–10 minutes. Adjustments are made if needed — grinding the shell for pressure points, adding or modifying posting, or adjusting the top cover. A brief acclimatization period (wearing 1–2 hours the first day, increasing daily) prevents arch soreness from sudden new mechanical loading.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Insoles
⭐ Highly Rated
The highest-quality OTC insole — try before committing to custom orthotics
Dr. Tom says: “For patients uncertain about custom orthotics, PowerStep Pinnacle provides a meaningful test: if OTC arch support significantly helps, custom orthotics will almost certainly provide even better control.”
First-line arch support trial, pre-custom orthotic assessment, everyday support
Patients whose clinical exam clearly indicates custom orthotic complexity
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CURREX RunPro Insoles
⭐ Highly Rated
Profile-matched dynamic running insoles — the most sophisticated OTC running insole
Dr. Tom says: “CURREX RunPro is the OTC insole closest to custom in terms of profile matching and dynamic support. For runners who respond well to CURREX, custom orthotics may add only marginal additional benefit.”
Runners considering custom orthotics, arch-type-matched OTC, athletic use
Severe biomechanical problems clearly requiring precision custom fabrication
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Custom orthotics are precision devices matching the individual’s exact foot shape
- 3D scanning makes the process fast and highly accurate
- Adjustments at fitting appointment fine-tune the device to the specific patient
❌ Cons / Risks
- Fabrication takes 3–10 days — patients need temporary accommodation footwear
- Custom orthotics require acclimatization — sudden full-day use causes arch soreness
- Not all insurance plans cover custom orthotics — cost $300–600 out of pocket
Dr. Tom Biernacki’s Recommendation
I love explaining the orthotic fabrication process to patients because it demystifies what we’re doing and why it works. When patients understand that we’re capturing their foot’s exact three-dimensional geometry, writing a precision prescription, and creating a device that holds their subtalar joint in the optimal position — they understand why it’s different from a $30 insole. The physics is straightforward: control the position of the subtalar joint and the entire lower extremity mechanics improve.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How long do custom orthotics last?
3–5 years with typical use. Running orthotics used daily may need replacement or refurbishment at 2–3 years. The shell lasts longer than the top cover.
Do custom orthotics hurt at first?
Mild arch soreness for the first 1–2 weeks of acclimatization is normal and expected. Sharp pain or pressure spots require adjustment.
Can orthotics be transferred between shoes?
Generally yes — if the orthotics are the same length as the target shoe. Separate prescriptions for different footwear types (running vs. dress shoe) give better results.
How do I know if my child needs custom orthotics?
Symptomatic flat feet with pain or deformity affecting activity, associated knee or back pain, or specific diagnoses (tarsal coalition, rigid flatfoot) are the primary pediatric indications.
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.
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
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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.