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Treatment at Balance Foot & Ankle: Custom 3D Orthotics →
Board-Certified Podiatric Foot & Ankle Surgeon · Last reviewed: May 4, 2026
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Custom prescription orthotics from Dr. Tom Biernacki are fabricated from a 3D digital scan of your foot, then precision-milled to correct your specific biomechanical faults. Unlike over-the-counter insoles, prescription orthotics address the root cause of your pain — overpronation, supination, leg length discrepancy, or plantar fascia overload — with medical-grade materials built to last 3–5 years.
What Are Custom Prescription Orthotics?
Custom prescription orthotics are medical devices fabricated specifically to your foot’s geometry and biomechanical needs. Unlike off-the-shelf insoles, which provide generalized cushioning, prescription orthotics are designed from a 3D digital scan or plaster cast of your foot and engineered to correct your specific gait faults — reducing abnormal forces that cause plantar fasciitis, bunion progression, knee pain, and back pain originating from the foot.
The Orthotic Fabrication Process at Balance Foot & Ankle
Dr. Biernacki’s orthotic workflow begins with a comprehensive biomechanical examination: gait analysis on a pressure plate, static foot posture assessment, joint range-of-motion measurement, and clinical evaluation of foot type (planus, cavus, neutral). A high-resolution digital scan captures the three-dimensional contour of your foot in subtalar neutral — the optimal functional position. This scan data drives CNC milling of your orthotic shell from rigid or semi-rigid polypropylene, with customized topcover materials matched to your activity level and footwear.
Conditions Treated with Custom Orthotics
Plantar fasciitis is the #1 indication for orthotic therapy. By controlling excessive pronation and redistributing ground reaction forces away from the calcaneal insertion, custom orthotics reduce fascial strain with every step. Orthotic therapy combined with stretching resolves plantar fasciitis in 85–90% of patients without surgery.
Bunions cannot be corrected by orthotics, but their progression can be significantly slowed. By maintaining proper first ray alignment and reducing medial column collapse, orthotics decrease the deforming force on the first metatarsophalangeal joint. Post-surgical orthotics are often prescribed to prevent recurrence.
Flat feet (adult-acquired flatfoot) associated with posterior tibial tendon dysfunction represent one of the most important orthotic indications. A custom UCBL (University of California Biomechanics Laboratory) orthotic or rigid AFO (ankle-foot orthosis) can halt progressive flatfoot collapse and prevent the need for reconstructive surgery when caught early.
Metatarsalgia and neuromas respond to orthotics that offload the metatarsal heads via a built-in metatarsal pad and toe separator. The pressure redistribution reduces nerve compression and capsular irritation in the ball of the foot.
Knee, hip, and lower back pain often have their origin in abnormal foot mechanics. Correcting pronation and supination at the foot level changes the kinematic chain through the entire lower extremity, frequently eliminating secondary joint pain without treating the knee or hip directly.
Custom vs. Over-the-Counter Orthotics
Over-the-counter insoles (PowerStep, PowerStep Pinnacle, Spenco) provide adequate support for mild biomechanical issues and are appropriate as a first-line trial for minor plantar fasciitis. However, they cannot address significant structural problems: they lack the precision correction possible with custom fabrication, they degrade within 6–12 months, and they are not prescribable as medical devices. Custom orthotics are the appropriate choice for failed OTC trials, moderate-to-severe biomechanical deformity, post-surgical management, and active patients who demand precision performance.
Orthotic Materials and Types
Rigid orthotics (polypropylene) provide maximum biomechanical correction and are indicated for significant flatfoot, posterior tibial tendon dysfunction, and post-surgical management. Semi-rigid orthotics (polypropylene with cushioned topcover) balance correction with comfort and suit most athletic and daily-use applications. Soft/accommodative orthotics (EVA foam) provide cushioning and pressure redistribution without rigid correction — appropriate for diabetic feet, elderly patients, and severe arthritis.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Maxx Motion Control Insoles
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Maximum motion control OTC insole for severe overpronation. Firm heel cradle, full-length rigid shell, and cushioned topcover. Podiatrist-recommended bridge to custom orthotics.
Dr. Tom says: “”Dr. Biernacki recommended these while my custom orthotics were being fabricated. They provided enough support to get me through 3 weeks without significant pain.””
Moderate overpronation, plantar fasciitis, flat feet — OTC alternative or bridge to custom
Not a substitute for prescription orthotics in severe biomechanical cases
Disclosure: We earn a commission at no extra cost to you.
PowerStep Pinnacle Orthotic Insoles
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
High-profile arch support insole with stabilizer cap and deep heel cup. Maximum structural support in the OTC category. Suitable for high-arched and flat-arched feet.
Dr. Tom says: “”My podiatrist prescribed custom orthotics but said PowerStep Pinnacle GREEN were the best OTC option while I waited. They’re still in my work shoes two years later.””
Plantar fasciitis, high arches, general pronation control in work/hiking footwear
Not appropriate for diabetic feet or patients requiring accommodative cushioning
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Fabricated precisely to your 3D foot scan for maximum biomechanical correction
- Medical-grade materials last 3–5 years vs. 6–12 months for OTC insoles
- Treats root cause of plantar fasciitis, flat feet, bunion progression, and lower extremity pain
- Insurance-reimbursable in many cases with documented medical necessity
❌ Cons / Risks
- Higher upfront cost than OTC alternatives (though insurance often covers with documentation)
- 2–3 week fabrication time — OTC insoles provide bridge support
- Require break-in period of 2–4 weeks to adapt
- Not all shoes accommodate orthotic depth — requires footwear evaluation
Dr. Tom Biernacki’s Recommendation
Custom orthotics are one of the highest-value interventions in all of podiatric medicine. When I hand a patient their custom orthotics and they walk across the room and say ‘I’ve never felt my feet this supported’ — that never gets old. The precision of a device built from your own foot’s geometry is simply incomparable to anything off the shelf.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How much do custom orthotics cost in Michigan?
Custom prescription orthotics typically cost $400–$600 out of pocket in Michigan. Many insurance plans cover orthotics with documented medical necessity — we handle all prior authorization paperwork. Medicare Part B covers therapeutic orthotics for diabetic patients with qualifying peripheral neuropathy.
How long do custom orthotics last?
Quality custom orthotics fabricated from polypropylene last 3–5 years under typical use. The shell rarely wears out — topcovers may need replacement every 12–18 months. Annual re-evaluation is recommended, especially if your weight, activity level, or foot symptoms change.
Are custom orthotics worth it for plantar fasciitis?
Research consistently supports custom orthotics as first-line treatment for plantar fasciitis — with 85–90% resolution rates when combined with stretching and appropriate footwear. For patients with biomechanical overpronation driving their plantar fasciitis, custom orthotics address the root cause rather than just treating symptoms.
Can I get custom orthotics covered by insurance?
Most major insurance plans — including Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare — cover custom orthotics with documented medical necessity. Medicare covers diabetic therapeutic shoes and inserts under DMEPOS. Our team handles all pre-authorization and documentation to maximize your coverage.
How long does it take to get custom orthotics?
At Balance Foot & Ankle, digital scanning takes 10 minutes at your appointment. Orthotics are fabricated and ready in 2–3 weeks. We provide an OTC bridge insole recommendation to keep you comfortable during the wait.
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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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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