Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Custom orthotics are prescription inserts made from a 3D scan of your foot. They address the structural cause of plantar fasciitis, flat feet, or metatarsalgia rather than just cushioning symptoms. Most patients feel improvement within 2-4 weeks. Covered by most PPO plans and Medicare when medically indicated.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Treatment at Balance Foot & Ankle: Custom 3D Orthotics →
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A podiatrist’s complete clinical guide to the best insoles — custom orthotics, OTC picks, and what actually works for plantar fasciitis, flat feet, neuropathy & more.
Read the Full Guide →The Insole-Orthotic Question Every Patient Asks
Custom orthotics are a cornerstone of conservative podiatric treatment, but they’re also expensive — often $400-600 per pair, with variable insurance coverage. Many patients ask whether over-the-counter insoles from a pharmacy or running store can achieve the same results. The honest answer: it depends on the condition, the biomechanical factors involved, and the patient’s specific foot anatomy. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we recommend OTC insoles when they’re likely to be effective and custom orthotics when the clinical situation justifies the investment.
When OTC Insoles Are Often Sufficient
Over-the-counter insoles — particularly higher-quality options like PowerStep Pinnacle — are effective for: mild to moderate plantar fasciitis in patients with average foot anatomy (arch height close to normal, minimal biomechanical deviation). General foot fatigue from occupational standing, where the primary need is cushioning rather than biomechanical correction. Athletes with normal foot anatomy who primarily need enhanced shock absorption for high-mileage activities. Mild metatarsalgia where metatarsal pad placement can offload the symptomatic region. Patients who are trying conservative treatment before investing in custom orthotics — trialing an OTC insole is a reasonable first step that provides information about whether orthotic support is going to benefit the condition.
When Custom Orthotics Provide Meaningfully Superior Results
Custom foot orthotics are indicated when: significant biomechanical deviation (severe flat feet, high rigid arch, significant leg length discrepancy) requires correction that cannot be achieved with stock arch heights. The patient’s foot anatomy is outside the range that OTC insoles accommodate (very wide, very narrow, asymmetric, or post-surgical anatomy). A specific prescription for posting (angular correction of rearfoot or forefoot position) is required that OTC insoles don’t provide. The condition is serious enough that precision matters — severe plantar fasciitis with significant biomechanical contribution, posterior tibial tendon dysfunction, cavus foot with ankle instability, or pediatric flatfoot with specific correction goals. The patient has tried quality OTC insoles without adequate improvement after 6-8 weeks of consistent use.
The Custom Orthotic Process
A proper custom orthotic is prescribed based on clinical examination of gait, standing alignment, and specific biomechanical assessment — not just a foam impression of the foot alone. The prescription includes rearfoot and forefoot posting angles, accommodation for deformities, material hardness appropriate for activity type, and specific design for the footwear it will be used in. Podiatrist-prescribed and lab-fabricated custom orthotics are distinct from “custom” insoles sold in mall kiosks from foot pressure maps without clinical evaluation. Contact Balance Foot & Ankle at (810) 206-1402 for a biomechanical evaluation and honest recommendation about whether your condition warrants custom orthotics or would respond adequately to OTC insoles.
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Balance Foot & Ankle — Howell & Bloomfield Township, MI
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BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
In Our Clinic
The patients we see for custom orthotic consultations usually fall into two groups. First are athletes — runners, hikers, basketball players — looking to correct a biomechanical asymmetry they’ve identified themselves or their coach has flagged. Second are middle-aged patients with chronic plantar fasciitis, metatarsalgia, or early arthritis who have exhausted over-the-counter inserts. Our process begins with a 3D foot scan plus a gait-video analysis on our in-office treadmill. We select materials based on activity — a stiffer carbon composite for performance running, a softer plastazote top cover for diabetic patients, a semi-rigid polypropylene for everyday wear. Most patients adapt in 2–4 weeks.
Most Common Mistake We See
The most common mistake we see is: Wearing new orthotics all day from day one. Fix: break-in schedule of 2 hours on day one, adding 2 hours per day until full-day tolerance.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- New sharp pain under the arch that did not exist before
- Skin breakdown over pressure points
- Diabetic patient with any new pressure spot
- Worsening of original symptoms after 4 weeks
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
More Podiatrist-Recommended Orthotics Essentials
PowerStep Pinnacle
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
The podiatrist-recommended OTC orthotic — arch support + heel cup.
CURREX RunPro Insole
- FEEL BETTER, PERFORM BETTER: Flexible support and shock absorbing cushioning from heel to toe help reduce fatigue, prevent common running injuries such as shin splints, and boost performance everywhere you run, from the trails to the track; the insoles also fold at the flex point, enabling maximum flexibility with movement
- 3D Dynamic Arch Technology & Multiprofile Arch Support: Our dynamic arch support insoles come in low, medium and high arch support profiles; they feature a deep decoupled heel cup that fits, wraps and locks the heel in place, improving stability, reducing pressure, and providing a perfect fit
- Engineered to Energize Your Running: Rebound cushioning and controlled power transmission provide faster regeneration and powerful propulsion with every stride; plus, a zero heel drop provides a great fit in most running shoes with optimized motion for all running foot strikes (insoles can also be trimmed to fit for the perfect fit)
- Moisture Management & Breathability: Top layer mesh and PORON premium foam design help dehumidify the inside of shoe, keeping the feet dry and running shoes fresh throughout exercise; note you should replace your CURREX insoles after 500+ miles or 12 months, whichever comes first
- Made for What Moves You: CURREX is the only insole company that offers a full line of activity-specific insoles customized to help improve how you move; whatever you or your family loves to do, from the workday through the weekend, CURREX makes moving more comfortable, leading to better performance and more fun
Performance insole for runners — reduces fatigue and prevents injuries.
Tuli’s Heel Cups
- ✶ALLEVIATES HEEL PAIN – Tuli’s Heavy Duty Heel Cups provide heel pain relief caused by plantar fasciitis, Sever’s disease, excessive pronation, Achilles tendonitis, etc. Ideal for those on their feet for most of the day or those looking for added comfort.
- ✶PODIATRIST PREFERRED – In an independent study conducted by M3 Global Research, podiatrists chose Tuli’s as the clear winner of recommended heel cup brands.
- ✶SHOCK-ABSORBING DESIGN – The multi-cell, multi-layer design absorbs shock and impact energy, mimicking the natural shock-absorbing system of your feet. As you walk or run, the design reduces the stress on your feet.
- ✶DOCTOR RECOMMENDED & APMA ACCEPTED – Tuli’s Heel Cups were designed by a leading podiatrist and have the honor of being accepted by the American Podiatric Medical Association.
- ✶FITS MOST LACE-UP SHOES – Best used in spacious lace-up shoes like athletic shoes / sneakers.
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
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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