Custom-Made Foot Orthoses versus Prefabricated foot Orthoses: A Review of Clinical Effectiveness and Cost-Effectiveness

Foot orthoses (commonly referred as “orthotics”) are devices made to insert into the shoes to provide cushioning and off-loading of foot structures. They are either prefabricated or custom-made. Custom-made foot orthoses are contoured devices made from a plaster cast or three-dimensional laser scan of the foot. Prefabricated foot orthoses (also referred as “over-the-counter” or “non-prescription”) are mass-produced based on foot sizes.Foot orthoses are used in adjunct to standard medical care of patients with foot and lower limb problems including pronated foot, plantar heel pain, rheumatoid arthritis, juvenile idiopathic arthritis, risk of diabetic plantar ulceration, or hallux valgus (bunions). They are intended to alter the function of the joints of the foot and lower limb during weight bearing activities including standing, walking or running, to reduce pain and improve the function of the foot and quality of life. Global demand of foot orthoses has dramatically increased over the past years and the market is estimated to reach $US 3.5 billion by 2020.Although custom-made foot orthoses are generally considered the gold standard, the underlined mechanism is not well understood. Several studies found that custom-made orthoses were more effective than prefabricated orthoses for objective outcome measures through biomechanical assessments including dynamic balance, and pressure relief and load redistribution across plantar regions.,, However, a previous systematic review found no evidence that custom-made orthoses were more effective than prefabricated orthoses in the treatment of different types of foot pain. As custom-made orthoses are relatively more expensive than prefabricated orthoses, their clinical effectiveness and cost-effectiveness need to be evaluated.The aim of this report is to review the comparative clinical and cost effectiveness of custom-made foot orthoses versus prefabricated foot orthoses for patients requiring a foot orthotics.