Custom orthotics versus the drugstore

A custom orthotic is a device made from a capture of your foot, prescribed after an exam, to change how load travels through the heel, midfoot, and forefoot. A drugstore insert is a catalog size with a marketing name.

We charge $470, and that includes 1 pair of Heath Foot & Leg Clinic inserts. We put it on the internet. If that is more than you want to spend, say so — there are over-the-counter devices we like, and we will point you at them instead of pretending every arch needs a lab.

Custom earns its keep when:

- Posterior tibial tendon is failing and the arch is collapsing. - A plantar fascia keeps tearing because the foot pronates through the first ray. - Metatarsal heads are overloaded and a simple cushion is not changing the geometry. - A prior injury left you with a foot that no longer matches a stock last.

It does not earn its keep as a ritual add-on at the end of a 12-minute visit. That is one of the reasons we space appointments at least 15 minutes apart.

Bring the shoes you work in. Dress shoes, court shoes, and the sneakers you actually walk the dog in. An orthotic that only fits the pair in a box is a paperweight.