Do Orthotics Really Work? What Science Says

Key Highlights

• Evidence suggests that orthotics can provide short-term relief from pain and improved function in certain conditions, but the long-term benefits are less certain.
• The effectiveness of orthotics depends on several factors, including device type (prefabricated vs. custom), the condition being treated, fit, and patient compliance.
• Scientific studies highlight modest improvements in outcomes like plantar fasciitis, overuse injuries, and flat feet—but many show mixed or low-certainty evidence.
• Orthotics work best when used as part of a comprehensive management plan, including exercise, biomechanics review, and monitoring.
• For those considering orthotics, partnering with a skilled clinician to assess the individual, select the correct device, and monitor progress is critical.

 

When someone recommends an orthotic device—whether a custom in-shoe insert, ankle-foot orthosis (AFO), or limb brace—the hope is clear: less pain, better alignment, improved mobility. But the question remains: Do orthotics really work? This blog explores what the science says about orthotics (the keyword), delving into research findings, practical implications, limitations, and how to maximise benefit.

Whether you’re considering orthotics for foot pain, joint support, walking assistance, or post-injury rehabilitation, understanding the evidence helps you ask the right questions and make informed decisions.

What Are Orthotics? A Quick Primer

An orthotic device broadly refers to a device designed to support, align, prevent, or correct deformities or improve the function of movable parts of the body. In the realm of lower-limb support, this often means things like foot orthoses (in-shoe supports), ankle-foot orthoses (braces that include the ankle and foot), knee braces, or other custom-moulded supports.

According to a reputable medical source, orthotics can help align and support feet and ankles, prevent/treat deformities, and improve function—but the evidence for many indications is still evolving.

To ask “Do orthotics really work?” means asking: for which conditions? under what circumstances? And with what expectations? The evidence yields some clear patterns—and many caveats.

 

What the Research Shows: Conditions, Evidence, and Outcomes

Here are the major findings from recent studies grouped by condition type.

Foot pain and plantar fasciitis

One landmark randomized trial for plantar fasciitis found that foot orthoses produced small short-term benefits in function and possibly small pain reductions compared with a sham device. However, at 12-month follow-up, there were no significant long-term differences.

Another systematic review found that most studies reported improvement in both orthotics and comparator groups, but the evidence comparing them was less clear.

Flat-feet (flexible pes planus)

A systematic review of orthotics for flexible flatfeet (children and adults) concluded that the effect of foot orthoses on pain, walking efficiency, and quality of life is uncertain due to heterogeneity and low-certainty evidence.

Overuse of running injuries and biomechanics

Recent work focusing on runners suggests that foot orthoses may lead to immediate and long-term decreases in pain and symptoms of overuse injuries (e.g., patellofemoral pain, medial tibial stress syndrome) and alterations in foot/ankle biomechanics (reduced eversion, shifts in plantar pressure).

Orthoses for joint/ankle/foot support (AFOs, etc)

Emerging evidence for ankle-foot orthoses shows promise, but is still limited. For example, a study compared AFO designs for muscle weakness and found differing outcomes across designs.

General functional rehabilitation

A review on orthotics in functional rehabilitation reported high effectiveness (89% success rate for pain reduction in plantar fascia degeneration) in some settings, but the authors emphasised context and careful prescription.

Interpreting the Evidence: What It Means in Practice

When you dig into the literature, a few key themes emerge:

• The benefit is often modest. Many studies report small effect sizes: modest reductions in pain, modest improvements in function. They are rarely “magic bullets”.
• Short-term benefits > long-term certainty. Many trials show benefits in the early phases (3-8 weeks), but fewer show strong, sustained long-term benefits (12 months+).
• Device type and fit matter. Custom vs prefabricated: the plantar fasciitis trial found little difference between custom and prefabricated. Condition-specificity is key. Orthotics seem to help more when the problem involves load/overuse/biomechanical stress rather than structural deformities alone.
• Part of a broader care plan. The running-injury review emphasised that orthoses integrated into comprehensive treatment (exercise, gait retraining) perform better than orthotics alone.
• Patient adherence and comfort matter. If devices are uncomfortable or do not fit well, the benefit drops significantly. The flat-feet review noted that compliance was low in some studies.

 

Summary of Evidence by Condition

Why Some Orthotics Work — And Why Others Don’t

Understanding why orthotics sometimes work and sometimes don’t helps set realistic expectations and improve outcomes.

Mechanisms of Action

Orthotics may work by:

• Altering tissue loading (reducing strain on fascia, tendons)
• Modifying foot/ankle posture and motion (reducing pronation, eversion, joint stress)
• Redistributing plantar pressure (e.g., shifting from a stressed area to a less-stressed)
• Enhancing comfort, thereby increasing mobility and function

 

For example, runners using foot orthoses showed decreased eversion at the foot/ankle complex and more lateral plantar pressure at heel/forefoot.

Key Factors for Success

• Proper fit and prescription: A generic device may not address the person’s unique anatomy or problem.
• Device design/features: Material, stiffness, arch support, and wedges matter.
• Patient compliance: If the device is uncomfortable or unused, the benefit is lost.
• Rehabilitation & adjunct treatments: Exercise, gait training, and strength work amplify benefits.
• Appropriate expectations: Orthotics ease symptoms and support function; they are seldom standalone cures.
• Monitoring & adjustment: Bodies change (weight, gait, activity), and so should orthotics.

 

Why They Sometimes Fail

• Mismatch between device and problem (e.g., using a flat-foot insert when the issue is ankle instability)
• Poor fit or discomfort leading to non-use
• Non-compliance with adjunct therapy (exercise, strengthening)
• Unrealistic expectation (expecting full cure when device is just one tool)
• Long-term structural issues not addressed by orthotics alone

 

Practical Guidance: How to Make Orthotics Work for You

Given the evidence and factors above, here are practical steps to maximise benefit from orthotic devices.

1. Start with a detailed assessment

• A clinician should assess your condition: what symptoms you have, where the pain or dysfunction lies, what your biomechanics are like.
• Identify why you need orthotics (e.g., foot pain, ankle instability, brace support) rather than just getting “an insert”.

 

2. Choose the right type and have it fitted

• Decide whether a prefabricated device might suffice or whether you need a custom moulded solution.
• Ensure the device is fitted properly, ideally with gait analysis, and the patient tries it out under typical activity.
• Factor in comfort, alignment, fit and interface with other footwear or braces.

 

3. Use as part of a comprehensive management plan

Orthotics alone are rarely enough. Complement with:

• Strength and conditioning (especially foot, ankle, core)
• Gait correction or retraining if needed
• Appropriate footwear and activity modification
• Monitoring of progress: is pain reduced, function improved, gait smoother?

 

4. Monitor progress and adjust

• Give it a trial period (e.g., 4-8 weeks) and assess changes: pain, mobility, comfort, orthotic fit.
• If no improvement, discuss with clinician: maybe device design needs adjustment, or focus should shift to other treatments.
• Long-term, check device condition (wear-and-tear), fit (body / activity changes), and whether new issues have emerged.

 

5. Set realistic expectations

• Orthotics may reduce pain, improve comfort or assist function—but may not eliminate every symptom or structural problem.
• Benefits may plateau and long-term gains may be uncertain in some conditions (e.g., flat-feet).
• Consistency and combined therapies are key.

 

Common Myths & Mis-Conceptions

• Myth: “Orthotics will fix my structural foot deformity completely.”
  Reality: Orthotics help manage function and load, but may not ‘correct’ bone structure—especially in adults. Evidence for deformity correction (e.g., flat-feet) is weak.
• Myth: “Custom orthotics are always far better than prefabricated.”
  Reality: In some studies (e.g., plantar fasciitis trial) custom and prefabricated performed similarly in short-term outcomes.
• Myth: “If I wear an orthotic, I don’t need to exercise.”
  Reality: Orthotics often work best when combined with rehabilitation, strength and movement correction.
• Myth: “Once I have the device, I’m done.”
  Reality: Long-term monitoring is needed—fit, activity, body change, device wear will affect outcomes.
• Myth: “Orthotics are for everyone with foot pain.”
  Reality: The prescription must match the individual’s condition, biomechanics, goals and preferences. Some conditions have limited evidence.

 

When to Re-Evaluate or Seek Further Help

Here are signs you may need to revisit your orthotic prescription:

• Persistent or worsening pain after 6-8 weeks of consistent use
• Discomfort, new pressure spots, skin issues under device or shoe
• No improvement in mobility or function despite correct device fit and use
• Body changes (significant weight gain/loss, new injury, changed activity level)
• Device is worn-out or altered shape/wear pattern
• New symptoms emerge in joints upstream (ankle, knee, hip) that may indicate altered biomechanics

 

In these cases, returning to the clinician for review, gait analysis, adjustment or alternative therapy is advisable.

Final Thoughts

So, do orthotics really work? The answer: yes — but conditionally. For many people and many conditions, properly prescribed orthotics can reduce pain, improve comfort, assist function and support rehabilitation. However, expectations must be realistic: benefits are often moderate, and long-term evidence for some conditions remains limited.

• Orthotics are one tool among many—not a stand-alone fix.
• The right match (device, fit, condition, user) matters.
• Integration with rehabilitation, exercise, monitoring and appropriate expectations improves outcomes.
• If you’re considering orthotics, invest in assessment, proper fitting and follow-up.

 

If you’re exploring orthotic or prosthetic support and would like expert guidance and custom solutions tailored to your mobility and lifestyle goals, our team at Orthotics Ltd. stands ready to assist—you can connect with us to discuss your needs, evaluation and device options. Contact us today!

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Frequently Asked Questions

1. How long does it take to feel the benefits from orthotics?

Typically, you might start to feel improvement within 4-8 weeks of consistent use, assuming correct fit and adjunct therapy. Some biomechanical changes may occur earlier (e.g., pain relief), but full adaptation may take longer.

2. Do I always need a custom-made orthotic for good results?

Not necessarily. Some studies (e.g., for plantar fasciitis) found similar short-term outcomes for prefabricated vs custom devices. Custom devices may offer improvements in fit, durability, and comfort, but they are costlier.

3. Will orthotics cure my condition permanently?

In many cases, orthotics manage symptoms and support function—they may not permanently alter the underlying structural issue or guarantee cure. Long-term benefit may diminish if other aspects (activity, mechanics, strength) are not addressed.

4. Can I just buy over-the-counter inserts and skip the clinician?

Over-the-counter inserts may help for minor discomfort, but for persistent pain, complex biomechanics, or orthotic devices (braces) supporting joints/limbs, professional assessment is strongly recommended. Many studies emphasise correct prescription and fit.

5. What maintenance or follow-up is required for orthotics?

Regular reviews are recommended: check for wear and tear, changes in body weight or activity, shoe compatibility, and fit changes. Many clinicians advise annual (or more frequent) follow-up for device condition and user biomechanics.

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Sources:

• https://pmc.ncbi.nlm.nih.gov/articles/PMC10659571/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC12141997/
• https://www.researchgate.net/publication/394858372_Effect_of_foot_orthoses_on_pain_and_disability_in_patients_with_low_back_pain_a_meta-analysis_of_randomized_controlled_trials
• https://www.sciencedirect.com/science/article/pii/S0021929025005603
• https://pmc.ncbi.nlm.nih.gov/articles/PMC12473615/