Choosing the right orthotic – Custom vs OTC

Both over the counter (OTC) and custom foot orthoses (CFO) should be capable of achieving a change of the ground reaction loads on the foot and foot tissue (Kirby, K. et al 2012). The clinical challenge is to consider which variables to apply for the unique presenting condition and treatment paradigm we have decided to follow.

Some clinicians prefer to start with a prefabricated orthosis before advancing to a custom-made device. This has several benefits including altering your prescription and getting your patient accustomed to having something in their shoe.



  • Durability: An OTC device will not maintain its clinical effectiveness as long as a CFO. OTC’s typically maintain their integrity 3-9 months, whereas highly durable shell materials selected in a CFO device can have a therapeutic range from 5 to 15 years (depending on use).
  • Adaptability: limitations to the level of stiffness, degrees of motion, variation of additions, bulk, cushioning and materials used within OTCs.
  • Availability: OTC orthoses can be an immediate solution whereas CFO will take longer. Also any adjustments to OTCs can be immediate whereas CFOs will need to be returned.
  • Cost: Upfront cost of an OTC orthoses is less, however when considering the ongoing reinvestment, CFO’s are typically more cost effective in the longer term.
  • Anatomy: You will be able to fit a CFO to a wider variety of foot types and as well as footwear.
  • Surface contouring: The true fit to foot of a CFO can allow more effective ground reaction force to be redistributed to where it is needed. OTCs are designed for “standardised” foot shape, yet every foot is different.



Further points to consider:

How confident are you at assessments, diagnosis and prescribing custom orthoses?

What sort of patients do you see?

What are your patient’s expectations?

What will your patient tolerate?

What footwear does your patient wear?

What activities does your patient do?

What sort of conditions do most of your patients present with?

What can your patients afford?

What sort of practice are you in?

Are you able to offer casting and fitting appointments?

How long are your patients willing to wait?