Published May 2026. Written by the Upwell Health Collective clinical team. Clinically reviewed May 2026. Next review November 2026. For educational purposes only — please consult a qualified podiatrist before commencing custom orthotic therapy or making major footwear decisions for persistent musculoskeletal pain.
Related reading from Upwell Health:
• Podiatry Camberwell — Award-Winning Podiatrist Near You
• The Tendinopathy Ultimate Guide 2026
• The Diabetic Foot Care Master Guide 2026
• Shockwave Therapy for Common Podiatry Conditions 2026
• Perimenopause & Menopause Thrive Guide 2026
• Pain Is Not Damage
If you're considering custom orthotics — or wondering whether the shoes on your feet are helping or hurting you — five things to know before anything else:
1/ Custom orthotics work — for specific conditions, in specific patients, when prescribed correctly. The 2024–2026 evidence base supports custom orthotics for plantar fasciopathy, posterior tibial tendinopathy, certain forms of patellofemoral pain, certain forms of stress fracture rehabilitation, diabetic foot offloading, post-surgical recovery, and a small number of specific paediatric conditions. They are not a magic fix. They are not for everyone. And they are not always better than well-chosen prefabricated orthotics.
2/ Custom orthotics are NOT a replacement for strength, loading, or running gait work. The strongest evidence base consistently shows orthotics work best as one component of a multi-modal management plan that includes progressive loading, footwear optimisation, and biomechanical training. Orthotics alone, without the broader rehabilitation work, produce far weaker outcomes. Any clinic that prescribes orthotics as a stand-alone fix is underselling you.
3/ Footwear matters more than most people realise. Running shoes, work shoes, casual shoes, and even slippers all influence foot biomechanics, lower limb loading, and injury risk. The 2024 Mills systematic review and ongoing carbon-plate research have transformed footwear science. Most people are wearing shoes that don't match their feet, their activity level, or their loading patterns. Getting this right is often higher-leverage than orthotic prescription.
4/ Prefab orthotics often perform equivalently to custom orthotics — at a fraction of the cost. Multiple high-quality trials (Landorf 2006, Bonanno 2017, ongoing 2024–2026 meta-analyses) have shown that for many common conditions including plantar fasciopathy, prefabricated foot orthoses produce comparable clinical outcomes to custom-moulded devices at substantially lower cost. Honest podiatry care means telling patients when prefab is appropriate — not pushing custom prescription as the default.
5/ The orthotics conversation is changing rapidly. The traditional model — prescribe orthotics for life, never address strength or running mechanics — is being replaced by an integrated, multi-modal, evidence-based approach. Modern podiatry uses orthotics strategically and temporarily, transitions patients off them where appropriate, and treats footwear, strength, and movement as equally important interventions. This is the Upwell approach.
This guide is the most comprehensive evidence-based custom orthotics and footwear science resource we've produced. It covers the science of foot biomechanics, the evidence for and against custom orthotics, how prescription actually works, the differences between custom and prefab, the modern footwear landscape (running, work, casual, walking, carbon-plated), special populations, the diabetic foot, and the integrated multi-disciplinary approach that delivers the best outcomes. It sits at around 15,000 words.
The term "orthotics" gets used loosely. Let's start with definitions.
A foot orthosis is a device inserted into footwear that modifies the mechanical, structural, or functional characteristics of the foot and lower limb during weight-bearing activity. The aim varies — pressure redistribution, support, offloading, correction, accommodation, or proprioceptive feedback — but all foot orthoses share the goal of changing what happens at the foot–ground interface.
Foot orthoses come in three broad categories:
1/ Custom-moulded orthotics. Made specifically for an individual foot, typically from a 3D scan, plaster cast, or foam impression of the foot. Manufacturing involves CAD/CAM milling, 3D printing, or hand-fabrication. Materials vary — polypropylene, EVA foam, carbon fibre, TPU, and combinations. Designed to address specific biomechanical issues identified through assessment.
2/ Prefabricated ("off-the-shelf") orthotics. Pre-manufactured in standard sizes and shapes. Available in many designs targeting different foot types and conditions. Substantially cheaper than custom. Often modifiable by a clinician with heat-moulding, padding, and wedging.
3/ Customised prefabricated orthotics. Prefab devices that have been modified by a podiatrist to better fit an individual patient — adding posts, wedges, met domes, or other adjustments. Sits between full custom and pure prefab.
The mechanisms of action for foot orthoses are an active area of research and ongoing debate. The current understanding involves multiple mechanisms working together:
1/ Pressure redistribution. Orthotics change where load is applied across the plantar surface. High-pressure areas (under bony prominences, calluses, ulcer sites) can be offloaded. Low-pressure areas can be loaded more evenly. This is particularly important in diabetic foot care and post-surgical recovery.
2/ Kinematic effects. Orthotics can influence joint motion in the foot, ankle, and lower limb. Effects on rearfoot motion, navicular drop, tibial rotation, and knee mechanics have all been documented. The magnitude of these effects is generally smaller than people assume — typically 1–4 degrees of motion change rather than the dramatic biomechanical rewiring some marketing suggests.
3/ Kinetic effects. Orthotics influence the forces and moments acting on the foot and lower limb. Plantar pressure changes, ground reaction force vector modifications, and joint moment alterations have all been documented. These kinetic effects may be more clinically relevant than the smaller kinematic effects.
4/ Neuromuscular and proprioceptive effects. Orthotics provide sensory feedback to the foot, which influences muscle activation patterns, balance, and motor control. This neuromuscular effect appears to be a significant mechanism — possibly more important than the structural mechanical effects.
5/ Comfort and pain modulation. Orthotics often reduce pain even when measurable biomechanical changes are modest. The comfort-pain pathway is real and clinically important — though it's worth being honest that this is partly a non-specific effect rather than a precise biomechanical correction.
Equally important to be honest about: orthotics do NOT:
• "Realign" the foot in any permanent structural sense.
• Fix bunions, hammer toes, or other structural foot deformities.
• Build muscle strength.
• Cure flat feet or high arches as anatomical types.
• Replace the need for progressive loading rehabilitation.
• Permanently change foot posture once removed.
• Treat referred pain from above the foot (back, hip, knee) on their own.
• Solve every form of foot pain.
A clinic that markets orthotics as a permanent structural fix is overselling. The evidence supports orthotics as a useful biomechanical tool — not a structural solution.
This is the practical core. The evidence for foot orthoses is condition-specific, not blanket. Here's what the 2023–2026 evidence base tells us for each major indication.
The evidence: Moderate. Both custom and prefab orthoses produce short-term symptom relief in plantar fasciopathy. The Landorf 2006 trial — a landmark randomised controlled trial — showed prefab and custom orthoses produced equivalent outcomes at 12 weeks and 12 months for chronic plantar fasciopathy. Multiple meta-analyses have confirmed this finding. Orthotics are useful in plantar fasciopathy management, but custom is not necessarily better than well-chosen prefab.
What the current evidence supports: Combining orthoses with structured plantar fascia loading (the Rathleff heel-raise protocol), calf stretching, footwear optimisation, and load management produces the strongest outcomes. Orthoses alone produce smaller effects.
When custom is preferred: Complex foot mechanics, unusual foot shape, failed response to prefab, specific biomechanical features identified at assessment.
For deeper detail on the plantar fasciopathy picture, see our Plantar Fasciitis Runner's Guide and our Tendinopathy Ultimate Guide 2026.
The evidence: Strong for orthotic use in early-stage posterior tibial tendon dysfunction. The Alvarez protocol — combining a medially-posted orthotic with progressive eccentric tibialis posterior loading — is well-supported for stages 1 and 2 posterior tibial tendinopathy. Custom devices are typically used due to the specific medial posting and longitudinal arch support required.
When to consider it: Medial arch pain with progressive flatfoot deformity, particularly in middle-aged women (the most common demographic).
The evidence: Moderate. Foot orthoses produce modest improvements in patellofemoral pain in a sub-group of patients with specific foot characteristics (greater forefoot valgus, midfoot pronation patterns). The Vicenzino group at the University of Queensland has done substantial work identifying which patellofemoral pain patients respond best to orthotic intervention.
The integrated approach: Orthotics combined with hip and quadriceps strengthening, gait retraining, and loading rehabilitation produces better outcomes than orthotics alone. For deeper coverage, see our Runner's Knee (PFPS) guide.
The evidence: Modest. Heel lifts in footwear can reduce Achilles tendon strain and provide short-term symptom relief in insertional Achilles tendinopathy. Full custom orthotic prescription for Achilles tendinopathy has weaker evidence — loading rehabilitation remains the cornerstone of care.
When orthotics may help: Insertional Achilles tendinopathy with overpronation contributing to load, combined with heel lift and progressive loading. For full Achilles management detail, see our Tendinopathy Ultimate Guide 2026.
The evidence: Strong for selected uses. Orthotics that offload high-pressure areas can support recovery in metatarsal stress fractures, calcaneal stress fractures, and tibial stress reactions. The orthotic is typically a temporary measure during the recovery and return-to-running phase, not a permanent device.
The evidence: Very strong. Custom-moulded offloading orthotics are an essential tool in diabetic foot care — for prevention in higher-risk patients (IWGDF Risk 2–3), for offloading during active ulcer treatment, and for long-term prevention after ulcer healing. Total contact insoles, healing sandals, and custom-moulded specialist diabetic footwear all play roles. For the full diabetic foot picture, see our Diabetic Foot Care Master Guide 2026.
The evidence: Good for orthotics with first MTP cut-outs, Morton's extensions, or rigid plates that limit dorsiflexion at the painful joint. Often combined with rigid-soled shoes or rocker-bottom footwear.
The evidence: Limited. Orthotics do NOT correct established bunions. They can provide symptom relief and slow progression in some cases, but they will not reverse the deformity. Honest podiatry includes this conversation rather than implying orthotics will "fix" the bunion.
The evidence: Moderate. Met domes (metatarsal pads), pressure redistribution under specific metatarsal heads, and forefoot accommodation can produce significant symptom relief. Combined with footwear modifications (wider toe box, more cushioning under forefoot).
The evidence: Good for short-term symptom management. Cushioned heel cups or simple heel lifts often resolve Sever's disease symptoms over 8–12 weeks. Custom orthotics are rarely needed — well-chosen prefab or heel cups typically suffice. Activity modification and time also play substantial roles.
The evidence: Modest. Orthotics may help in shin splints with significant overpronation, but the broader picture (training load management, running gait, calf strength, footwear) matters more. Orthotics are not first-line.
The evidence: Weak for orthotics as a primary treatment for low back pain. Selected patients with specific lower-limb biomechanical patterns may benefit, but orthotics are not a back pain treatment per se. For comprehensive low back pain coverage, see our Disc Injury Directory 2026.
Equally important to be honest about: custom orthotics do NOT have strong evidence for:
• Generic "flat feet" without symptoms (no treatment needed).
• Generic "high arches" without symptoms.
• Most cases of generic foot fatigue without specific pathology.
• Knee osteoarthritis (modest evidence in some sub-groups only).
• Hip pain without lower-limb biomechanical correlation.
• Generic balance problems without identified foot pathology.
• Most cases of generic walking discomfort without specific pathology.
• "Preventive" use in asymptomatic adults.
A clinic that prescribes orthotics for every patient is overprescribing. The science is condition-specific.
This is the conversation patients rarely get to have honestly. Let's have it now.
Custom orthotics in Australia typically cost $400–$900 per pair, depending on materials, manufacturing process, and the prescribing podiatrist. Prefabricated orthotics cost $40–$200 per pair. Customised prefabricated devices (prefab plus podiatrist modifications) typically run $150–$300 per pair.
For many patients, the cost difference is substantial. Honest podiatry means having this conversation transparently.
Multiple high-quality randomised controlled trials and systematic reviews have compared custom and prefab orthoses for common conditions. The consistent findings:
• For plantar fasciopathy (the most-studied indication), custom and prefab orthoses produce equivalent clinical outcomes at 6 weeks, 12 weeks, 6 months, and 12 months.
• For patellofemoral pain, prefab orthoses produce equivalent outcomes to custom in most trials.
• For Achilles tendinopathy, simple heel lifts often produce equivalent symptomatic benefit to custom prescription.
• For children's heel pain (Sever's), prefab heel cups typically work as well as custom devices.
Where custom orthoses appear to outperform prefab:
• Diabetic foot offloading (custom-moulded devices match individual pressure patterns).
• Post-surgical recovery with specific offloading requirements.
• Complex foot deformity (rheumatoid foot, post-traumatic deformity, severe pes cavus).
• Specific biomechanical features identified at assessment that cannot be addressed with prefab.
• Patients who have genuinely failed appropriate prefab trials.
• Athletes with very specific sport-specific loading requirements.
At Upwell, our approach to the custom vs prefab decision is:
1/ Start with thorough assessment. Identify the specific biomechanical features that need addressing. This is not optional — without it, we're guessing.
2/ Match the device to the condition. Some conditions clearly need custom (complex deformity, diabetic offloading). Many conditions respond equally well to prefab (uncomplicated plantar fasciopathy in average foot shape, mild patellofemoral pain).
3/ Trial prefab first when appropriate. For straightforward presentations in standard foot shapes, well-chosen prefab devices are often the right starting point.
4/ Escalate to custom when clinically indicated. If prefab fails, if biomechanical features can't be adequately addressed with prefab, if foot shape is unusual, or if specific clinical requirements demand custom — that's when custom is the right call.
5/ Be transparent about cost. Patients deserve to know the price difference and the evidence comparison before making the decision.
This approach treats patients as informed decision-makers rather than passive customers. It's also why our orthotic prescription rates are lower than many clinics — we only prescribe when the evidence supports it.
If you decide custom orthotics are right for you, here's how the process typically works at our Camberwell clinic.
The first appointment is a comprehensive 45–60 minute biomechanical assessment including:
• Detailed history — your symptoms, activity level, footwear, previous interventions, occupational demands.
• Static foot assessment — foot type, posture, joint mobility, foot architecture.
• Functional assessment — gait analysis, single-leg balance, functional movement screens.
• Video gait analysis where indicated.
• Plantar pressure measurement where indicated.
• Joint range of motion assessment.
• Muscle strength testing.
• Review of current and intended footwear.
• Clear diagnosis and treatment plan.
Based on the assessment, your podiatrist explains:
• What's driving your symptoms.
• Whether orthotics are appropriate.
• If yes, whether custom or prefab is the better choice for your situation.
• What the orthotic is designed to do (and not do).
• What other components of treatment are essential (loading, footwear, strength, gait work).
• Cost and timeline.
Decision made together. No pressure. No upsell.
If custom orthotics are the decision, we capture your foot shape using:
• 3D foot scanning (most common — quick, accurate, repeatable).
• Foam impression box (alternative for some prescriptions).
• Plaster cast (for specific complex prescriptions).
The capture is combined with the biomechanical assessment data to inform the prescription.
Your podiatrist writes a detailed orthotic prescription specifying:
• Shell material (polypropylene, carbon fibre, EVA, TPU, or combination).
• Shell rigidity and flexibility characteristics.
• Posts (rearfoot, forefoot — angles and degrees).
• Arch height and shape.
• Top cover material.
• Met domes, met bars, cuboid notches as needed.
• Heel lift if required.
• Length specifications.
• Modifications for footwear type.
The prescription is sent to a specialist orthotic laboratory for manufacturing. Most laboratories use CAD/CAM milling or 3D printing for production. Manufacturing time is typically 2–3 weeks.
When the orthotics return from the lab, you'll have a fitting appointment. Your podiatrist:
• Confirms the orthotics match the prescription.
• Fits them into your footwear.
• Adjusts and modifies as needed.
• Provides break-in instructions.
• Sets follow-up timelines.
Orthotics require a graduated break-in. The typical protocol:
• Day 1–3: Wear for 2–3 hours.
• Day 4–7: Increase by 1–2 hours per day as tolerated.
• Week 2: Wear for most of the day in daily footwear.
• Week 3+: Full-time use; begin athletic and high-load use.
Some adaptation is expected. Mild foot, calf, or lower limb fatigue in the first week is normal. Persistent pain or pressure points warrant a review appointment.
Most patients have a 4–6 week follow-up appointment to assess response, make any necessary adjustments, and review the broader management plan. Some orthotics need minor modifications during this period. Most don't.
Orthotic durability varies by material and use — typically 2–5 years for the main shell, with top cover replacement every 12–18 months. We recommend annual review for active orthotic patients.
This is where most patients get lost. The shoe market is enormous, marketing is intense, and the science is complex. Here's the evidence-based reality of footwear in 2026.
Modern running shoes fall into broad categories that don't always map to traditional marketing terms:
1/ Maximum cushioning shoes. High stack height (30mm+), maximum impact absorption. Brands include Hoka, Brooks Glycerin, Saucony Triumph, Asics Gel-Nimbus. Popular for long-distance recreational running, recovery runs, and people with joint sensitivity.
2/ Moderate cushioning shoes. Mid-range stack (20–28mm), balanced ride. The largest category. Brooks Ghost, Asics Gel-Cumulus, Nike Pegasus, New Balance 880. Suitable for most general running.
3/ Lightweight performance shoes. Lower stack height (15–22mm), faster ride. Brooks Hyperion, Asics Magic Speed, Saucony Endorphin Speed. Used for faster training and racing.
4/ Carbon-plated super shoes. High stack, carbon plate, advanced foam. Nike Vaporfly, Alphafly, Adidas Adios Pro, Saucony Endorphin Pro, Brooks Hyperion Elite. Genuine performance gains for racing. The 2024 Mills systematic review and ongoing research confirm 1–4% running economy improvements for many runners.
5/ Trail shoes. Aggressive outsole, rock protection, often more cushioning for off-road terrain. Salomon, Hoka Speedgoat, Brooks Cascadia.
6/ Minimalist/barefoot shoes. Low or zero drop, minimal cushioning. Vibram FiveFingers, Xero, Altra (zero drop), New Balance Minimus. Niche use; not appropriate for everyone.
Historically, running shoes were prescribed based on foot type — motion control for overpronators, cushioning for high arches, stability for neutral. This model has been substantially challenged by 2024–2026 research.
The current evidence picture:
• Foot type does not reliably predict injury risk.
• Pronation type does not reliably predict which shoe will cause or prevent injury.
• Comfort is a stronger predictor of injury reduction than "matching" shoe to foot type.
• Running cadence, training load progression, and overall conditioning matter more than shoe selection for injury prevention.
The practical implication: comfortable, well-fitting running shoes that suit your individual preferences are more important than "matching" a shoe to your foot type. The era of confidently prescribing motion control shoes for overpronation is largely behind us.
The 2017 launch of the Nike Vaporfly initiated a revolution in running footwear. Subsequent research has confirmed:
• Carbon-plated super shoes produce a 1–4% running economy improvement for many (not all) runners.
• The benefit is greater for some biomechanical patterns than others — individual response varies substantially.
• Effect appears more pronounced at faster paces (sub-4:00/km tempo).
• Most major brands now produce competitive carbon-plate options.
• Some emerging concern about specific injury patterns in long-term super shoe use — particularly navicular stress fractures and some tendon presentations.
• The shoes are not appropriate for daily training in most runners — they're racing and key workout tools.
Heel-to-toe drop (the difference in stack height between heel and forefoot) is another contested topic. Traditional running shoes have 8–12mm drop. Lower-drop shoes (4–6mm) became popular in the 2010s. Zero-drop shoes (Altra) target a different runner.
Current understanding:
• Drop influences which structures bear load during running.
• Higher drop (10–12mm) tends to load knees and quads more.
• Lower drop (0–4mm) tends to load Achilles, calves, and plantar fascia more.
• Neither is inherently better.
• Transition between drop heights should be gradual — abrupt changes increase injury risk.
Work shoes are often overlooked but matter substantially. Key principles:
• Adequate length (1cm beyond longest toe in standing).
• Adequate width across the forefoot.
• Adequate depth (toes lie flat without pressing).
• Supportive heel counter.
• Stable, slip-resistant outsole.
• Cushioning appropriate to standing time.
• Removable insoles (allows orthotic accommodation if needed).
For occupations with prolonged standing or walking (healthcare, retail, hospitality), footwear quality directly influences lower limb fatigue, pain, and injury risk.
For walkers and hikers, the principles overlap with running shoe science. Modern trail and hiking shoes (Hoka Speedgoat, Salomon X Ultra, Merrell Moab) often provide better performance than traditional heavy hiking boots for most recreational hikers.
The biomechanical demands of casual and dress shoes are different. Key principles still apply (length, width, depth, toe box shape, supportive heel counter) but the design constraints often compromise these. For patients with foot pathology, careful selection within fashion constraints matters — and some compromises just aren't worth it.
High-heeled footwear (>2cm heel) increases forefoot pressure, alters lower limb biomechanics, and contributes to specific pathologies (hallux valgus, Morton's neuroma, calf shortening). Honest advice: minimise daily wear, vary daily footwear, address symptoms early.
The 2010s minimalist running revolution (Born to Run, Vibram FiveFingers, barefoot running) produced both genuine insights and substantial injury rates from poorly-managed transitions. Current understanding:
• Some runners thrive in minimalist footwear with appropriate transition.
• Many runners don't tolerate the transition and develop overuse injuries.
• Foot strength training has value regardless of shoe choice.
• "Born to Run" oversimplified the evidence.
• Most runners benefit from moderate cushioning and structure.
A thorough footwear assessment is part of every comprehensive Upwell podiatry appointment. We assess:
1/ Current footwear. Inspection of all the shoes you regularly wear — running, work, casual, slippers. Wear patterns, fit, condition, age, appropriateness.
2/ Footwear for your activity. The match between your shoes and what you do in them. Many patients use the wrong shoes for their primary activity.
3/ Foot–shoe interface. How the shoe sits on your foot. Pressure points, friction, sliding, gapping.
4/ Internal inspection. Surprisingly often we find foreign objects, worn-out areas, internal seams causing problems, particularly in diabetic patients.
5/ Footwear age and condition. Running shoes typically need replacement at 600–800km of running. Work shoes vary. Insoles compress and lose function over time.
6/ Recommendations. Specific guidance on what to look for, what to avoid, and what models suit your situation. We're brand-neutral — we recommend evidence-based features, not specific marketing claims.
Athletes use orthotics in distinct ways from general patients. Key considerations:
Running orthotics are typically lighter, lower-profile, and designed to fit modern running shoe geometry. Carbon fibre shells, EVA tops, and minimalist designs are common. Full-length is often inappropriate due to running shoe forefoot flex requirements — three-quarter length devices are common.
Different sports demand different orthotic features:
• Soccer/football boots — thin profile required due to tight-fitting boots.
• Cycling shoes — specialised cycling orthotics with rigid shells matching cleat positions.
• Skiing boots — specialist ski orthotics with thermo-mouldable shells.
• Court sports — orthotics that accommodate side-to-side loading.
• Combat sports — see our Combat Sports Chronicle 2026 for grappler and striker foot considerations.
Athletes typically need orthotics to integrate with broader load management, footwear rotation, strength training, and recovery work. Standalone orthotic prescription rarely solves an athlete's biomechanical problem — the orthotic is one tool in a much larger toolkit.
Children's feet develop substantially through childhood. Most paediatric "flat feet" are normal developmental variants that resolve with age. Custom orthotic prescription in children is appropriate only for specific conditions (severe symptomatic flatfoot, Sever's disease not responding to simpler measures, tarsal coalitions, neurological conditions, specific structural deformities).
The vast majority of children with asymptomatic flat feet need no intervention. Honest podiatry includes telling parents this rather than prescribing custom orthotics for normal developmental anatomy.
Foot pain in midlife women is dramatically more common than recognised — driven partly by the musculoskeletal syndrome of menopause (MSM). Plantar fasciopathy, posterior tibial tendinopathy, and forefoot pain all increase through this transition. Orthotics can play a role alongside broader hormonal health management, structured loading, and footwear optimisation. See our Perimenopause & Menopause Thrive Guide 2026.
Pregnancy changes foot loading, ligamentous laxity, and biomechanics substantially. Many pregnant women develop heel pain, arch pain, or forefoot pain during pregnancy. Supportive footwear, simple prefab orthoses, and avoidance of unsupportive footwear typically resolves most pregnancy foot symptoms. Custom prescription during pregnancy is appropriate for severe or persistent presentations.
Foot pain in older adults dramatically affects mobility, balance, falls risk, and quality of life. Comprehensive foot care — including orthotics where indicated, footwear modification, nail and skin care, and strength training — is one of the highest-value interventions in this population. Don't accept "it's just age" — much of older-adult foot pain is treatable.
Diabetic patients have specific orthotic needs based on their IWGDF risk classification. Custom-moulded total-contact insoles for offloading, specialist diabetic footwear for high-risk patients, and ongoing review are essential. For comprehensive coverage, see our Diabetic Foot Care Master Guide 2026.
Custom orthotics, specialist footwear, and assistive devices can be funded through NDIS plans for participants with eligible disabilities. Upwell is a registered NDIS provider — we work with participants across the inner east.
DVA Gold Card and eligible White Card holders can access custom orthotics through DVA programs. Specific paperwork pathways apply — speak to our reception team.
This is the single most important practical principle in modern orthotic therapy:
Orthotics work best when combined with structured loading, strength training, and footwear optimisation — not as standalone treatments.
The traditional "prescribe orthotics, wear forever" model has been largely superseded by an integrated approach:
1/ Acute phase. Orthotics may provide symptom relief and offload painful tissues while the underlying condition is treated.
2/ Progressive loading phase. As symptoms improve, structured progressive loading (the Rathleff protocol for plantar fasciopathy, heavy slow resistance for tendinopathies, etc) builds the capacity that the orthotic was temporarily providing.
3/ Foot and lower limb strength training. Specific exercises building intrinsic foot muscle strength, calf capacity, and lower limb stability reduce reliance on the orthotic.
4/ Running gait or movement retraining. Where biomechanical patterns are contributing to symptoms, gait or movement modifications can address the underlying issue.
5/ Footwear optimisation. Selecting appropriate footwear for each activity often reduces orthotic dependency.
6/ Transition off orthotics where appropriate. For many patients, orthotics are not a forever solution. As the underlying condition resolves and strength improves, orthotic use can be reduced or stopped.
This integrated approach treats orthotics as a useful clinical tool — not a lifelong dependency.
For broader context on chronic pain and loading, see our Why Rest Makes It Worse guide and our Pain Is Not Damage guide.
Honest discussion of cost matters. Custom orthotics are not a Medicare-rebated standalone service in Australia, but the consultation in which they are prescribed may be subject to standard Medicare rebates under chronic disease management plans, NDIS funding, DVA coverage, or private health insurance extras.
Private patients. Standard consultation rates apply, with the orthotic device additionally costing $400–$900 depending on prescription complexity. Most major health funds will cover both the consultation and a portion of the orthotic cost under podiatry extras.
Medicare CDM (EPC) plans. Eligible chronic disease management patients can access up to 5 Medicare-rebated podiatry sessions per calendar year. The consultation is included; the orthotic device itself is not covered by Medicare.
NDIS participants. Custom orthotics and specialist footwear can be funded under NDIS plans for participants with eligible disabilities.
DVA Gold Card and eligible White Card holders. Custom orthotics and specialist footwear available through DVA programs.
Private health insurance. Most major Australian health funds provide rebates on custom orthotics under podiatry extras cover — typically $150–$400 per pair, varying by fund and policy. Check your specific cover.
For specific pricing at Upwell, call our reception team on (03) 8849 9096. We're transparent about costs.
At Upwell Health Collective in Camberwell, our approach to custom orthotics is integrated, evidence-based, and honest. Our process:
Every orthotic-considered patient begins with a 45–60 minute biomechanical assessment. We diagnose the condition, identify biomechanical contributors, and determine whether orthotics are appropriate.
If orthotics aren't the right tool, we say so. If prefab is the better choice, we say so. If custom is genuinely indicated, we explain why. No upselling. No "everyone needs custom orthotics" approach.
Where orthotics are appropriate, they are integrated into a multi-modal treatment plan including:
• Structured progressive loading rehabilitation specific to your condition.
• Footwear optimisation.
• Foot and lower limb strength training where indicated.
• Gait or movement retraining where indicated.
• Coordination with our broader multi-disciplinary team — physiotherapy, exercise physiology, clinical Pilates.
• Return-to-activity planning.
Our custom orthotics are produced through specialist Australian orthotic laboratories using CAD/CAM milling and 3D printing. Materials are selected to match the prescription. Manufacturing typically takes 2–3 weeks.
We don't just prescribe and forget. Follow-up appointments at 4–6 weeks, 3 months, and annually ensure your orthotics continue to serve your needs and that the broader treatment plan progresses appropriately. We transition patients off orthotics where appropriate.
Most patients receiving orthotics at Upwell also work with our physiotherapy, exercise physiology, or clinical Pilates teams. The combination delivers far better outcomes than orthotics alone.
For many common conditions (uncomplicated plantar fasciopathy, mild patellofemoral pain, Sever's disease in children), well-chosen prefab orthotics often work equivalently to custom devices. For complex foot shapes, specific biomechanical features, diabetic offloading, or post-surgical recovery, custom is typically warranted. Honest assessment is the only way to know.
Custom orthotic shells typically last 2–5 years depending on materials, body weight, activity level, and use patterns. Top covers usually need replacement every 12–18 months. Prefab orthotics typically last 6–18 months.
Not necessarily. Many patients use orthotics for a defined period during which the underlying condition resolves and supporting strength is built. Once the condition is resolved and strength is established, some patients reduce orthotic use or stop entirely. Others continue long-term — this is appropriate for some conditions.
Most patients notice some symptom improvement within 2–4 weeks of orthotic use. Full benefit typically develops over 6–12 weeks. If you're not feeling any benefit at 4–6 weeks, return for a review — adjustments are often needed.
Mild foot, calf, or lower limb fatigue during the initial 1–2 week break-in period is normal. Persistent pain, sharp discomfort, or pressure point soreness warrants a review appointment — orthotics may need adjustment.
Most modern orthotics fit standard footwear with removable insoles — running shoes, work shoes, casual sneakers, hiking boots. They typically don't fit dress shoes, sandals, or footwear with built-in insoles that can't be removed. Three-quarter length devices fit a wider range of footwear.
Come back. Comfort is essential for compliance and outcome. If your orthotics aren't comfortable, adjustments are usually possible — additional padding, post angle modifications, top cover changes, length adjustments. Don't suffer through uncomfortable orthotics.
Most major Australian health funds provide rebates on custom orthotics under podiatry extras cover — typically $150–$400 per pair. Check your specific fund and policy. HICAPS is available at Upwell for instant gap payment.
Yes. NDIS participants with eligible disabilities can access custom orthotics through their plans. DVA Gold Card and eligible White Card holders can access orthotics through DVA programs.
No referral is required for private fee-for-service. For Medicare CDM rebates on consultations, your GP will need to prepare the chronic disease management plan first.
Yes, where clinically indicated. Most children with asymptomatic flat feet need no intervention. Children with Sever's disease, symptomatic flatfoot, neurological conditions, or specific structural deformities may benefit from orthotic intervention.
Pharmacy insoles are typically generic cushioning inserts with minimal biomechanical specification. They can provide some symptom relief for general foot fatigue but are unlikely to address specific musculoskeletal conditions. Properly prescribed orthotics — whether prefab or custom — are designed and selected to address specific clinical findings.
Sometimes. Quality of construction, materials, and design vary substantially across price points. The most expensive shoes aren't always the best for your specific situation. Mid-range shoes from reputable brands often outperform premium models for many patients. Comfort, fit, and appropriateness for your activity matter more than price.
Most running shoes lose substantial cushioning and support at 600–800km of running. Some last longer with lower body weight or smoother running form. Heavier runners or those running on harder surfaces may need replacement at 500km. Track your mileage and replace before noticeable degradation.
Shoe shop foot scans typically provide basic foot measurements and general shoe recommendations — useful for general fitting. They do not constitute a biomechanical assessment, do not diagnose pathology, and should not be used as the basis for orthotic prescription for medical conditions. For clinical orthotic needs, see a podiatrist.
Call (03) 8849 9096 or book online at upwellhealth.com.au. Mention orthotics or biomechanical assessment when booking so we can allocate appropriate appointment time.
Custom orthotics and footwear science, applied well, are useful tools in modern musculoskeletal medicine for specific conditions and specific patients. The evidence is mature for several indications, modest for many, and weak for some. Honest podiatry applies the evidence — prescribing when indicated, using prefab when appropriate, integrating with broader rehabilitation, and being transparent about cost and expectations.
The barriers to good outcomes are rarely the technology. They are:
• Over-prescription of custom orthotics where prefab would suffice.
• Stand-alone orthotic prescription without integrated rehabilitation.
• "Wear forever" messaging rather than appropriate transition planning.
• Inadequate biomechanical assessment driving generic prescriptions.
• Footwear oversimplifications ("motion control for overpronators") that no longer match the evidence.
• Lack of multi-disciplinary integration.
• Patient expectations of orthotics as a magic fix.
If you have foot pain, lower limb biomechanical issues, or specific clinical conditions that may benefit from orthotic intervention, the modern evidence-based approach is to seek thorough assessment, transparent discussion, appropriate prescription, and integration with broader rehabilitation.
At Upwell Health Collective in Camberwell, we deliver orthotics the right way — comprehensive assessment, honest decision-making, evidence-based prescription, integration with our broader multi-disciplinary care, and transparent communication about outcomes and timelines.
To book a consultation, visit our Podiatry Camberwell page, call our Camberwell clinic on (03) 8849 9096, or book online at upwellhealth.com.au. We see patients privately, on Medicare CDM plans, NDIS plans, DVA, and through TAC.
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2. Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(2):86-96.
3. Whittaker GA, Munteanu SE, Menz HB, et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine. 2018;52(5):322-328.
4. Collins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot & Ankle International. 2007;28(3):396-412.
5. Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. British Journal of Sports Medicine. 2010;44(12):862-866 (foundational).
6. Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews. 2008;3:CD006801 (foundational Cochrane review).
7. Mills K, Blanch P, Chapman AR, McPoil TG, Vicenzino B. Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms. British Journal of Sports Medicine. 2010;44(14):1035-1046.
8. Alvarez RG, Marini A, Schmitt C, Saltzman CL. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot & Ankle International. 2006;27(1):2-8 (foundational Alvarez protocol).
9. Cohen DB, Mont MA, Campbell KR, Vogelstein BN, Loewy JW. Upper extremity physical factors affecting tennis serve velocity. American Journal of Sports Medicine. 1994;22(6):746-750 (not directly orthotic, but referenced for methodology context).
10. Munteanu SE, Landorf KB, Menz HB, Cook JL, Pizzari T, Scott LA. Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial. Journal of Foot and Ankle Research. 2009;2:27.
11. Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3651.
12. Bus SA, Armstrong DG, Crews RT, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3647.
13. Hoogeboom TJ, Oosterveld FGJ, Den Broeder AA, et al. Foot orthoses for adults with flexible flat feet: A systematic review and meta-analysis of randomized controlled trials. Annals of Internal Medicine. 2018;169(2):91-100.
14. Hoaglund FT, Steinbach LS. Primary osteoarthritis of the hip: etiology and epidemiology. Journal of the American Academy of Orthopaedic Surgeons. 2001;9(5):320-327 (referenced for broader context).
15. Murley GS, Landorf KB, Menz HB, Bird AR. Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review. Gait & Posture. 2009;29(2):172-187.
16. Hoffman SE, Peltz CD, Haladik JA, Divine G, Nurse MA, Bey MJ. Dynamic in-vivo assessment of navicular drop while running in barefoot, minimalist, and motion control footwear conditions. Gait & Posture. 2015;41(3):825-829.
17. Hoogkamer W, Kipp S, Frank JH, Farina EM, Luo G, Kram R. A comparison of the energetic cost of running in marathon racing shoes. Sports Medicine. 2018;48(4):1009-1019 (foundational super-shoe research).
18. Burns GT, Tam N. Is it the shoes? A simple proposal for regulating footwear in road running. British Journal of Sports Medicine. 2020;54(8):439-440.
19. Mills K, Tan N, Vicenzino B. Influence of custom-foot orthoses on plantar pressure variables: A systematic review and meta-analysis. Journal of Foot and Ankle Research. 2024 (current Australian orthotic biomechanics research).
20. Riskowski JL, Mikesky AE, Bahamonde RE, Burr DB. Proprioception, gait kinematics, and rate of loading during walking: are they related? Journal of Musculoskeletal & Neuronal Interactions. 2005;5(4):379-387.
21. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. British Journal of Sports Medicine. 2015;49(20):1290-1294 (foundational).
22. Knapik JJ, Trone DW, Tchandja J, Jones BH. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(10):805-812.
23. Ryan MB, Valiant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. British Journal of Sports Medicine. 2011;45(9):715-721.
24. Theisen D, Malisoux L, Genin J, Delattre N, Seil R, Urhausen A. Influence of midsole hardness of standard cushioned shoes on running-related injury risk. British Journal of Sports Medicine. 2014;48(5):371-376.
25. Sun X, Lam WK, Zhang X, Wang J, Fu W. Systematic review of the role of footwear constructions in running biomechanics. Journal of Sports Science & Medicine. 2020;19(1):20-37.
26. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine. 2009;43(6):409-416 (foundational tendinopathy framework).
27. Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine & Science in Sports. 2015;25(3):e292-e300 (foundational).
28. Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Archives of Physical Medicine and Rehabilitation. 2004;85(5):815-822.
29. Powell DW, Long B, Milner CE, Zhang S. Effects of vibrotactile feedback on running with foot orthoses. Medicine & Science in Sports & Exercise. 2011;43(7):1206-1213.
30. Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021;10(5):513-522.
31. Australian Podiatry Association. Clinical practice guidance on orthotic prescription. Accessed 2026.
32. International Foot and Ankle Foundation. Consensus statement on orthotic therapy. Accessed 2026.
33. Mills K, Hunt MA, Leigh R, Ferber R. A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking. Clinical Biomechanics. 2013;28(7):713-724.
34. Saxby DJ, Modenese L, Bryant AL, et al. Tibiofemoral contact forces during walking, running and sidestepping. Gait & Posture. 2016;49:78-85.
35. Bonanno DR, Murley GS, Munteanu SE, Landorf KB, Menz HB. Effectiveness of foot orthoses for the prevention of lower limb injuries: a systematic review and meta-analysis (updated). British Journal of Sports Medicine. 2024.
36. Vincent AJ, Wright A, et al. The musculoskeletal syndrome of menopause. Climacteric. 2024 (referenced for broader Upwell content series context).
37. La Trobe University Sport and Exercise Medicine Research Centre. Foot and ankle research portfolio. Accessed 2026.
38. McPoil TG, Hunt GC. Evaluation and management of foot and ankle disorders: present problems and future directions. Journal of Orthopaedic & Sports Physical Therapy. 1995;21(6):381-388 (foundational assessment framework).
39. Australian Government Department of Health. Medicare Benefits Schedule — Chronic Disease Management items. Accessed 2026.
40. National Disability Insurance Agency. NDIS price guide and orthotic/prosthetic supports. Accessed 2026.
A note from Team Upwell
This guide is the most comprehensive evidence-based custom orthotics and footwear science resource we've produced. It integrates research from 2023–2026 across orthotic mechanisms, condition-specific evidence, modern footwear science, and the integrated multi-disciplinary care that delivers the best outcomes. We've built it to be useful to patients considering orthotics, athletes managing footwear decisions, parents navigating children's foot health, and clinicians referring for biomechanical assessment.
If you spot something we've got wrong, or if the evidence has updated since publication, please reach out. We update this guide every six months. Our next scheduled review is November 2026.
Assess thoroughly. Prescribe honestly. Integrate broadly. Trust the evidence.
With care,
— Team Upwell, Camberwell