So, are they worth it?
The short answer: sometimes, and it depends far more on what's actually wrong with your feet than on how much a device costs. For the most heavily researched everyday complaint — plantar fasciitis and general plantar heel pain — good-quality evidence shows a well-chosen off-the-shelf insole often performs just as well as a custom-made one, and this is a reasonable guide for other mild, non-specific arch or heel aches too. For structural deformities, diabetic foot complications, inflammatory arthritis, or feet that have been changed by surgery or injury, a device that's individually assessed, cast or scanned and manufactured for you genuinely does more than a generic shelf product can. The rest of this article unpacks that split so you can work out which side of it you're likely on.
What the evidence actually shows
A Canadian health-technology rapid review that pooled the trial evidence on custom-made versus prefabricated foot orthoses for plantar heel pain found no meaningful difference between the two for pain reduction or functional improvement at around 12 weeks or at 12 months — the review's authors note this finding is specific to plantar heel pain and shouldn't be generalised to other foot conditions (Custom-Made Foot Orthoses versus Prefabricated Foot Orthoses, CADTH via NCBI Bookshelf). A separate systematic review and meta-analysis of 19 randomised trials in more than 1,600 people with plantar heel pain found the same pattern: customised and prefabricated orthoses produced no meaningful difference in pain or function at any follow-up point (Foot orthoses for plantar heel pain: a systematic review and meta-analysis, British Journal of Sports Medicine, via PubMed). Cleveland Clinic and the American Academy of Orthopaedic Surgeons frame this the same way clinically: try a well-selected over-the-counter insole first for mild symptoms, and step up to a custom device only if that doesn't help or if the foot problem needs more correction than a generic shape can provide (Orthotics: Definition, Risks, Benefits, Types & Tips, Cleveland Clinic; Orthotics, OrthoInfo/AAOS).
Who genuinely benefits from a custom device
The picture changes for feet that don't fit an "average" shape, or where an underlying condition is putting skin or joints at risk. People with significant structural deformity, foot complications linked to diabetes, or inflammatory conditions such as rheumatoid arthritis are among the groups where an individually designed orthosis has shown a real advantage over a generic insert (Orthotics: Definition, Risks, Benefits, Types & Tips, Cleveland Clinic; Orthotics, OrthoInfo/AAOS). The clearest example is diabetes-related foot disease: a systematic review of offloading devices for diabetic foot ulcers found custom-made devices were likely more effective than standard, off-the-shelf offloading — in one included study, ulcer incidence at twelve months was 12.8% with a custom device versus 38.6% with standard care (The efficacy of custom-made offloading devices for diabetic foot ulcer prevention, PMC). If you have diabetic neuropathy, a healed ulcer, or a foot shape altered by surgery, trauma or a neurological condition, this is where the extra assessment and manufacturing behind a custom orthosis is more likely to pay off. You can read more about our custom orthotics service, or browse common conditions we assess.
Who can reasonably start off the shelf
If you have a mild, generic ache — first-time heel pain, tired arches after standing all day, or mild flat feet without other complications — a well-fitted prefabricated insole combined with the basics (supportive footwear, calf and plantar fascia stretching, sensible changes to activity) is a reasonable first move, and the evidence above suggests you're unlikely to get a better outcome by paying for a custom device instead. Cleveland Clinic describes exactly this stepped approach: try an over-the-counter device for mild symptoms, and only move to something custom-made if symptoms persist or worsen (Orthotics: Definition, Risks, Benefits, Types & Tips, Cleveland Clinic). Our off-the-shelf orthotics service exists for exactly this scenario — properly selected and fitted, not just picked off a shelf at random.
Clicks and Dis-Chem insoles versus a clinician-made device
In South Africa, that first step usually means a pharmacy insole. Ranges such as Footlogics are sold online and through South African clinics and pharmacies, offering prefabricated inserts shaped for particular shoe types and everyday complaints like heel pain, plantar fasciitis and mild overpronation (Footlogics South Africa); Clicks and Dis-Chem also stock their own-brand shelf insoles for similar general foot and heel discomfort. These are engineered, tested products, and for the mild, uncomplicated problems described above they're a sensible, low-cost starting point. What they can't do is respond to your specific foot: they come in a handful of standard sizes and shapes, built for an "average" foot rather than yours. A clinician-made device starts from an actual assessment of how your foot moves and bears load, is built around your specific deformity or pressure pattern, and can be reviewed and adjusted as your condition changes — which matters most for the higher-need groups above, and less so for a mild, generic ache.
How a custom orthosis is actually assessed and made
A proper custom orthotic isn't simply a firmer insole. It starts with a clinical assessment — gait analysis, a look at footwear wear patterns, joint range of motion and, where relevant, a skin and sensation check (particularly important in diabetes). The orthotist then captures the shape of your foot, either through a plaster or foam-box impression or a digital scan, corrects that shape to your specific biomechanical goals, and has the device manufactured in a rigid, semi-rigid or cushioned material depending on whether it needs to control movement or simply accommodate and protect the foot (Orthotics: Definition, Risks, Benefits, Types & Tips, Cleveland Clinic; Orthotics, OrthoInfo/AAOS). In South Africa, this assessment, prescription, design and fitting must be carried out by a clinician registered with the Health Professions Council of South Africa (HPCSA) — the same statutory body that regulates doctors and physiotherapists — which is what separates a clinically prescribed orthosis from a retail insert (SAOPA — South African Orthotic & Prosthetic Association).
What it costs, and how funding works
Custom orthoses cost more than a pharmacy insole, largely because you're paying for the clinical assessment, the individual casting or scanning, and manufacturing time — not just a piece of moulded foam. We can't give you a figure without seeing your feet and understanding what the device needs to do, so always ask for a written quotation before committing to treatment. Medical scheme cover varies by plan and diagnosis: the Prescribed Minimum Benefits framework is built around around 271 defined Diagnosis Treatment Pairs plus 26 Chronic Disease List conditions, and orthotic devices aren't named as their own category within either list — although treatment linked to a Chronic Disease List condition such as diabetes may still be covered under your scheme's Prescribed Minimum Benefits, so it's worth asking your scheme directly and requesting pre-authorisation (Prescribed Minimum Benefits, Council for Medical Schemes). Where an injury falls under a Road Accident Fund claim, orthotic costs may also be recoverable as part of that process — we can help you work through the paperwork either way.
When to see an orthotist
If a pharmacy insole hasn't settled a mild ache after a few weeks, or if you have a structural foot problem, diabetes, arthritis, or any condition where skin protection and precise correction matter, it's worth having a proper assessment rather than trying another retail product on guesswork. We see patients at our Centurion practice and also offer home and hospital visits for people who find travelling difficult. This article is general information and isn't a substitute for individual clinical advice — every foot and every condition is different, so book an assessment and we'll tell you honestly whether a custom device, an off-the-shelf one, or something else entirely is the right next step for you.
Key takeaways
- For plantar fasciitis and general plantar heel pain, evidence reviews find custom orthoses are no more effective than a well-chosen prefabricated insole.
- Custom devices show a genuine, evidence-backed advantage for diabetic foot complications, significant structural deformities, and inflammatory arthritis.
- Pharmacy insoles (like those from Footlogics, Clicks or Dis-Chem) are a reasonable, low-cost first step for mild symptoms; a clinician-made device is individually assessed, cast or scanned, and built to your specific foot.
- In South Africa, custom orthotics must be assessed and prescribed by an HPCSA-registered orthotist/prosthetist — ask about medical aid PMB routes and always request a written quotation.
- If off-the-shelf options haven't helped, or you have diabetes, arthritis or a deformity, book a professional assessment rather than trial-and-error with more retail products.
Have a question about your own situation?
Every device we provide starts with an individual assessment — at home, in hospital, or at the practice.
References
- Orthotics: Definition, Risks, Benefits, Types & Tips — Cleveland Clinic
- Orthotics — OrthoInfo — American Academy of Orthopaedic Surgeons (AAOS)
- Custom-Made Foot Orthoses versus Prefabricated Foot Orthoses: A Review of Clinical Effectiveness and Cost-Effectiveness — CADTH, via NCBI Bookshelf
- Foot orthoses for plantar heel pain: a systematic review and meta-analysis — British Journal of Sports Medicine, via PubMed
- The efficacy of custom-made offloading devices for diabetic foot ulcer prevention: a systematic review — PMC, National Library of Medicine
- Prescribed Minimum Benefits — Council for Medical Schemes (South Africa)
- SAOPA — South African Orthotic & Prosthetic Association — SAOPA
- Footlogics Orthotics — Heel & Foot Pain Orthotic Insoles, South Africa — Footlogics South Africa