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Hello everybody, today I'm starting with the big question: orthotics.

Pre-made orthotics versus custom orthotics—which ones are actually good? There are so many brands out there, and the price range is enormous. They can range from twenty bucks to $700 for a custom orthotic. Which one should you get? Should you start with the $20 one, or should you go with the more expensive option?

I'm here to tell you what works.

Orthotics can be really good or really bad, and there are a lot of conflicting philosophies out there. Should you focus on barefoot walking and muscle strengthening, or should you wear a maximalist shoe with the world's biggest orthotics and cushion your feet? What’s the deal here? There are a lot of conflicting studies, but let’s talk about what is practical.

The Rise and Fall of Orthotics' Reputation

In the 1970s and 1980s, orthotics became very popular. They were big moneymakers for doctors, and almost all insurance covered them. But then, everybody got in on the game. Essentially, chiropractors, stores, pop-up stores, mail-order companies with boxes—everybody was dispensing orthotics like candy. Over the years, they developed a pretty bad reputation because of the lack of consistency and clinical oversight.

Today, technology allows for iPhone scanners, tablets, and boxes that you can step into, have your foot 3D-printed, and mailed to your house. We will explore all these modern options and determine the best approach for different needs.

Analysis of Popular Orthotic Brands: Pros, Cons, and Cost

I’m going to go over the major brands in no particular order and tell you the pros and the cons. Please note: Prices mentioned are approximate based on current market trends and may fluctuate due to inflation and retailer pricing.

Orthotics Brand Type Focus/Gimmick Pros Cons Cost
     
aetrex insoles
        
Aetrex Pre-made/Semi-Custom iStep Scanner (3D image/foot type analysis) Good starting point; identifies foot type; effective for many users. More expensive due to scanner costs; still mostly under-corrective compared to true custom. $60 - $70
spenco insoles
Spenco Pre-made Comfort, durability, cushion Praised for durability, good cushion, and reducing discomfort. Quality is reported to be lower than in the past; it has gone heavily commercial. $20 - $40
upstep custom orthotics
Upstep Semi-Custom (Mail Order) Mail-order box for impression; 3D printed. Great reviews; good semi-custom option for stubborn problems. Expensive (almost custom price); often not aggressive enough in correction. $200 - $300
superfeet insoles
Superfeet High-End Pre-made High quality, slim design, expensive pre-made. Beneficial for many; higher quality materials; good support reviews. It can be too slim or under-corrective for severe issues. $45 - $60
dr scholl inserts
Dr. Scholl's Entry-Level Pre-made Gel inserts, grocery store scanners. Very popular, accessible; good for older people needing a soft cushion; least "risky." Very under-corrective; gel slabs offer minimal true support; doesn't stabilize joints. $15 - $30
foot levelers orthotics
Foot Levelers Custom/Dispensed Vertical compression, chiropractic partnership. Helps with vertical compression; geared toward back pain. Does not effectively stabilize the foot from overpronation; very under-corrected cushion pad. $300 - $500
powerstep insoles
PowerStep High-Quality Pre-made Podiatrist-started; aggressive options available. Number one seller of higher quality pre-mades; good introductory support; widely available. Price has increased; slightly softer (4-5/10 correction matrix). $35 - $50
walk hero insoles
Walk Hero Popular Online Pre-made Lower-cost version of PowerStep. Very effective; slightly lower cost option; becoming more mainstream. Fewer options; prices are starting to rise as they go mainstream. $25 - $40
PCSsole insoles
PCSsole Popular Online Pre-made Often focuses on arch support and deep heel cups. High cost-performance ratio, orthopedic-grade support that fits like a custom fit. It felt a bit stiff when first wore it. $20 - $40

 

The Correct Approach: Starting with a Good Shoe

My personal results show that all of these orthotics can work great. I personally lean more towards PowerStep and Walk Hero as my reliable pre-made options. I’ve spent thousands of dollars on orthotics over the years, and I would say that 70% of the time, the pre-made ones can do a great job for conditions like heel pain, arch pain, ball of the foot pain, ankle pain, knee pain, and even hip pain.

However, the most critical first step is the shoe.

I always tell people: you want to go in steps. Specifically, you must start with a good supportive shoe. If you don't have a good supportive shoe and you're trying to use an orthotic, you are going to fail no matter what. That orthotic will be unstable, and the wall of your shoe is going to collapse and flap side to side.

Recommended Supportive Shoe Brands:

I like Brooks, Asics, New Balance, Orthofeet, On, Kuru, and Saucony.

You should purchase one of these supportive shoes, take out the insole that comes with it, and stick your pre-made orthotic in there. That is a great start.

The Sequential Strategy: Soft to Firm

For most foot conditions, the best approach is to start softer and gradually move to firmer support, depending on your age and tolerance.

Level 1 (Softest/Least Risky): Dr. Scholl's

Best For: Individuals in their 80s or 90s, or those with highly sensitive feet needing maximum cushioning.

Result: Hardly does anything in terms of support, but it’s the least risky option for initial comfort.

Level 2 (Moderate Support/Low Risk): PowerStep, Walk Hero, or PCSsole

Best For: The general population and those in the fifth athletic category, as well as durable individuals (if you’re not over 70).

Result: These hold your foot a little bit straighter than Dr. Scholl's and offer actual support for athletic activities.

Level 3 (Semi-Custom Digital): Upstep or Fits Perfect

Best For: Patients whose moderate pre-meds are no longer feeling corrective after a couple of months.

Method: You use a mail-order box (Upstep) or an iPhone app (Fits Perfect) to scan and create an impression, which is then 3D-printed into an orthotic. This is a step toward customization without a clinical visit.

Level 4 (True Custom Clinical): Podiatrist Dispensed

Best For: Long-standing, stubborn problems that haven't responded to Levels 1-3.

Method: This requires a visit to a podiatrist. These orthotics are custom-made and can be adjusted from appointment to appointment.

The Customization Philosophy: Like a Dentist

When I dispense a custom orthotic, I look at your leg kind of like a dentist looks at a tooth. You don’t want to straighten that tooth all at once; you want to get used to it a little bit straighter, a little bit straighter, a little bit straighter.

When your foot is now straight, your soft tissue gets used to it. Your hamstrings, your thigh muscles, your hips, and your lower back—over a couple of months, they all get used to walking straight.

Crucially, this is when barefoot walking makes sense. This is when strengthening your muscles makes sense. At first, you want to just get used to walking straight, and your muscles will adapt. Using this method, virtually 100% of patients who come to see me do see improvement. The cost does not have to be high; what is a $20 or $30 pre-made orthotic when you’re weighing surgery as a result?

The Necessity of the Biomechanical Exam

The biggest secret is that you have to get a biomechanical exam. If something is hurting when you wear your orthotics, you have to get it looked at. I check your hips, knees, thighs, hamstrings, and calf muscles. I bend your ankles up and down, and your big toe joints up and down. I check where it's tight and what kind of adjustments we have to make.

If you have underlying tightness, you might have to massage, use a foam roller, get physical therapy, or even get an injection or shockwave therapy to "ungunk your body" before you can successfully start walking straight.

A Note on PCSsole Insoles

The PCSsole brand has gained significant traction online. It is generally considered another effective pre-made orthotic option that competes directly with brands like Walk Hero and PowerStep, particularly in the online marketplace.

Evaluation:

PCSsole insoles are praised by many online reviewers for offering excellent high arch support and a deep heel cup at a competitive price point, often making them a high-value choice for consumers. They effectively provide the necessary support to mitigate overpronation and reduce the fatigue that contributes to leg cramps.

However, like all pre-made insoles, they are based on a generalized foot mold. They cannot match the precise, clinically adjustable correction provided by a custom orthotic dispensed by a doctor after a thorough biomechanical exam.

If you are looking for a good, cost-effective starter orthotic to test the waters (Level 2), PCSsole is a viable, budget-friendly option alongside Walk Hero and PowerStep, especially if your primary need is robust arch support.