March 2018

Navigating disruption in the foot orthotics landscape—Are you ready?

Bruce Williams, DPM, DABPS

For more than 50 years the custom foot orthotic industry has pretty much stayed the same. Of course, change has occurred, such as the introduction and widespread adoption of digital casting and CAD/CAM production vs hand-poured plaster. Nevertheless, podiatrists and other medical professionals continue to follow a longstanding procedure for supplying orthotics to our patients; take cast, write prescription, receive the finished product at the office, provide device to patient, and receive payment.

But times, they are a-changing! A recent report predicts that the foot orthotic market will grow from $1.2 billion in 2016 to $1.7 billion by 2022, just in North America, while observing that the high cost of orthotic insoles may impede that growth.1 The report foretells disruption in this market, noting that technological advancements in foot orthotic insoles will likely expose new avenues for the foot orthotic insoles market. As you read this editorial, the foot orthotic market is already undergoing this disruption.

Companies no longer sell-off-the shelf products to patients only through the big box chain stores, running shoe stores, and drug stores. They now offer customers the opportunity to take a picture or “scan” their foot using a smart phone that leads to the creation of 3D-printed devices that are then mailed to the customer’s home. Or, a patient can have her feet scanned at a kiosk at the mall and have the devices 3D printed while they wait.

The disruption continues. This summer, a few specialty-running shoe stores will introduce foot pressure mapping and scanning that can result in a 3D printed comfort insole, or a custom-made device built into a market-leading, name-brand running shoe. In short, individuals who have foot discomfort will be able to obtain a custom-made foot device with no involvement from a medical professional who specializes in foot orthotics.

Smartphone foot scanning, mall kiosks, shoe-store pressure mapping, 3D printing—where does the podiatrist fit in?

Don’t panic just yet, however, because devices built for what is termed “customized comfort” do not necessarily affect foot and ankle biomechanics in the same manner as do medically-prescribed functional orthotics. We all recall the patients with heel pain who swore by the comfort afforded by their foam clogs, and yet were unable to realize relief from their heel pain. Comfort is not always the answer!

Medical practitioners know that a foot orthotic that is uncomfortable will not be worn, regardless of how well it improves a patient’s foot function. And yet because comfort is specific to each patient, we have no reliable measure for it. This is where the crossover point lies in determining the futures of medically-prescribed devices and customized comfort insoles and shoes.  Will patients 1 day have available to them the combination of individualized comfort with functional performance improvements, without undergoing a clinical examination by a foot orthotic specialist? Yes, I believe so.

Like it or not, disruption is underway, and although there will always be a need for medically-prescribed foot orthotics, many patients will find their solution at the running shoe store, the mall kiosk, or the internet. Increasingly, as people bypass medical professionals to acquire foot orthotics, companies that supply these devices will likely continue to improve both comfort and overall function.

Devices built for customized com- fort do not necessarily affect foot and ankle biomechanics in the same manner as do medically prescribed functional orthotics

We medical practitioners must do a better and more thorough job in improving our orthotic outcomes, or patients will go elsewhere. We can do this by continually educating ourselves regarding the most cutting-edge knowledge on how and why orthoses work. We must better appreciate the benefits and shortcomings of technologies used to quantitate foot function and gait, to better inform our decisions regarding their use, or at least, understand why it is used at all.

With patients’ health insurance deductibles so high already, why would anyone spend more for a medical visit and device until that deductible is met? Why would you not try a device that is customized to your foot and has a high likelihood of mitigating your symptoms?

The disruption is here, and it is building. Will you be ready when it fully arrives?

Dr Williams is director of gait analysis studies at Weil Foot Ankle and Orthopedic Institute, and president of Breakthrough Sports Performance in Chicago.


  1. Zion Market Research. Foot orthotic insoles market by material (leather, polypropylene, and others) for sports, medical and other end users: North America industry perspective, comprehensive analysis, and forecast, 2014 – 2022. https://


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