People experiencing foot pain and problems often seek relief with over-the-counter insoles. They may go a step further and visit a shoe fitting store that has a pedorthist to get a custom shoe fitting and insole recommendation. Here are some frequently asked questions about the limitations of these methods and when it is best to see a podiatrist.

Q: When should a patient consult a podiatrist vs. visit a pedorthist to have shoe modifications/inserts recommended?

A: Any time someone has actual lower extremity symptoms of pain, numbness, tingling, burning, or loss of function for a week or more warrants a visit to the foot doctor.

The best case scenario is when the pedorthist and podiatric physician can work together to optimize the patient’s biomechanics.

If someone has an acute injury, swelling, bruising, or sudden pain, a podiatrist should always be the first stop. A podiatrist will be able to diagnose the problem with an X-ray, ultrasound, and other modalities and get the patient on the road to recovery fastest. A podiatrist can prescribe medication, administer injections, prescribe custom orthotic devices, and—when necessary—perform surgery to resolve a particular foot problem. A pedorthist can be consulted when there is a persistent ache or pain when walking or running. The pedorthist then will be in a good position to recommend a particular shoe, insert, or combination to improve the gait and foot efficiency, as well as reduce the level of pain.

I would recommend that patients be first evaluated by the podiatrist to truly diagnose what the problem may be. We do often see issues with improper shoes or inserts, but we also see underlying causes of pain and discomfort that shoes/inserts alone will not treat. I will refer patients to the pedorthist once the diagnosis of an appropriate condition is made in which shoe modifications, inserts, or even custom braces are indicated.

Q: What conditions are appropriate for the level of expertise that can be performed by a pedorthist at a shoe fitting store?

A: Pedorthists are not licensed to diagnose acute issues. However, they are skilled at recommending the appropriate shoes to fit a particular foot type. They also are able to recommend and produce insoles, both off-the-shelf and custom, to support a person’s foot properly. For those who wear a custom orthotic from a podiatrist, the pedorthist can recommend the best shoe to maximize the effectiveness of the orthotic device. Having a pedorthist around ensures that the customer will be able to purchase a ‘best fit’ shoe or over-the-counter arch support. This helps with shoe performance and shock absorption.

The pedorthist can also carry out prescription items such as diabetic therapeutic shoes and accommodative inserts, custom shoes, and custom modifications to shoes. Again, if a person believes he has a “condition,” I would advise working with the podiatric physician in conjunction with the pedorthist. So many people buy their shoes based on the looks and ignore the comfort of the shoe. I tell my patients that the sales representative is the most important person to consult when looking at shoes for specific issues.

The pedorthists are trained in most of the common foot conditions that we see on a regular basis, including flat feet, painful arches, painful heels, bunions, hammertoes, diabetes, arthritis, etc. The pedorthist is also trained in casting and molding custom inserts to better fit the patients/customers. Patients should not be fooled by online “custom” orthotics, which are not truly custom, just to save some money. With orthotics and braces, you get what you pay for. You get not only a quality product, but the training behind it which allows the pedorthist to diagnose the problem, determine which materials are needed, and fabricate the inserts properly.


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