Customized foot orthotics based off a clinical examination, plaster or foam cast have been utilized for decades in order to treat overuse injuries of the foot, ankle, knee, hip and even spine.  These orthotics are usually not covered by insurance and usually run into the hundreds of dollars compared to an off the shelf model.  Many businesses have opened up lately specializing in the prescription and fabrication of orthotics for these conditions claiming correction of the foot and ankle can change the mechanics up the kinetic chain.  Up to this point, with a few patient exceptions, customized orthotics have not been proven more effective than cheaper off the shelf orthotics.  

This blog has previously posted on many aspects of achilles tendinopathy.  A recent article examined in the British Journal of Sports Medicine randomized 140 patients with achilles tendinopathy to either a sham orthotic or a customized orthotic (Munteanu et al. 2015).  In addition, both groups were given eccentric calf strengthening exercises.  The patients were followed over a total of 12 months.  Authors noted improvement in both groups, but no difference between groups at either short or long term functional or clinical outcomes.    It appears the orthotic did not improve symptoms or function above or beyond improvements noted with the eccentric exercise.  

In short, consistent with prior research, customized orthotics are not more effective than other interventions for overuse injuries of the lower extremity.  Future research should attempt to identify any individual factors that may indicate a need for an orthotic intervention.