An orthotic that is doing its job is easy to forget about. It goes in a shoe, you walk on it, and your feet stop asking for attention. When one starts making itself known again, with an edge biting under the arch or the old ache creeping back by mid-afternoon, the question worth asking is narrower than "do I need new ones." Usually the answer is one of three things: the device needs a small change, the device has reached the end of its working life, or the device is fine and something around it moved.

This is written for people who already own a prescribed pair. If you are still deciding whether to get them at all, start with how custom orthotics are prescribed and fitted instead. If what you are wearing came off a pharmacy shelf, the retail versus custom comparison is the more useful read.

An adjustment and a rebuild are different jobs

An adjustment is work done on the device you already own. A chiropodist can grind back a rim that is catching, add or reduce posting so the heel sits differently, move or soften a metatarsal pad, replace a worn top cover, or reshape the arch profile slightly with heat. The shell survives. The prescription survives. Most of the time you walk out with the same pair in your shoes.

A rebuild starts from a new impression or scan of your foot and produces a new shell. Different appointment, different cost, and usually a different line on your benefits claim. There are only two good clinical reasons for it: the shell no longer does mechanically what it was built to do, or your foot has changed enough that the old model is no longer an accurate description of it.

Two checks worth doing before you book

Take both devices out of your shoes and set them on a hard floor. Press into each arch with your thumb. A shell that has fatigued gives more easily than it used to, and often more easily on one side than the other. Rock each heel cup gently; it should stay planted rather than tip. You have been wearing these since they were new, so you are the person best placed to notice the difference. Asymmetry that was not there at the fitting is real information.

Then look at the surfaces. A worn top cover, a forefoot pad flattened to nothing, a cover peeling at the edge: surface problems, and surface problems are refit territory. A crack running through the shell, a heel cup splayed open, or a visible twist along the length of the device is not.

People usually want a number of years instead, and the number is the least useful thing on offer. Two identical devices, one under someone running sixty kilometres a week and one under someone at a desk three days a week, are nowhere near the same schedule. The two physical checks tell you more than the calendar does.

What tends to point toward an adjustment

• One pressure point you can cover with a fingertip, in the same spot every time.

• Discomfort that started when you changed shoes rather than when your feet changed.

• The arch feels slightly too high or slightly too low, but the shell is still stiff and true.

• The top cover is worn through, or the cushioning under the forefoot has packed down.

• Symptoms that came back mildly and gradually while the device kept its shape.

What tends to point toward a new pair

• Noticeably more flex under your thumb than the matching device has, or than you remember.

• Foot surgery, a significant change in body weight, a pregnancy, or a new diagnosis since the model was taken.

• The original symptoms back at full strength and holding there for several weeks.

• Visible cracking, layers separating, or a shell that has taken a permanent twist.

• A foot whose shape has moved on, for instance a bunion that has progressed or an arch that has dropped.

Sometimes the device is not the problem

Shoes are the common culprit. A midsole that has collapsed tilts whatever sits on top of it, and the orthotic gets blamed for a change it did not make. Factory insoles matter too. If one shoe still has its own footbed in and the other does not, the fit goes wrong on exactly one foot, which is a baffling symptom right up until you look.

Other times a new problem has appeared that the existing prescription was never written for. Sharp heel pain in the first ten steps of the morning, numbness between two toes, a specific bone that hurts when you press it: these deserve assessment on their own terms rather than being handled as a fitting complaint. That is the job of a biomechanical assessment, and it is often what a gait analysis makes visible.

What a refit appointment involves

Bring the devices, and bring the shoes you actually wear them in. Not the good pair. The work pair, the ones you walk the dog in, the boots you will be living in by November. Half the useful information at a refit comes from seeing the device inside the shoe it spends its day in, and a device that is right for a runner can be wrong in a slim dress shoe without either being defective.

Say where it hurts and when. "It burns under the ball of my right foot after about two hours of standing" gives a chiropodist something to work with. "They stopped feeling right" is a starting point and not much more. Small modifications are often made during the visit and worn out of the clinic; bigger changes can mean leaving the devices behind for a few days.

Coverage, and the order you do things in

Ontario extended health plans generally fund the device rather than the visit, and many reset on a fixed cycle. That makes sequence worth a thought. If you are near the end of a cycle, an adjustment that carries you through another season can be the better use of a plan that will fund only one shell in that window. Plans vary enough that it is worth checking yours before you book; here is how extended health coverage for orthotics works in Ontario.

Frequently Asked Questions

Can a chiropodist modify a device that was made somewhere else?

Usually yes. Most modifications are done on the physical device and do not need the original prescription or lab. What cannot be recovered is the reasoning behind the original build, so bring whatever paperwork you still have and expect a short assessment first, so that changes are made for a reason rather than by guesswork.

Is the work done while I wait, or do I leave them behind?

Grinding an edge back, adding a pad or swapping a top cover is typically same visit. Reshaping a shell or changing the posting may need the devices for a few days. Ask when you book, so you can plan which shoes you are in that week.

Only one of my two feels wrong. Do both need work?

Not necessarily, although both get looked at. Feet are rarely symmetrical and the two devices rarely wear at the same rate, so it is normal for one to need attention first. If the pair is being rebuilt rather than adjusted, they are made together.

Would new shoes fix this instead?

Sometimes, and it is cheap to rule out. If the discomfort began within a week or two of a new pair of shoes, or your current shoes are well past their mileage, try the devices in a different pair before booking anything. If the problem follows the orthotic from shoe to shoe, the orthotic is the thing to look at.

Should I keep wearing them until the appointment?

If they are uncomfortable but not damaging skin, yes. Keep wearing them and pay attention to where and when the discomfort turns up, because that detail shortens the appointment. If they are rubbing a raw spot or breaking skin, or you have diabetes or reduced sensation in your feet, stop and get seen promptly rather than working around it.

Not sure whether yours need a small change or a rebuild? Bring your current pair and the shoes you wear them in to Donwood Foot Clinic in North York, and we will check the shell, the fit and the footwear together. Book an appointment online, or call the clinic if you would rather talk it through first. A chiropody foot assessment is the right starting point when the symptom turns out to be something new, and custom foot orthotics covers what a rebuild involves.