Why Your Orthotics Don't Feel Right in Your Shoes (and What to Look For)
Heel slipping, toes cramped, orthotic sliding around? It is usually the shoe, not the device. Here is how to tell, and what to look for instead.
Yoni Hochberg
Podiatrist, OnePointHealth, Ryde NSW
AHPRA-registered podiatrist, 10+ years' clinical experience
Read Yoni's full bioWhen someone tells me their new orthotics feel wrong, I ask them to bring in the shoes they have been wearing them in. More often than not, the device is fine. The problem is the shoe it has been dropped into.
An orthotic only works when the shoe gives it room and a stable base. The shoes that carry one well share four things: an insole you can lift out, enough depth, a firm heel and a fastening you can adjust. Miss one of those and the complaints are predictable. The heel lifts out, the toes feel squashed, or the device has slid forward by lunchtime.
This guide works through those problems one at a time, so you can fix the shoes you already own or know what to check before you buy the next pair. It applies to custom orthotics and over-the-counter insoles alike.
Key Facts
- Most common causeLeaving the shoe's original insole in and stacking the orthotic on top. That lifts your foot and makes the shoe too shallow.
- What to look forA removable insole, enough depth, a firm heel counter, a stable midsole, a roomy toe box and laces or adjustable straps.
- Quick checkCan you lift the insole out? If it is glued in, there is rarely room for an orthotic.
- When to go backPain, blisters, numbness or a fit problem that does not settle after the wear-in period. Your podiatrist can adjust the device.
Why don't my orthotics feel right in my shoes?
Usually because the shoe was never designed to hold one. An orthotic takes up room under your foot, so it needs a shoe with space to spare and a firm structure around it. Put it in a shallow, soft or narrow shoe and your foot sits higher than the shoe expects, which is where heel slip, crowded toes and rubbing come from.
This is what I check first, in this order.
| What you feel | Most likely cause | First thing to try |
|---|---|---|
| Heel lifts out of the shoe | Orthotic stacked on the original insole, or a shallow shoe | Take the original insole out; lace or strap firmly |
| Toes cramped, top of foot pressed | Not enough depth or toe-box room | Remove the insole; try a deeper shoe or a wide fitting |
| Orthotic slides forward | A three-quarter device in a loose shoe or sandal | Fasten firmly; fill the gap at the front |
| Rubbing at the heel or sides | Soft heel counter, or the device sitting off-centre | Seat the orthotic right at the back; choose a firmer heel |
| Arch feels hard or pushy | A new device you are still wearing in | Build up wear gradually; book a review if it persists |
Should I take the original insole out before adding my orthotic?
Yes, almost always. This is the single most common mistake I see. Leaving the factory insole in and putting the orthotic on top can add several millimetres under your foot, which lifts your heel towards the top of the heel cup and squeezes your toes into the roof of the shoe.
Lift the original insole out, put the orthotic in its place and push it right back until it sits snugly against the heel. Keep the original insole somewhere safe. If the shoe turns out to need it for a different outfit or a day without your orthotics, you will want it.
One exception: if your podiatrist has made a slim device designed to sit on top of a particular insole, follow their instructions for that pair.
Why does my heel slip when I wear orthotics?
Heel slip means your foot is sitting too high in the shoe, or the back of the shoe is not holding it. Taking out the original insole fixes most cases on its own. If it still slips, check three things.
- Depth. Some shoes are simply too shallow at the heel to take an orthotic. Shoes sold as orthotic-friendly tend to have extra depth built in for this reason.
- The heel counter. Squeeze the back of the shoe. If it folds easily, it will not hold your heel down over a full day.
- How you fasten it. Use the top eyelet. A heel-lock lacing pattern (sometimes called a runner's loop) pulls the heel back into the shoe without tightening across the toes. In a sandal, an adjustable heel strap does the same job.
Why do my toes feel cramped with orthotics in?
Cramped toes usually mean the shoe has run out of vertical room, not that it is too short. Your orthotic raises your foot, so the front of the shoe presses down on your toes and the top of your foot.
Start by removing the original insole. If the toes still feel tight, you need a shoe with a deeper, rounder toe box, or a wide fitting. Length still matters too: healthdirect recommends about a thumb's width (around 1.5cm) between your longest toe and the end of the shoe.1 Do not trim a custom orthotic yourself to make it fit. Bring it back to your podiatrist, who can adjust it without changing how it works.
What if my orthotic slides, rubs or presses into my arch?
Sliding is common with three-quarter length devices, which stop behind the ball of the foot. In a closed shoe, firm lacing will hold most of them. In a sandal there is nothing above the foot to stop the device moving, so a forefoot filler that sits in front of the orthotic can take up the gap.
Rubbing at the heel or sides is a sign the orthotic is not seated properly, or the heel counter is too soft. Take the shoe off, push the device right to the back and try again. A hard edge you can feel through your sock is worth showing your podiatrist. Do not just put up with it.
Arch pressure is a little different. A new orthotic can feel firm under the arch at first, and that often settles as you get used to it. Pressure that turns into pain, or that is still there after the wear-in period, means the device needs reviewing.
How long should orthotics take to feel comfortable?
Most people need a short wear-in period. Start with 1 to 2 hours on the first day, and gradually increase by an hour each subsequent day until you are wearing them comfortably all day. Orthotics typically start to feel comfortable after one to two weeks as your feet adapt to the new load pattern.
Mild awareness of the device is normal in that window. Sharp pain, blisters, numbness or pain somewhere new are not. If you get any of those, stop wearing them for long periods and book a review.
What should I look for in a shoe for orthotics?
When patients ask what to check in the shop, I give them six things, in the order I check them.
- An insole you can lift out. The most important feature. If it is glued in, the shoe is not built for an orthotic.
- Enough depth. With the orthotic in, your heel should sit inside the heel cup, not perched at the top of it.
- A firm heel counter. It should hold its shape when you squeeze it, so your heel stays put on top of the device.
- Adjustable fastening. Laces, hook-and-loop or buckled straps let you fine-tune the fit around the orthotic and over a long day.
- A roomy toe box. Toes need space to spread with the extra height underneath.
- A stable midsole. It should bend at the toes and resist twisting through the middle, so the orthotic has a steady platform.
The Comfort Co sums up the same ground in its Recipe of Comfort (cushioning, support and fit), and its explainer on orthotic-friendly footwear goes into each feature in more detail.
Not every shoe needs to take an orthotic. Slim dress flats and minimal sandals rarely have the depth, and for some people a well-made shoe with a supportive built-in footbed is enough on lighter days. Your podiatrist can tell you which days your orthotics matter most.
Shoes that take an orthotic well
These styles all have a removable footbed and the depth to replace it with your own device.
About these picks
The products below are suggestions from The Comfort Co team, not Yoni's clinical recommendations. For advice on your own orthotics and how they fit, book in with your podiatrist.
Sandal for orthotics
Revere Geneva Sandal
For anyone who gives up on their orthotics once summer arrives.
- Removable footbed, regular-to-deep fit
- Two adjustment points plus strap extenders for extra width
- Medium and Wide widths
- Heads up: open toes, so not for every workplace
Most adjustable sandal
Revere Miami Adjustable Sandal
Three straps to tune, useful when your heel slips or your forefoot feels squeezed.
- Three points of adjustment, including the heel
- Removable, orthotic-friendly footbed
- Medium and Wide widths
Dressier slingback
Revere Como Adjustable Slingback Sandal
For when you want something smarter that still takes your device.
- Adjusts across three points
- Full-grain leather, lined in leather
- Medium and Wide widths
- Heads up: a slingback holds the heel less firmly than a closed shoe
Closed-in, adjustable
Revere Virginia Adjustable Casual Sneaker
A closed shoe for people whose feet are hard to fit with laces.
- Criss-cross hook-and-loop strap
- Extra depth for custom orthotics
- Comes with a 3mm filler to fine-tune the fit
Everyday walker
Vitasole Walker Mesh III
For daily walks and long days on your feet with your orthotic in.
- Breathable mesh upper over a cushioned VX Technology midsole
- Removable footbed and lace-up fit
- Medium and Wide widths
Tidier walker
Vitasole Walker Leather
The same idea in leather, for work or anywhere mesh looks too sporty.
- Removable VX Technology footbed
- Lace-up fit to hold the heel
- Heads up: Medium width only
For style
Mia Vita Ramona II Lace-Up Sneaker
For anyone who wants their orthotics in a shoe that looks like a fashion sneaker.
- Leather and suede retro trainer shape
- Removable footbed with arch support
- Heads up: Medium width only, and a lower profile than the walkers
If your device slides
Revere Forefoot Fillers
Fills the gap in front of a three-quarter orthotic in a sandal or slide.
- Trims to fit
- Hook-and-loop base holds it in place
- Women's and men's versions
The Comfort Co Breakdown
The short version
If your orthotic feels wrong, look at the shoe first. Take the original insole out, push the orthotic right to the back and fasten the shoe properly. If it still slips or squeezes, the shoe is probably too shallow or too soft at the heel for a device.
When you buy, start with one question: can you lift the insole out? Then check depth, a firm heel and straps or laces you can adjust. Every Revere, Vitasole and Mia Vita style in the list above passes that test. If you would like a second opinion on fit, our team can help over live chat or at a Comfort Co store.
Written by The Comfort Co team.
When should I go back to my podiatrist?
Book a review if any of these apply. A device that once fitted well can need adjusting as your shoes, your activity or your feet change.
- Pain, blisters or redness that was not there before the orthotics
- Numbness, tingling or pain in a new spot
- A fit problem that does not settle after the wear-in period
- The top cover is worn through, cracked or coming away
- You have diabetes or reduced circulation and notice any rubbing or pressure
- You are moving them into a very different shoe, such as from a walker to a sandal
Bring the shoes you wear most to the appointment. Seeing the orthotic and the shoe together makes most problems obvious within a couple of minutes. If you are not near a OnePoint clinic, the Australian Podiatry Association lists podiatrists across the country.2
Keep Reading
Quick questions
Why do my orthotics hurt in some shoes but not others?
Because the shoe changes how the orthotic sits. In a deep shoe with a removable insole and a firm heel, the device sits flat and your heel stays put. In a shallow or soft shoe, your foot is pushed up and moves around, which causes rubbing, heel slip and pressure.
Do I need to remove the insole when using orthotics?
In most cases, yes. Take the shoe's original insole out and put the orthotic in its place. Stacking the two makes the shoe too shallow and lifts your heel. Follow your podiatrist's advice if your device was designed to sit on top of a specific insole.
Can I wear orthotics in sandals?
Yes, if the sandal has a removable footbed, a heel strap and adjustable straps. A forefoot filler stops a three-quarter orthotic sliding forward in an open sandal.
Should I buy shoes a size up for orthotics?
Not usually. Going up a size adds length, but the common problem is depth and heel hold. A shoe in your normal size with a removable insole and extra depth, or a wide fitting, is the better fix for most people.
What shoes are best for orthotics?
Shoes with a removable insole, enough depth, a firm heel counter, a stable midsole, a roomy toe box and laces or adjustable straps. Supportive walkers, adjustable sandals and lace-up casual sneakers with lift-out footbeds are good starting points.
If your orthotics still do not feel right, bring them and your favourite shoes to OnePointHealth and we will look at the pair together.
Sources
- healthdirect Australia. Foot care. healthdirect.gov.au
- Australian Podiatry Association. Find a podiatrist. podiatry.org.au