Custom foot orthoses - to Scan or Not to Scan? What This New Orthotic Study Really Means for Runners and Clinicians | Find Your Stride | Edinburgh Podiatrist

Introduction

Custom foot orthoses are a mainstay in managing running-related injuries, foot pain, and lower limb musculoskeletal conditions. As digital workflows become more common in podiatry and sports medicine, a key practical question remains:

Does scanning the foot directly actually lead to better outcomes than traditional foam-box casting?

A 2025 randomised controlled trial by Barr et al. finally gives us high-quality data to answer this question. Here’s a critical breakdown of what the study tells us and what it doesn’t, through the lens of running performance, sports injuries, and podiatric practice.

A wide range of orthoses can now be fabricated using an accurate, direct scan of a foot. But, does scanning lead to better outcomes than traditional foam-box casting?

Study Overview: What Did the Researchers Do?

This was a double-blinded randomised controlled trial conducted in an NHS orthotic service, comparing two ways of capturing foot shape for CAD/CAM custom insoles:

• Direct 3D foot scanning (fully digital workflow)

• Traditional foam-box casting, later scanned into CAD/CAM software (hybrid-digital workflow)

A total of 114 adults with foot and ankle musculoskeletal pathologies were recruited and followed over 12 weeks. Importantly, the cohort was heterogeneous, reflecting real-world clinical practice rather than a single diagnosis like plantar fasciopathy.

Key outcome measures:

• Pain, function, foot health, and footwear (Foot Health Status Questionnaire)

• Patient satisfaction (OPUS-CSD)

• Adherence (hours per day wearing orthoses)

• Need for manual orthotic adjustments

• Cost and staff time

The Headline Finding: Clinical Outcomes Were the Same

From a purely pain and function perspective, the results were surprisingly clear:

• Both groups improved significantly in pain, foot function, and foot health

• Improvements occurred within 4 weeks and were maintained at 12 weeks

• No meaningful difference between scanning and foam-box casting for these primary outcomes

👉 For runners and clinicians:

If your main goal is reducing pain and improving daily function, both methods work. This supports what many clinicians already suspect: the orthotic prescription itself matters more than how the foot shape is captured.

Where Direct Scanning Pulled Ahead

Although pain and function were equivalent, several secondary outcomes clearly favoured direct scanning:

1. Better Adherence

Participants with scanned orthoses wore them about 1 hour more per day on average.

For runners, adherence matters. Orthoses that spend more time in shoes are more likely to:

• Influence load distribution

• Reduce symptom flare-ups

• Support consistent training

2. Higher Patient Satisfaction

The direct scan group reported significantly higher satisfaction scores at 12 weeks.

In sports medicine, satisfaction often correlates with:

• Long-term compliance

• Willingness to train through rehab phases

• Confidence in the intervention

3. Fewer Adjustments Needed

Only 4 people in the scan group required manual modifications, compared to 15 in the foam-box group. This suggests:

• Better initial fit

• Less arch irritation

• Fewer follow-up appointments interrupting training blocks

4. Lower Overall Cost

Direct scanning was ~23% cheaper per patient, largely due to:

• Reduced staff time

• No foam materials

• Less need for review appointments

For clinics treating large numbers of runners or athletes, this has clear service-level implications.

What This Means for Runners and Sports Injury Management

Performance Considerations

This study did not measure:

• Running economy

• Kinematics

• Ground reaction forces

• Return-to-running timelines

So while scanned orthoses were worn more and adjusted less, we cannot say they improve running performance directly.

Injury-Specific Insight Is Limited

The participants had mixed diagnoses (Achilles tendinopathy, plantar heel pain, forefoot pathology, etc.), which improves external validity but limits conclusions for any single running injury.

👉 For clinicians treating runners:

• The findings support workflow decisions, not diagnosis-specific prescriptions

• More targeted research is still needed for conditions like plantar fasciopathy or tibial stress injury

Strengths of the Study

• Robust randomised, double-blinded design

• Clinically meaningful outcome measures

• Real-world NHS setting

• Inclusion of cost, adherence, and sustainability data

• Early and sustained follow-up points

This is one of the best-designed trials to date on orthotic manufacturing workflows.

Limitations Worth Noting

• Single-centre study with limited ethnic diversity

• Majority female cohort with relatively high BMI

• No biomechanical or sport-specific outcomes

• Short-term follow-up (12 weeks)

For competitive runners, longer-term outcomes and performance metrics remain unanswered.

Bottom Line: Should Podiatrists and Clinics Switch to Scanning?

Yes—if you’re using CAD/CAM orthoses already. This study shows that:

• Direct scanning is just as effective for pain and function

• It leads to better adherence, satisfaction, and efficiency

• It reduces costs, waste, and clinical friction

For athletes and runners, the key takeaway is simpler: Orthoses made from scans won’t magically improve performance but you’re more likely to wear them consistently and comfortably. That alone can make a meaningful difference in injury management.

Citation

Barr L, Richards J, Dickson C, et al. To scan or not to scan? Comparing the effectiveness and cost differential of insoles manufactured from foam-box casts versus direct scans in treating musculoskeletal conditions of the foot and ankle: a double-blinded randomised controlled trial. BMC Musculoskeletal Disorders. 2025;26:282.

Find Your Stride!