evidencereferralswellness

Are Custom Insoles Worth It? A Therapist’s Guide to Gait Scans and Client Outcomes

mmasseur

2026-02-12

10 min read

A 2026 therapist's guide to 3D-scanned insoles and gait analysis—what works, what doesn't, and how to integrate scans into care without overpromising.

Are custom insoles worth it? A therapist's guide to gait scans and client outcomes (2026 update)

Hook: Clients arrive asking for “custom insoles” after a Google search, a TikTok, or a shop window. You want to help, but you’re juggling limited evidence, expensive direct-to-consumer (DTC) options like Groov-style DTC products, and the real clinical work of reducing pain and restoring function. This article cuts through the hype around 3D-scanned insoles and gait tech in 2026 and gives therapists practical, evidence-informed ways to use gait findings without overpromising.

The state of the field in 2026: trends you should know

From late 2024 through 2025 we saw an explosion of DTC companies offering fast, visually compelling 3D scans and bespoke insoles printed or milled to match a foot scan. By early 2026 those products are mainstream in retail chains and pop-up clinics. Startups like Groov received high-profile press—but also sharp criticism for leaning on aesthetics, marketing, and placebo-driven consumer satisfaction rather than independent clinical trials. For therapists vetting partners, see our quick vendor checklist and broader marketplace reviews when evaluating vendor claims.

"This 3D-scanned insole is another example of placebo tech" — coverage of Groov (The Verge, Jan 2026)

Meanwhile, clinical gait analysis tools migrated toward AI-driven smartphone video analysis and pressure-platform-in-shoe systems that stream cloud dashboards. Regulators and researchers started demanding validation studies in 2025; some companies responded with randomized trials, others with observational user metrics. The result: more tools, more data, but still mixed evidence for clinical benefit of 3D-scanned, DTC-printed insoles over well-designed prefabricated options.

What the evidence actually says (short version)

High-quality studies and systematic reviews published through 2025 generally show:

For common mechanical foot pain (for example, plantar heel pain), orthoses—both prefabricated and custom—can reduce pain and improve function in the short to medium term.
Differences between expensive custom orthoses and good-quality prefabricated insoles are often small and not always clinically meaningful for many patients.
For complex conditions (significant deformity, neuropathic diabetic foot with ulcer risk, major biomechanical deformities), true clinical-grade custom orthoses and specialized offloading devices show clearer benefit.
Evidence specifically supporting 3D-scanned, DTC-printed insoles (as offered by many new companies) is still limited—independent, peer-reviewed randomized controlled trials were sparse as of early 2026.

Takeaway: Custom insoles can help—but they’re not a magic bullet. Use them selectively, measure outcomes, and don’t rely on a scan alone to justify a prescription.

Where gait scans help—and where they don’t

Gait technology can be valuable if used correctly. It shines in three areas:

Objective pressure mapping: Identifies high plantar pressure zones useful in diabetic foot care and ulcer prevention.
Baseline and progress data: Quantifies stride symmetry, cadence, and pressure distribution so you can measure change over time.
Client engagement: Visuals from scans can motivate clients to adhere to exercise plans and footwear changes.

But gait scans have limitations you must communicate clearly:

Many systems provide static scans (arch shape while standing) rather than dynamic loading in the client’s own shoes; that limits ecological validity.
Smartphone or video-based gait analysis can misclassify gait characteristics if not calibrated or if the client is fatigued, barefoot vs shod, or walking on an atypical surface.
Scan-derived "perfect alignment" claims often ignore neuromuscular control, proximal contributors (hip, trunk), and the role of progressive loading and exercise in recovery.

How to evaluate a 3D-scanned insole company (quick checklist)

When a client asks about a brand or you consider partnering with a vendor, check for these signals:

Independent validation: Look for peer-reviewed studies, not just company-hosted before/after visuals.
Transparency: Can the vendor export pressure maps, force-time curves, or raw gait metrics for clinician review?
Clinical partnerships: Are there published collaborations with universities, hospitals, or podiatry departments?
Data privacy: How is gait video and biometric data stored and shared? (GDPR/CCPA compliance matters.)
Trial period and warranty: Is there a staged trial or refund policy if the device doesn’t help?

Integrating gait findings into therapy without overpromising: a practical workflow

Below is a stepwise protocol you can implement in a clinic or mobile practice. It centers on clear measurement, shared decision-making, and conservative escalation.

Step 1 — Screen and prioritize red flags

Before any orthotic talk, rule out urgent issues and refer when needed. Red flags include:

Unexplained rapid swelling, warmth, or erythema (possible infection)
Signs of neuropathy with ulcer risk, or previous ulcers (consider podiatry/vascular)
Severe deformity limiting walking or shoe fit (orthopedic/podiatry referral)

Step 2 — Baseline measures and goals

Use simple, reliable outcome measures so you can quantify change. Recommended toolkit:

Pain: Numeric Pain Rating Scale (NPRS) or VAS — clinically meaningful change is typically ~1.5–2 points on a 0–10 scale.
Function: Foot and Ankle Ability Measure (FAAM) or Foot Function Index (FFI); if you prefer brief tools, use the Patient-Specific Functional Scale (PSFS).
Activity: Steps/day from a phone or wearable and a 6-minute walk (if appropriate).
Clinical tests: Windlass test, single-leg heel raise capacity, ankle dorsiflexion measurement.

Step 3 — Conservative first: footwear, education, and exercise

Before buying custom insoles, try a planned conservative pathway (4–8 weeks) unless there’s a clear indication for custom devices. This includes:

Footwear optimization (stiffer sole, rocker profile for some heel pain types)
Targeted loading programs (progressive plantar fascia loading, intrinsic foot muscle strengthening)
Short-term prefabricated insoles as a diagnostic trial (cheap, reversible)
Manual therapy where indicated and education on pacing

Why? Good-quality prefabs often deliver similar results for many mechanical complaints and are cost-effective.

Step 4 — Use gait scan data to inform, not replace, clinical judgment

If you perform a gait scan, use it as one data point. Practical rules:

Compare barefoot vs in-shoe metrics — the shoe often changes pressure zones dramatically.
Look for consistent, reproducible abnormalities across trials before attributing symptoms to a scanned “problem.”
Use pressure maps to target offloading—especially in neuropathic foot care—rather than to promise biomechanical “corrections.”
Document the scan result in clinic notes and link it to your functional plan (e.g., “scan shows elevated first-metatarsal head pressure; plan: rocker sole + targeted pad + reassess 6 wks”).

Step 5 — Set expectations and shared decision-making

Say this to clients: "An insole may reduce your pain by redistributing pressure and increasing comfort, but it's unlikely to 'fix' your mechanics alone. We'll measure outcomes and change course if needed." Clear, honest conversations reduce disappointment and improve adherence.

Step 6 — Trial, measure, escalate if needed

Implement a short, documented trial:

Offer a 4–8 week trial with prefabricated insoles or over-the-counter orthoses.
Collect NPRS and a function score at baseline and 6–8 weeks. Look for the minimal clinically important difference (MCID) thresholds (e.g., ~1.5–2 points on 0–10 pain scale).
If no meaningful improvement and the problem persists, discuss clinical-grade custom orthoses or specialist referral.

Special cases where custom 3D insoles are more clearly indicated

Consider clinical-grade custom insoles sooner when:

There’s significant foot deformity or structural asymmetry that compromises shoe fit.
Patients have neuropathy and documented high plantar pressure regions — pressure-redistribution can prevent ulcers.
Failed an adequate trial of conservative care and prefabricated orthoses.
Athletes with sport-specific footwear needs where a precise in-shoe solution is required alongside a loading plan.

Case vignettes from practice (real-world examples)

Case 1 — Plantar heel pain, 42-year-old office worker

Presentation: 6 months of morning heel pain, pain 6/10. Exam: positive windlass test, reduced single-leg heel raises.

Plan: footwear change, progressive loading, 6-week prefabricated insole trial, NPRS and PSFS at baseline and 6 weeks. Outcome: 3-point drop in NPRS and return to running at 8 weeks. No custom orthoses used.

Case 2 — Diabetic neuropathy with focal high pressure

Presentation: history of healed plantar ulcer, focal callus and high-pressure area under 1st met head on pressure scan.

Plan: urgent podiatry referral, pressure-redistribution orthosis custom-molded and verified using in-shoe pressure mapping. Outcome: pressure offloading confirmed on repeated scans and no recurrence at 12 months.

Lesson: In routine mechanical foot pain, conservative care + prefabs often suffice. In ulcer-risk diabetic patients, custom devices plus objective pressure reduction are lifesaving.

Outcome measures and documentation: what to track

Track these consistently to evaluate effectiveness and support referrals:

Baseline and follow-up pain (NPRS/VAS)
Function (FAAM, FFI or PSFS)
Objective gait metrics when available (step symmetry, peak plantar pressure zones, cadence)
Patient-reported satisfaction and adherence to wearing insoles/footwear
Return-to-activity benchmarks (e.g., walking minutes/day, running tolerance)

Practical tips for working with vendors like Groov

If a client brings in a DTC scan or asks about a brand:

Ask for the company’s clinical validation; few DTC brands had robust peer-reviewed RCTs by early 2026.
Request raw or exportable data so you can compare pre/post pressure maps.
Confirm trial/refund policies and product lifespan—some printed insoles deteriorate faster than molded orthoses.
Don’t rely solely on the vendor’s algorithmic “correction.” Use the result in the context of your exam and rehab plan.

Communicating with clients: scripts that work

Use clear phrases that set realistic expectations:

"Let's try an evidence-based, stepwise approach: footwear, exercises, and a trial of prefabricated insoles. If that fails, we'll consider a custom solution."
"A scan is a useful snapshot — it helps us see pressure points — but it’s not proof the insole will cure the problem by itself."
"We’ll measure outcomes so we know if the insole helped in a meaningful way for you."

Ethics, billing, and practical clinic notes

Document informed consent about benefits, risks, costs, and alternatives. If you recommend a vendor that provides referral fees or discounts, disclose that relationship. For billing, capture the clinical indication and objective measures you used to reach a decision—this protects the client and your practice.

Future predictions (2026–2028): what to expect next

Based on 2025–2026 trajectories, expect:

Stricter regulatory scrutiny and more independent RCTs from device companies by 2027.
Greater integration of in-shoe sensors with wearables and telehealth platforms so you can monitor adherence and pressure over weeks.
Smarter prescription pathways: AI will recommend when a client should try a prefab vs custom device, but clinicians will still be essential for judgment and care integration.

Until then, therapists who combine critical appraisal, conservative care, objective outcome measurement, and selective use of custom devices will deliver the best client outcomes.

Actionable takeaways — put this in your notes today

Start every foot/ankle case with red-flag screening and baseline outcome measures (NPRS + FAAM/PSFS).
Offer a 4–8 week conservative trial (footwear + exercises + prefabricated insoles) before recommending expensive custom devices unless clinically indicated.
Use gait scans to measure and target problems (pressure offloading), not to make sweeping biomechanical promises.
Track objective change and document MCID thresholds (e.g., ~1.5–2 points on a 0–10 pain scale) to guide escalation.
Vet vendors for independent validation and exportable data; beware of marketing hype (Groov-style examples show why).

Closing: how therapists can lead the conversation on custom insoles

Custom insoles — including the new wave of 3D-scanned products — are tools, not cures. In 2026, the smart therapist uses them selectively, measures outcomes, and keeps conservative treatment first. That approach protects clients from unnecessary spend and improves the chance of meaningful recovery.

Call to action: Want a ready-to-use gait-scan integration checklist and client script? Download the free one-page toolkit at masseur.app/resources or schedule a short practice consult to review how gait scans could fit into your workflow. Use data, not hype, and your clients will notice the difference.

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