Orthopedic Shoes / Custom Orthotics
Orthopedic shoes and custom orthotics are specialized footwear and inserts designed to support proper alignment, relieve pain, and improve mobility for individuals with foot, leg, or posture-related conditions. These items are often prescribed to correct biomechanical issues, provide additional cushioning, or accommodate deformities caused by medical conditions such as arthritis, diabetes, or plantar fasciitis.
How It Works
A custom orthotic is a removable foot-care device worn inside a shoe and made from a three-dimensional cast impression of your foot, constructed from raw materials to your individual specifications to support, align, prevent, and accommodate foot abnormalities and improve how the foot functions, while orthopedic shoes are footwear used to accommodate, control, or support the therapeutic needs of a foot deformity or an abnormality in the leg, knee, or ankle, and must come from recognized and reputable orthopedic footwear manufacturers. Under a Canadian health benefit plan, custom orthotics, orthopedic shoes, and custom orthopedic shoes are covered only when they are medically necessary and prescribed to treat a diagnosed medical condition. The prescription generally needs to come from a physician, chiropodist, podiatrist, or orthopedic surgeon and must set out the medical diagnosis that makes the supply necessary, since a prescription that lists symptoms rather than a diagnosis will not be sufficient. For a custom orthotics claim, insurers typically also require supporting documentation such as a copy of the biomechanical examination or gait analysis, an itemized receipt, a description of the casting technique used, and a detailed lab invoice. The Canadian Life and Health Insurance Association publishes a reference document on understanding claims for footwear and orthotics, noting that all such claims are adjudicated according to the terms of the group benefit plan under which they are claimed.
Example:
Under a Canadian extended health benefits plan, custom orthotics and orthopedic shoes are reimbursed only when they are medically necessary and prescribed for a diagnosed condition such as plantar fasciitis or a diabetic foot. A plan member who buys retail comfort shoes or drugstore arch-support insoles for general foot pain would have the claim denied. By contrast, custom orthotics cast from a three-dimensional impression of the foot and prescribed by a podiatrist, submitted with a biomechanical assessment and an itemized receipt, would qualify for reimbursement up to the plan's coverage percentage and benefit-period maximum.
What to Watch For:
Off-the-shelf, non-orthopedic footwear such as comfort shoes and sandals, shoes purchased for sports or recreation, and pre-fabricated orthotics like Dr. Scholl's insoles are not covered under these benefits. The same line holds for tax purposes, since under CRA guidelines only custom-made footwear and orthotics specifically designed and engineered for your feet are eligible medical expenses, and shoes, boots, or inserts purchased off the rack are not eligible for reimbursement even with a practitioner's recommendation or prescription. When the footwear is custom-made and prescribed by an authorized medical practitioner for a specific foot or gait condition, the CRA lists orthopaedic shoes, boots, and inserts as eligible under the Medical Expense Tax Credit, and they can be reimbursed through a Health Spending Account.
