I found a distinct difference when I was able to take a patient to the street. In one case of a world class marathoner it made the crucial refinement possible for his performance. All inserts are not orthotic by a long shot. And I am only scratching the surface. Functional casting is essential to critical control.
Control is the keyword.
The majority of cases require limitation of excessive motion, primarily in hyperpronation. Accurate casting is not easy, even in the expert hands of the podiatric specialist. So casting foam is eschewed in such cases and generally reserved for the simpler situations, such as for accommodative appliances. These are usually for the softer variety providing mainly cushioning, as for a geriatric arthritic or older diabetic for whom little else may be advisable. But first it must be clearly established that only an accommodative is best indicated.