Included with every pair are inserts with 3 size options - Lo, Mid, & Hi, to accomidate everyones unique pressure sensitivities. Start using your AVOS with the Lo insert and adjust to your own preference. Although we include Lo, Mid, & Hi, that doesn't necessarily mean the goal is to use the Hi insert. We merely provide the option to accommodate everyone with flat arches to high arches. ‍ Injuries can be tricky and we always recommend talking to your physician.