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OBJECTIVES This study compared the effectiveness of soft versus hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost and number of visits for orthotics and explored if age was a factor in orthotic effectiveness. DESIGN This is a randomized clinical trial. Prior to randomization, patients were stratified by age (younger versus older adults), in blocks of four to ensure that there are an equal number of participants in each group (soft versus hard orthotics). SETTING The settings that participants were recruited from were 1) an orthotic clinic in a community-based hospital and 2) a private orthotic clinic. PARTICIPANTS The participants were adults (18+) with heel pain and plantar fasciitis. INTERVENTION Participants received hard or soft customized orthotics. MAIN OUTCOME MEASURES Participants rated their pain intensity and pain interference pre and post orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost and number of visits were also compared. RESULTS There was a reduction in pain intensity (P=0.010) and pain interference (P<0.001) but no change in function over time (P=0.333), and no difference between the groups who received hard versus soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<0.0001) and required fewer visits for fabrication (P<0.0001). CONCLUSION Both soft and hard orthotics provided effective pain relief, however, soft orthotics are less expensive.