This discussion over which is better or more appropriate has been on my radar for over 25 yrs now and it still has not been resolved. Not one of the studies (or systematic reviews) has satisfactorily answered the question except for the ‘orthotically naive’. If you look at the studies on this that have been done and ask yourself this question: are the foot orthotics that are used in the study typically of the type and design that would commonly be used in clinical practice for the pathology under investigation? Usually the answer is ‘no’. The custom made designs are usually some sort of generic prescription missing many design features that would be typically be used for that pathology and the prefabricated designs are just used as a basic shell – no one does that in real clinical practice. So we have studies on a basic shell of a prefabricated orthotic vs a generic custom made device, neither with the design features needed for the actual pathology present. No wonder they find no differences.