This is the specialty where the gap between commercial messaging and the randomised trials is widest. No trial shows a custom orthotic outperforms an off-the-shelf one. No publication supports the claim that 80 percent of chronic pain is postural. The diabetic foot and the painful bunion, by contrast, do have solid data.
The questions we get asked
Is a custom orthotic better than one off the shelf?
No trial or meta-analysis we found shows a difference. The most precise direct comparison gives 0.03 points. A double-blind trial even concludes by recommending prefabricated devices first line.
Can a postural assessment find the source of a pain?
The French health authority accepted posturography in December 2025, but for neurological and vestibular disorders and falls in older people. Musculoskeletal pain is not an accepted indication. People with back pain do sway more on average, but the amplitude of their sway correlates with neither the intensity nor the location of their pain.
Should a bunion be operated on?
When it hurts, surgery clearly relieves: 83 percent improved at one year against 24 percent with nothing. But waiting a year does not compromise the final result, and at two years all three arms of the trial had the same pain.
And the diabetic foot?
This is where podiatric care has the best evidence-to-practice ratio, at least for healing. Offloading with a non-removable device is the best demonstrated intervention in the field. For preventing recurrence the trials are more disappointing, and adherence is the factor that separates them.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Custom against prefabricated | 0.03 points of difference | Rasenberg et al., Br J Sports Med, 2018 |
| Lateral wedge against neutral insole, knee | 0.03 standard deviations | Parkes et al., JAMA, 2013 |
| Correlation of postural sway with pain intensity | none | Ruhe et al., Eur Spine J, 2011 |
| Bunion, pain at 2 years | identical across the 3 arms | Torkki et al., Acta Orthop Scand, 2003 |
| Prevention of stress fractures by orthosis | risk reduced by 41 percent | Bonanno et al., Br J Sports Med, 2017 |
| Survival 5 years after a diabetic foot ulcer | 50.9 percent | Chen et al., Diabetes Obes Metab, 2023 |
What Noria Health does, and does not do
We organise a podiatry and foot orthopaedics consultation with a specialist team near Brussels, clinical examination, gait analysis and imaging review according to the reason for referral. Feasibility confirmed within 24 to 48 hours, follow-up documented at D14, D30 and D90.
We do not prescribe orthotics remotely, we do not carry out postural assessment from photographs, and we set no surgical indication without examination.
Who reviewed this page
Noria Health editorial team.
Our posturology and podiatry articles
- Orthotics: no trial shows custom beats off-the-shelf
- Posturography: what the regulator accepted, and what it left out
- Bunions: waiting a year does not compromise the result
- Diabetic foot: what heals an ulcer, and what does not prevent one
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.