what-when-how
In Depth Tutorials and Information
C h a p t e r
3 
Chapter contents
Foot orthoses
Introduction  29
Terminology to describe foot 
orthoses  29
Design of foot orthoses  30
Prefabricated foot orthoses 31
Casted foot orthoses 33
'Which orthosis type is
best?' 33
Importance of the flex line
in the forefoot 34
Biomechanical objectives  
of foot orthoses  34
Controlling pronation of the
foot 37
Reducing foot pressures and
shear forces 40
Foot orthoses for medial 
compartment osteoarthritis  
of the knee  44
Foot orthoses for the at risk 
foot  45
Foot orthoses for people with
rheumatoid arthritis 45
Foot orthoses for people with
diabetes 49
Evidence base for foot 
orthoses  51
Summary  51
Review questions  52
Reflection 52
Self-assessed questions 52
References  52
Further reading  54
Introduction
With the plethora of foot orthoses available for
the clinician to choose from, it is often a difficult
task to match the correct design to the pre-
senting foot problems. Without an understand-
ing of the relative advantages of the different
types of orthoses available, it is impossible to
make an informed selection for each patient. In
attempting to derive some understanding of
the effectiveness and mechanisms of action of
foot orthoses to inform orthotic selection, a key
difficulty lies in understanding exactly what is
meant by the term 'foot orthoses'.
Terminology to describe  
foot orthoses
Any material placed between the sole of the
foot and the inside of the shoe could be con-
sidered a foot orthosis since it will influence the
forces acting on the foot; however, a great deal
of time has been dedicated to classification
and comparison of different types of foot ortho-
sis. They are commonly classified according
to the method of manufacture, being made
either bespoke to the patient's foot via a cast
of the foot (often termed 'casted' or 'bespoke'
orthoses) or 'off-the-shelf' orthoses, that are
standardized in their shape as determined by
the manufacturer (often termed 'prefabricated'
or 'preformed' orthoses). Orthoses may also
be classified by intended function, so an ortho-
sis with an arch support and made of rigid
 
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