• Ball KA
• Afheldt MJ

• Foot / physiology
• Orthotic Devices
• Subtalar Joint / physiology

DATA SOURCES: Studies evaluating the relationship of foot type (medial arch height) and use of foot orthoses to the motions of the foot and ankle were compared and contrasted. A search was conducted to evaluate other possible mechanisms of orthotic intervention.

RESULTS: Although Root's methods of foot evaluation (subtalar neutral position) and casting (non-weight-bearing) are well referenced, these methods have poor reliability, unproven validity, and are, in fact, seldom strictly followed. We challenge 2 widely held concepts: that excessive foot eversion leads to excessive pronation and that orthotics provide beneficial effects by controlling rearfoot inversion/eversion. Numerous studies show that patterns of rearfoot inversion/eversion cannot be characterized either by foot type or by orthotics use. Rather, subtle control of internal/external tibial rotation appears to be the most significant factor in maintaining proper supination/pronation mechanics. Recent evidence also suggests that proprioceptive influences play a large, and perhaps largely unexplored, role.

CONCLUSIONS: Considerable evidence supports the exploration of new theories and paradigms of orthotics use. Investigations of flexible orthotic designs, proprioceptive influences, and the 3-dimensional effects of subtalar joint motion on the entire kinetic chain are areas of research that show great promise.

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