Foot Orthoses: Are Physios Using Them Enough?

Foot orthoses have evidence supporting their use in several lower limb conditions, but are physios utilising them enough?

As the profession moves away from strictly biomechanical treatment models, some physios may feel less certain about where orthoses fit within modern practice, while others may simply lack the confidence to prescribe them effectively.

In his Case Study, expert podiatrist Blake Withers explains his clinical reasoning when using foot orthoses for lower limb conditions. Rather than framing them purely as a biomechanical intervention, he introduces a broader perspective that may change how clinicians think about their role in patient management. This blog provides a snapshot of Blake’s perspective and how orthoses can be used more confidently by physios.

If you want to see exactly how expert Blake Withers uses orthoses in clinic, watch his full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

More than biomechanics

Orthoses have traditionally been viewed through an orthomechanical lens, where the goal is to change foot mechanics or alignment. This perspective can sometimes feel incongruous for physios who take a more biopsychosocial approach.

Blake offers a refreshing take. He describes the concept of modulomechanical therapy, where orthoses provide mechanical input that may influence both local biomechanics and responses within the nervous system. These effects may occur centrally and peripherally, meaning the impact of orthoses may extend beyond simple biomechanical changes. See him explain this in the clip below from his Case Study:

This broader view recognises that several factors may contribute to symptom change when orthoses are introduced. Mechanical load modification is likely one component, but sensory, perceptual and psychological influences may also play a role.

This idea is similar to many physiotherapy interventions such as joint mobilisations and soft tissue massage. While these are often described using mechanical explanations, the exact processes behind their clinical effects remain unclear. However, if an intervention can help modulate a patient’s symptoms, that may be reason enough to use it.

For physios, this shifts the focus away from trying to precisely explain biomechanical changes and fixing something that’s “wrong”, towards understanding what the intervention allows the patient to tolerate. In many cases, orthoses can simply be viewed as another intervention we have available to modify load.

How we can apply them

Blake notes that physiotherapists already have the principles and knowledge in place to use orthoses more frequently in practice. Namely, physios already understand load modification.

If orthoses are viewed primarily as load modifiers, clinical decision-making becomes less about correcting an “abnormal” foot and more about whether changing load might help a particular patient.

He outlines a framework for applying orthotic interventions in the clinic. Watch this clip from his Case Study:

Blake also presents several real-life cases involving orthotic prescription. In this example from his Case Study, he demonstrates how he applies an orthotic for a nurse presenting with peroneal tendon pain.

How to determine dose?

Dosing is a key consideration with any intervention we implement, and it’s no different for orthoses. This is important to consider before discarding an orthotic that’s not achieving the desired effect.

Blake describes several factors he considers when deciding whether a patient can tolerate a higher orthotic “dose”, such as a higher medial wedge. These include the patient’s history and tolerance to load, whether their footwear has sufficient volume to accommodate an orthosis, body mass index (with individuals with higher BMI often tolerating a higher dose), and the presence of asymmetries that may influence how load is distributed through the lower limb.

When to consider custom orthoses?

A common question in clinical practice is whether custom orthoses provide advantages over prefabricated devices.

Blake explains that custom orthoses may be particularly helpful in certain situations. These include cases where the patient has an unusual foot shape, when deformity is present, or when more specific force application is required. Durability and patient preference can also influence the decision. Some patients may need materials that can withstand demanding environments, while others may simply feel more confident using a custom device.

As with most clinical decisions, the choice between custom and prefabricated orthoses often depends on the individual patient rather than a universal rule.

Wrapping up

Pre-fabricated foot orthoses can be a cost-effective intervention available to physios, but their role is often misunderstood, which may lead some clinicians to use them less frequently in practice.

By shifting our view of orthoses from a tool that corrects biomechanics to one that helps modulate load, clinicians may find a clearer framework for integrating them into patient management.

To see how Blake Withers assesses, reasons and prescribes orthoses in practice, watch his full Case Study here.