Foot orthoses are custom made or custom fit foot shoe interfaces that allow for control of abnormal biomechanics that may be producing pain with standing and ambulation. In other words foot orthoses provide a balanced foot shoe interface that reduces compensations made by the foot and ankle complex for abnormal positions or movements that are causing pain. The concept of restoring the foot to a neutral or “normal” position has been replaced with providing a balanced position that allows for pain free standing and ambulation. This “balanced position” will allow the foot to move and work with the rest of the body by providing appropriate pain free proprioceptive input for better posture and balance. By decreasing the amount of pressure and force on any one area of foot, orthoses allow for the redistribution of pressure across the entire plantar surface. Anytime that you have an uneven distribution of weight and pressure on a part of the body (for example in the foot); other joints that are adjacent to the abnormal functioning joint have to compensate and carry the load.

Over time these other joints also become pathological due to being overworked and overused. The foot and ankle can then be realigned to reduce compensatory positions that are producing pain with standing and ambulation. Foot orthoses have been shown to improve somatosensory input by stimulating foot plantar mechanoreceptors that reduce pain and improve posture and stability [10]. In a study conducted in by Donatelli, et al. [11] 70% of the patients treated with orthoses reported that they were able to return to normal everyday activity. Gross et al investigated the effects of foot orthoses on balance in adults age 65 or older. The study included elderly patients who have had at least one fall in the previous year [12,13]. They concluded that custom foot orthoses can indeed improve balance in both standing phase and moving phase of gait [14]. Aboutorabi A, et al. [15] evaluated the effects of foot orthoses on balance control in older adults. Their results showed that foot orthoses improve postural stability via somatosensory or biomechanical effect. Footwear alone with the proper features can be an appropriate initial intervention to address pain and reduce falls in the elderly [15]. They also are the foundation for any orthosis and therefore as important a component of the prescription as the orthotic itself. de Morais Barbosa, et al. [10] deduced that foot orthoses were effective for improving balance and for reducing pain and disability in elderly women. They also concluded that orthoses can be used as an adjuvant strategy to improve balance and to prevent falls in the elderly [16-21].

In 2018 de Morais Barbosa, et al. [10] looked at the effects of insoles on the balance in patient’s age 65+ in primary care practices. The results showed that foot orthoses were effective in improving balance and posture. Foot orthoses have historically been beneficial in alleviating patelloferomal pain and helping correct the pathology in children. Collins NJ, et al. [22] wanted to investigate and find out if anterior knee (Patellofemoral) osteoarthritis in the elderly could also be managed with orthoses. They found that foot orthoses compared to shoes alone dramatically reduced pain during walking and during step-downs [22]. In a related study, Gross and his colleagues investigated whether flat feet are a cause of knee pain and cartilage damage in older adults. They looked at 1903 patients and concluded that those with flat feet were 1.3X more likely to have knee pain and 1.4X more likely to have cartilage damage in the medial tibiofibular part of the knee [23].