This review challenges the traditional belief that foot orthoses function by correcting the alignment and movement patterns of the knees, hips, and spine. Research indicates that while these devices are clinically beneficial, they produce negligible changes in the actual kinematics, or joint angles, of the proximal joints and torso. Instead, the evidence suggests that orthoses act primarily as kinetic modulators, altering the internal forces and pressure distribution across the lower limbs. These findings also suggest that visual gait analysis may be an unreliable method for evaluating orthotic success because the most significant changes occur in loading patterns rather than visible motion. Consequently, the presenters advocate for a paradigm shift in clinical practice, moving away from a focus on skeletal positioning toward a better understanding of force management. This transition reconciles historical theories with modern data to provide a more accurate mechanical explanation for how foot inserts alleviate musculoskeletal pain in the proximal joints.

This podcast introduces a kinetic framework for evaluating limb-length discrepancy (LLD), moving away from traditional postural narratives and static measurements. The presenters argue that because small anatomical differences often overlap with measurement errors, clinical focus should shift toward how these inequalities affect asymmetrical loading over time affecting long-term joint health. By utilizing dynamic plantar pressure mapping, practitioners can identify specific load signatures, such as differences in impulse, stance time, and regional force distribution. This methodology prioritizes the mechanical consequences of gait over simple millimetre counts to better manage risks like osteoarthritis. Ultimately, the proposed protocol emphasizes a measure-intervene-remeasure cycle to ensure that orthotic adjustments positively modulate the body's interaction with the ground.

This podcast muses on the kinetic effects of probably the most ubiquitous foot orthotic prescription item - the metatarsal dome. While metatarsal domes are considered a low-risk solution for forefoot pain, they function as significant mechanical interventions rather than simple metatarsal head spreaders and pressure reducuers. By shifting plantar pressure away from the metatarsal heads, these inserts create a functional fulcrum shift that alters how the foot handles weight during movement. This redistribution effectively bypasses the metatarsophalangeal joints, reducing the external dorsiflexion forces acting on the distal forefoot and the ankle. Consequently, the effective lever arm effect of the foot is shortened, which can change gait timing and force more proximal joints like the knee and hip to compensate in some patients. Clinicians must recognise that even though these devices may successfully alleviate local symptoms in the forefoot, they may exert system-level kinetic consequences that fundamentally transform walking mechanics.