Sports medicine professionals often prescribe prosthetics or orthotics to treat a variety of musculoskeletal problems. Pro-sthetics are artificial limbs or body parts. Orthotics are devices or braces that sup

port, cushion, or guide the motion of a body. Shoe inserts and ankle, knee, or wrist braces are examples of orthotics. Orthotics can be bought "off the shelf" or custom-build for a particular patient.

Shoe inserts are a common orthotic treatment for excessive pronation of the sub-talar joint. One origin of excessive pronation is believed to be a low arch or flat foot. A person with a subtalar joint axis below 45° in the sagittal plane will tend to have more pronation from greater eversion and adduction of the rear foot. It has been hypothesized that the medial support of an orthotic will decrease this excessive pronation.

Figure 12.3 illustrates a rear frontal plane view of the maximum pronation position in running for an athlete diagnosed with excessive rear-foot pronation. The two images show the point of maximum pronation when wearing a running shoe (a) and when wearing the same shoe with a custom semirigid orthotic (b). Imag

Figure 12.3. Rear frontal plane view of the positions of maximum pronation in running in shoes (a) and shoes with a semi-rigid orthotic (b) on a treadmill at 5.5 m/s.

ine that you are the athletic trainer working with this runner. The runner reports that it is more comfortable to run with the orthotic, an observation that is consistent with decreased pain symptoms when using orthotics (Kilmartin & Wallace, 1994). You combine this opinion with your visual and videotaped observations of the actions of her feet in running.

Inspection of Figure 12.3 suggests that there is similar or slightly less pronation when the runner is wearing an orthotic. Biomechanical research on orthotics and rear-foot motion have not as of yet determined what amount of pronation or speed of pronation increases the risk of lower-extremity injuries. The research on this intervention is also mixed, with little evidence of the immediate biomechanical effects of orthotics on rear-foot motion and the hypothesized coupling with tibial internal rotation (Heiderscheit, Hamill, & Tiberio, 2001). In addition, it is unclear if the small decrease in pronation (if there was one) in this case is therapeutic. The comfort and satisfaction perceived by this runner would also provide some support for continued use of this orthotic.

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