During orthotic casting, the midtarsal joint should be pronated.

• A. Pronated
• B. Supinated
• C. Neutral
• D. Everted

Answer: (A)

During orthotic casting, you want to capture the foot in the position it uses during weight bearing so the device can support the arch throughout stance. The midtarsal joint (the Chopart joints between hindfoot and forefoot) should be pronated because this mirrors the functional flattening and forefoot abduction that occur when the foot pronates in gait. Casting with the midtarsal joint pronated allows the orthosis to fill the arch, support the medial column, and control pronation without overcorrecting. If the midtarsal joint were neutral or supinated, the orthosis would be built around a stiffer midfoot and may not adequately support the arch or limit pronation; an eversion posture would overstress the device and not reflect typical functional loading.