When casting for orthotics, in what position should the medial and longitudinal axes be held?

• A. Neutral
• B. Dorsiflexed
• C. Maximally pronated
• D. Maximally supinated

Answer: (C)

When casting for orthotics, you want to reproduce the foot in the position that reveals how it tends to move during stance. Holding the medial and longitudinal axes in a maximally pronated position during the cast captures the alignment of the arch and forefoot relative to the hindfoot when the foot is collapsing inward. This gives the orthosis the shape and posting needed to support the medial column and limit eversion, helping to control excessive pronation during gait. Casting in neutral, dorsiflexed, or a maximally supinated position would not reflect the pronatory mechanics the device is meant to correct, so the resulting orthosis would be less effective at stabilizing the foot.