A 16-year-old female soccer player presents to her family doctor with lateral ankle pain, onset two months with the progression of her season after a mild ankle inversion sprain. The doctor diagnosed her with Peroneal Tendonitis and referred her to a local Canadian Certified Pedorthist for evaluation and treatment. https://pedorthic.ca/find-a-pedorthist/

The Pedorthist conducts an extensive history and assessment, including a range of motion testing, gait analysis, and footwear evaluation. The Pedorthist finds:

  • ROM/Non-Weight Bearing Evaluation
    • Subtalar joint inversion hypermobile R>L, right side produces pain during passive and active inversion
    • All other ROM normal at the foot/ankle
    • Mild edema around the right lateral malleolus
    • Pain on palpation along the peroneal tendon and into the muscle belly, right side
  • Weight Bearing Evaluation
    • Flexible Pes Cavus foot type bilateral
    • Neutral Knee alignment
  • Gait analysis
    • Excessive lateral heel contact bilateral
    • Lack of pronation during midstance, the foot remains in a supinated position through gait resulting in a lack of shock absorption and excessive strain to the lateral ankle musculature
  • Current Footwear Evaluation
    • Soccer cleats – provide limited ankle support
    • Running Shoes at school – currently wearing unsupportive running shoes with limited torsional stability, narrow through the midfoot, and no heel counter
    • No footwear worn in the house

The Pedorthist educates the patient on their findings and the importance of Footcare/Foot health.

The Pedorthist treats with:

  • Ankle Bracing
    • Strap system ankle brace dispensed with lateral rigid stays to reduce excessive ankle inversion
    • To be worn during soccer practices and games
  • Custom-made orthotics fabricated from a 3D casting


  • Rubber material used as the orthotic shell with higher lateral borders to provide shock absorption and assist in stabilizing the ankle to reduce excessive ankle inversion
  • Due to ankle brace usage, no extra medial hindfoot posting was incorporated into the orthotic
  • To be worn in all footwear
  • Footwear education
    • Advised to try to find soccer cleats with as much ankle support as possible (sides that come up as high around the ankle as possible)
    • Advised proper running shoes: shoes with a stiff midsole, wide base of support and a rigid heel counter
    • Advised footwear in the house, a slipper with the orthotics
  • Referrals to other health professionals
    • Physiotherapy referral to treat the inversion sprain with therapeutic modalities and a strengthening program