At Realta Labs, we often say: orthoses are only as good as the clinical reasoning behind them. For private podiatry clinics, the real power of orthoses comes not from “supporting arches” but from understanding anatomy, biomechanics, and tissue stress in a way that makes each prescription purposeful.
The tissue stress theory asks us to identify which tissue is overloaded, why, and how to reduce that load. But you can’t identify tissue stress without knowing anatomy in detail. This isn’t just about knowing what bone connects to what it’s about insertion points, tendon pathways, and mechanical advantages.
Take two prime examples:
Posterior tibial tendon (PTT): Inserts mainly at the navicular but also fans into the cuneiforms and metatarsal bases. Its pathway around the medial malleolus makes it a key inverter and medial arch supporter. Overload here is linked to adult-acquired flatfoot deformity, posterior tibial tendon dysfunction (PTTD), and medial ankle pain.
Peroneals: Both peroneus longus (inserting at the base of the first metatarsal and medial cuneiform) and peroneus brevis (inserting at the base of the fifth metatarsal) run posterior to the lateral malleolus. Their oblique tendon pathways create a mechanical advantage; the angular deviation means they can generate strong eversion moments with relatively modest muscle force.
The peroneals’ pathway gives them leverage over the subtalar joint axis. This angular deviation allows them to produce eversion efficiently, acting as both stabilisers and antagonists to the posterior tibial tendon.
This balance between medial and lateral structures is crucial. When PTT is overloaded and weakens, the peroneals often dominate, driving further pronation. Orthoses, designed with the tissue stress model in mind, aim to:
Reduce tensile load on the posterior tibial tendon by decreasing pronation moments.
Control the peroneal advantage by modifying the ground reaction force and subtalar joint axis location.
Rebalance load across the foot to restore functional symmetry rather than simply “holding up the arch.”
When you apply this anatomical lens, the tissue stress theory becomes more than a concept—it’s a clinical decision-making tool:
Identify the overloaded tissue. For example, posterior tibial tendon in medial ankle pain.
Understand the mechanics. The tendon’s course around the malleolus places it at risk when pronation moments are excessive, especially against strong peroneal pull.
Apply orthotic design to modify stress. Adjust posting, contouring, and load redistribution to ease PTT strain while not over-restricting normal peroneal function.
This approach is just as applicable to the Achilles, plantar fascia, or tibial shaft. The key is always anatomy → biomechanics → stress reduction.
For podiatry practices, demonstrating this level of understanding does three things:
Improves patient outcomes by targeting the actual stressor, not vague “poor alignment.”
Raises clinical credibility when you explain treatments in terms of anatomy and function, not just support.
Creates replicable systems across practitioners in your clinic everyone reasoning from the same framework.
At Realta Labs, every orthosis we manufacture is built on this philosophy. We combine precise anatomical knowledge, tissue stress theory, and 3D-printed design to deliver devices that do more than support they actively manage pathological load.
When you prescribe with anatomy in mind, orthoses become precision-engineered tools to reduce stress, restore balance, and keep patients moving.