Forefoot Post

Balancing the Forefoot to the Rearfoot

The process starts by drawing a line that bisects the Achilles tendon at its posterior distal insertion, following the sagittal plane, on the positive foot model.

Next, place the foot model on a flat surface so that three points are in contact (plantigrade):

• the calcaneus (heel),
• the 1st metatarsal head,
• and the 5th metatarsal head.

Once positioned, observe the angle of the bisecting Achilles tendon line.

• If this line tilts inward (inverted away from 90°), the 5th metatarsal is elevated — this is the clinical presentation of forefoot valgus (TILTOUT™).
• If this line tilts outward, the 1st metatarsal is elevated — this is the clinical presentation of forefoot varus (TILTIN™).

Correction — Forefoot Valgus (TILTOUT™): Material is added beneath the 5th metatarsal, lowering the 5th metatarsal head and stabilising the forefoot. The goal is to restore a vertical Achilles bisection line while keeping all three plantigrade points in contact. Material is tapered smoothly from the 5th metatarsal head toward the base of the metatarsals.

Correction — Forefoot Varus (TILTIN™): Material is added beneath the 1st metatarsal, lowering the 1st metatarsal head and stabilising the forefoot. The goal is the same — a vertical Achilles bisection line with all three points plantigrade.

Perpendicular Option: If the clinician selects perpendicular alignment, the rearfoot Achilles bisection line is set to vertical. Forefoot balancing then reduces medial arch height, decreases medial orthotic reaction forces, and increases lateral orthotic reaction forces.

Adjustable Positioning: At the practitioner's discretion, the forefoot can be balanced to specific angles — 2°, 4°, 6°, or 8°. This adjustment further modifies arch height, plantarflexes the relevant metatarsal using added material, and changes the shape of both the foot model and the orthotic.

Metatarsal Wedge: A varus metatarsal wedge can be combined with forefoot posting when higher varus correction is desired. It consists of semiflexible to rigid EVA material added to the superior edge of the distal frame, extending into the forefoot and terminating at the sulcus. Recommended for angulations of 2°–6°, it can be coupled with varus intrinsic forefoot posting for cases requiring greater correction.