The SHIFT Project proposes a kinetic paradigm for orthotic therapy, moving away from kinematic models based on geometric correction of foot posture. It defines foot orthoses as devices that modulate ground reaction forces and joint moments—often without altering observable foot posture. Rather than relying on highly contoured designs, flat insoles with regionally varied stiffness can modify ground reaction force vectors, shift the center of pressure relative to joint axes, alter internal joint moments, and thereby reduce tissue stress.

This review challenges the traditional belief that foot orthoses function by correcting the alignment and movement patterns of the knees, hips, and spine. Research indicates that while these devices are clinically beneficial, they produce negligible changes in the actual kinematics, or joint angles, of the proximal joints and torso. Instead, the evidence suggests that orthoses act primarily as kinetic modulators, altering the internal forces and pressure distribution across the lower limbs. These findings also suggest that visual gait analysis may be an unreliable method for evaluating orthotic success because the most significant changes occur in loading patterns rather than visible motion. Consequently, the presenters advocate for a paradigm shift in clinical practice, moving away from a focus on skeletal positioning toward a better understanding of force management. This transition reconciles historical theories with modern data to provide a more accurate mechanical explanation for how foot inserts alleviate musculoskeletal pain in the proximal joints.

This podcast introduces a kinetic framework for evaluating limb-length discrepancy (LLD), moving away from traditional postural narratives and static measurements. The presenters argue that because small anatomical differences often overlap with measurement errors, clinical focus should shift toward how these inequalities affect asymmetrical loading over time affecting long-term joint health. By utilizing dynamic plantar pressure mapping, practitioners can identify specific load signatures, such as differences in impulse, stance time, and regional force distribution. This methodology prioritizes the mechanical consequences of gait over simple millimetre counts to better manage risks like osteoarthritis. Ultimately, the proposed protocol emphasizes a measure-intervene-remeasure cycle to ensure that orthotic adjustments positively modulate the body's interaction with the ground.