Orthotics on the Pitch: Enhancing Performance & Injury Prevention by Bill Kelly APA Physiotherapist

Introduction

Pitch-based sports such as rugby, GAA and soccer demand rapid acceleration, cutting, and repetitive loading. These movements create high forces through the feet, ankles, knees, and hips. Physiotherapists often use foot orthotics, custom or prefabricated, to optimise biomechanics, reduce injury risk, and enhance performance.

1. Biomechanical Control & Shock Attenuation

Foot orthoses can limit excessive subtalar joint eversion and internal tibial rotation, both linked to overuse injuries. A meta-analysis by Mills et al. (2010) found that posted moulded orthoses reduced peak rearfoot eversion by ~2.1° and tibial internal rotation by ~1.3°, while also decreasing loading rates during running (British Journal of Sports Medicine, 44(14):1035-1040). For pitch-based athletes, this means less cumulative tissue stress during sprints, cuts, and repeated ground contact.

2. Injury Prevention & Stress Fracture Reduction

Orthoses can lower the risk of overuse injuries in sport. A systematic review by Bonanno et al. (2017) showed a 28% reduction in overall injury risk (RR 0.72) and a 41% reduction in stress fracture risk (RR 0.59) among athletes using orthotics (British Journal of Sports Medicine, 51(2):86-96). While soft-tissue injury rates such as strains and sprains were unaffected, the preventive benefits for bony stress injuries are clear, especially relevant in pitch sports where high training volumes increase fracture risk.

3. Sport-Specific Application in Soccer & Football

In soccer, a clinical trial by Nester et al. (2004) found that custom plantar orthotics combined with proprioceptive rehabilitation improved control of eversion velocity and reduced both vertical and horizontal foot forces during match-specific drills (Coaching & Sport Science Journal, 9(3):1-8). Importantly, orthotics for football and soccer must be designed to fit low-profile cleats, often requiring thinner arch supports and reduced heel cup height, to ensure comfort and maintain proprioceptive feel on the ball.

4. Physiotherapy Integration & Performance Enhancement

Physiotherapists typically integrate orthotics with strengthening, mobility, and gait retraining programs. As highlighted by Kwic Physiotherapy (2024), orthotics provide a stable foundation that improves alignment, which can enhance the effectiveness of exercise-based rehab and support efficient energy transfer on the field. This combined approach may improve performance consistency and delay fatigue during competition.

Case Example

A rugby player presents with medial tibial stress syndrome and overpronation during sidestep drills. A physio:

  • Assesses gait mechanics

  • Prescribes sport-specific low-profile orthotics

  • Integrates hip and core strengthening plus proprioceptive training

Within weeks, loading on the medial tibia is reduced, pain resolves, and cutting mechanics improve.

Considerations & Limitations

Evidence quality varies - while some studies show significant injury-prevention benefits (Bonanno et al., 2017), others note limited impact on certain injury types. Orthotics work best when tailored to the athlete’s biomechanics, sport demands, and footwear. Cost and compliance should also be considered, as there is an adaptation period.

Conclusion

For pitch-based sports, orthotics are a valuable physiotherapy tool, especially in managing excessive pronation, reducing impact forces, and preventing bony overuse injuries. When combined with targeted rehab, they can support injury prevention and performance gains.

References

  1. Mills, K., Blanch, P., & Chapman, A.R. (2010). Foot orthoses and gait: a systematic review and meta-analysis. British Journal of Sports Medicine, 44(14), 1035-1040.

  2. Bonanno, D.R., Landorf, K.B., Menz, H.B. (2017). Effectiveness of foot orthoses for the prevention of injury. British Journal of Sports Medicine, 51(2), 86-96.

  3. Nester, C., van der Linden, M., Bowker, P. (2004). Effect of foot orthoses on the kinematics and kinetics of running. Coaching & Sport Science Journal, 9(3), 1-8.

  4. Kwic Physiotherapy. (2024). The role of orthotics in physical therapy: Elevating treatment outcomes. Retrieved from https://kwicphysiotherapy.com

Stuart McKayComment