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It has been claimed, in past P-A threads, that orthotic intervention without a medial arch inclusion would be 'uncomfortable' for the pt., specifically for non-custom foot orthoses with just rearfoot and / or forefoot posts (wedges).
Yet the foot naturally, barefoot or shod, does not weight-bear in the Internal Longitudinal Arch so how could the omission of an orthotic intrinsic medial arch result in subsequent 'pain'?, thanks

 

I frequently use forefoot and rear foot positioned Eva wedging strip on flat EVA insoles without causing additional / new pain.

 

I have a patient with the most extreme lateral STJ axis I have seen. We have been working through various designs one of the most successful is a lateral skiv with no medial arch.

Have also built a custom orthotic brace with similar design will upload a pic or 2 later

 

Another way to look at your question is to ask what does the medial arch of an orthotic do for your. The answer is that increases forces under the medial arch and this can shift the center of pressure more medial (assuming that there is no change in muscle activity.) In the foot with a more medial STJ axis, pressure in the arch has little leverage to create a supination moment. With extreme axis position, pressure in the arch will still be on the pronation side of the axis. I have one of those feet and orthoses with high medial arches can be quite painful from applying too much pressure to the plantar arch without getting any supination motion. So, too much arch can cause pain. I agree with the other two posters on not necessarily needing a medial arch. Some feet do better with it. Some do better without it.

 

Thankyou Messrs. Spooner, Weber and Fuller.
May I quote you gents to the 'knockers'.

It has been a great day as I got my 6/12 'oncology' check and my pancreatic tumours are still benign !! and more importantly my wife and I got to see a son (and his partner) we only get to see occasionally. Enjoying life more as i get older ...

 

Not the best photo