Athletes often suffer from recurrent or chronic overuse symptoms of the lower extremities. During the office visit it is essential to analyse the patient's shoes, gait cycle, lower extremities and, especially, the talocrural, subtalar and more distal joints of the ankle and foot. The basic (clinical) biomechanical analysis can be supplemented by radiographs, treadmill and video analysis and mirror table (podoscope) examinations. Ideally, successful pain relief by correction of the observed abnormality with an orthotic device completes the diagnostic procedure, especially if symptoms return soon after the removal of the device. In treatment custom-made, expensive orthotics should not be prescribed for overuse symptoms without an obvious malalignment, for asymptomatic athletes with a malalignment, or for symptoms in which the causal relationship between the biomechanical abnormality and symptoms is difficult to see. Strict indications for prescription of orthotics and close cooperation between the attending physician, physical therapist and orthotist are prerequisites for obtaining good, long-lasting results.