A review of recent literature indicates several divergent perspectives are used currently in managing patients with spastic lower extremities. The intent of this article is to analyze methods presented in published clinical orthotic studies regarding biomechanical and neurophysiological approaches to tonereducing orthoses. Each management rationale will be briefly summarized, including biomechanical, primitive reflex activity, pressure over muscle tendons, prolonged stretch, and orthokinetics. Results of lower-extremity orthotic studies will be reviewed. Discussion will focus on current research efforts and indications for future clinical practice.