Orthotic intervention should be individualized and patient or client centered. The best outcomes occur when orthotic interventions are designed with patient involvement and holistic consideration of the individual’s unique personal attributes, context, and environment. The authors discuss Shelley’s story, which illustrates an approach to orthotic intervention that is based on Engel’s biopsychosocial model and the International Classification of Functioning, Disability and Health. Fifteen guiding principles for the biopsychosocial orthotic approach are presented. Orthoses that are thoughtfully designed with patient input, carefully constructed and monitored, and modified as needed, can make a difference in a person’s life by relieving pain, providing joint stabilization, protecting vulnerable tissues and enabling valued activity and participation. This, in turn, promotes physical and emotional well-being.