This article summarizes design methods for pile foundations subjected to axial and lateral loading. It addresses the main factors that need to be considered in a basis of design, focusing on driven steel pipe piles, which are almost universally used in offshore practice. The response of less frequently used piles grouted into stronger sediments, such as calcarenite and other weak rock, is also considered. Modern design approaches based on data from cone penetration testing are outlined. For lateral response, the main focus is on load transfer methods. Reference is also made to elastic solutions that can provide a useful approach for operational loading, particularly for large diameter monopiles such as are used in the offshore wind industry. Just as for axial loading, the potential use of cone penetration data as the basis for deriving lateral load transfer curves is also discussed. Underlying principles of the effects of cyclic loading are presented. The article concludes with brief comments on scour and seismic design, two other considerations for the design of offshore piles.