Prescribing Orthoses For Metatarsalgia From An Iatrogenic Short First Ray

I had a patient present with lesser metatarsal pain secondary to an iatrogenic short first metatarsal. In fact, the first metatarsal head did not touch the ground, leading to rather severe pressure (and pain) under the other metatarsal heads.  

Our treatment goals were to help the first metatarsal head bear weight and transfer pressure off the lesser metatarsal heads.   

You can see in the picture at the top right how the first metatarsal head is not bearing weight. Our orthotic prescription was for a semi-rigid polypropylene orthosis with both a rearfoot post and a forefoot post. I prescribed the forefoot post with 3 degrees of varus correction to support the first ray and essentially bring the ground up to meet the foot (see photos at left).

In addition, we included a Morton's extension to support under the first metatarsal head. We left the cover unglued on the front half of the orthosis so we could modify the Morton's extension if necessary. You can see in the bottom right photo how the orthosis is now supporting the first ray and the first metatarsal head. If the patient continues to have pain, we may increase the thickness of the Morton's extension.    

Editor’s note: This blog was first published at

https://www.prolaborthotics.com/Blog/tabid/90/EntryID/200/Default.aspx and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com .