Custom foot orthotics are often not considered a front line treatment option for several common distal forefoot complaints. However, these conditions can all be potentially treated successfully by controlling abnormal biomechanical factors that are pathological and causative in nature.
Examples of these conditions include hammertoe deformity, both reducible and rigid, metatarsal phalangeal joint capsulitis, plantar plate disruption, isolated elongated or plantar flexed metatarsals, plantar bursitis, intermetatarsal neuromas as well as tailor bunions (bunionettes). Metatarsal stress reactions/fractures, painful hyperkeratotic lesions on the plantar forefoot can be ameliorated with functional orthotics with appropriate padded extensions. It is incumbent on the practitioner to have knowledge of the various conditions that afflict the human foot, how they present, and be able to differentiate one from the others, especially when they are present simultaneously.For example, when a patient presents with a dorsally and medially deviated and contracted second toe, while simultaneously not being able to wear a closed shoe for more than a few minutes without electric shocks shooting into the third and fourth toes. Two separate pathologies that can present independently or together, but likely have a common cause.
It behooves the specialists who treat conditions of the lesser metatarsal phalangeal joints to have an appreciation of the complexity of the anatomy and physiology of all the structures affecting the forefoot. The long flexor and extensor muscles which have multiple tendons that cross multiple joints before reaching their insertion points in the toes. The intrinsic muscles of the foot, which create stability in the forefoot and coordinate with the flexors and extensors which are the primary movers of the forefoot. The importance of the intermetatarsal ligaments as well as the plantar plates. It is very complex and problems happen easily due to very subtle errors that repeat many times each day.
It is easy to dismiss a painful corn on the toe, or a simple case of Morton’s Neuroma, treat it symptomatically or have the patient come back for surgery when they can't stand it any longer. These conditions usually have a mechanical basis for being present, therefore it is only logical to attempt to treat them from a mechanical basis as well.
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