A quick perusal of the “Custom Modifications” tab on the KevinRoot Medical website will lead you to several options available to help accommodate or reduce pressure under one or more of the lesser metatarsals. These may also shift weight off the big toe joint when needed. These options can be used individually or in combination depending on the given structural or functional state of the patient’s forefoot. How to choose which metatarsal accommodation to use? Please let me offer some suggestions.
The first option I will be discussing is the metatarsal pad 2-4, available in different thicknesses for 1.5 mm to 6 mm. This option is a good choice when dealing with digital contractures, such as reducible or semi-reducible hammertoe deformities. It is a good alternative to a neuroma pad in cases of Morton’s neuroma. It is also good for preventing forward slippage of the foot relative to the orthotic device. The next option is the forefoot cookie extension, which is basically a cut out on the extension padding for the middle three metatarsal heads; it can be helpful with plantar plate disruption cases with plantar prominence of the soft tissue of the forefoot. It can also be combined with the metatarsal 2-4 pad to maximize offloading of the middle three metatarsals. The metatarsal balance pad can be used to accommodate an individual metatarsal head in case of hyperkeratosis, metatarsalgia or stress reaction. The metatarsal punch is similar to the balance pad and can be used for the same purpose, but uses less space within the shoe. The metatarsal slot accommodation is a cutout for the entire ray segment (metatarsal head and digit) and is my favorite when treating post metatarsal stress fracture particularly if “floating toe” or hammertoe is present. Metatarsal bar 1-5 is a pad that cushions all five metatarsals, a good choice in a cavus foot. It is available in 4 different thicknesses. Another viable option for cushioning painful metatarsal conditions is a simple padded extension, either sulcus or full length, and/or a cushioned top cover to allow the pressure to disperse naturally.
The ability to relieve painful plantar forefoot conditions via a functional orthotic device is only limited by the practitioner’s creativity and imagination. It would also be advisable to be adaptive in treating these conditions, as it may take some trial and error with appropriate adjustments over time in order to optimize results.
