What type of Morton's Extension are you looking for?
Originally, Morton's Extensions were only for weight transfer to the 1st metatarsal when there was a long 2nd metatarsal or Morton's toe.
Morton's Extensions have been used for over 100 years. They were originally only used to support directly under the first metatarsal head when the second metatarsal head was taking too much pressure (typically with an observable long 2nd metatarsal and digit aka Morton's Toe). By doing so, Morton's syndrome feet became so much more stable.
I will talk more about this, but today let's just review the 4 classic Morton's Extensions used. They are:
- Support alone under the first metatarsal (painful 2nd MPJ) and historically, the classic Morton's Extension
- Support under the first metatarsal and onto the hallux (proximal phalanx alone, or the complete hallux) (painful 2nd MPJ with need for pronation support)
- Support under the first metatarsal and hallux with some limitation of 1st MPJ motion (painful 1st MPJ)
- Support under the first metatarsal with complete limitation of 1st MPJ motion (painful 1st MPJ)
It is extremely important when you are making the last 2 modifications to do so to treat pain. These patients typically need a more standard orthosis when they are not in pain usually including the opposite Reverse Morton's Extension (aka Dancer's Padding) seen in blue in the above illustration. The principle is to not restrict motion in any joint unless needed for pain.
This superior view shows the Morton's extension starting on the plastic and can be utilized in Type 3 or 4. Common materials used are EVAs with high durometer (inflexibility), and occasionally propylene. With this view you can imagine all of the types of Morton Extensions (with #1 just under the first metatarsal, #2 and #3 typically extending out to the sulcus, and #4 either to the sulcus or the full length of the toe as shown here).
This is a magnified view of Types 3 and 4 from the medial view again showing the Morton's extension starting on the plastic and can be used to slightly or completely to limit big toe joint motion in painful hallux rigidus situations for example.
The four examples below represent in orange the 2 types of Morton's Extensions described, and in blue, their counterparts in the 2 types of Reverse Mortons Extensions called Dancer's Padding.
These illustrations show the positions of the orange Morton's extensions and the blue Dancer's Pads (aka Reverse Morton's Extensions. I typically use poron or crepe or grinding rubber (cork and rubber) for all my dancer's pads, and Types 1 to 3 of my Morton's Extensions.
The illustrations below show the two main types of Mortons and Dancers either starting on the plastic so that some limitation of MPJ motion may be obtained, or starting where the plastic ends so that there is minimal disruption to the MPJ motion.
