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Dec 7

Written by: Larry Huppin, DPM
12/7/2009 12:23 PM

I had a question from a client this morning regarding a patient with hallux limitus. They wanted to know if they should include a first ray or first metatarsal cut-out on the orthosis.  A first ray cut-out is shown below on the left and a first metatarsal cut-out on the right.

The idea behind a first ray/first metatarsal cut-out is to cut away the medial distal portion of the plate of the orthosis in order to let the first ray plantarflex more effectively. When the first ray is allowed to plantarflex the windlass mechanism functions normally and compression is reduced in the first MPJ and tension is reduced in the plantar fascia. This would seem to be a good idea. So why do we rarely recommend it?


Primarily, we don’t recommend 1st ray cut-outs and 1st metatarsal cut-outs very often because there are better ways that an orthosis can encourage plantarflexion of the first ray and by narrowing the front edge of the orthosis, the first ray cut-out destabilizes the orthosis. I’ll list those methods below and then you can use the links to read further about them elsewhere on this website. If you are a ProLab client, feel free to call one of our medical consultants to discuss this further.

How to encourage the first ray to plantarflex:

When the above do not provide adequate relief, then I will sometimes try the first metatarsal cut-out. But I never include it in my initial prescription.

We encourage you to read the following information on hallux limitus as it address this issue:

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2 comments so far...

Re: First Ray Cut-outs for Foot Orthotics: Why We Rarely Recommend this Modification

Would you recommend a first ray cut away for a pes cavus foot with plantar flexion of the 1st ray only?

By Julie on   10/27/2013 6:55 AM

Re: First Ray Cut-outs for Foot Orthotics: Why We Rarely Recommend this Modification

A first ray cut out is usually not necessary, but it depends on the quality of the negative cast and the positive cast. If you have a quality negative cast and quality cast work, the orthosis should conform well to the arch of the foot and no cut-out will be necessary. If you have an orthosis that gaps from the arch the cu-out may be helpful.

I'll write a blog post on this subject. Look for it toward the end of this week.

Larry Huppin

By LH1000 on   10/27/2013 6:55 AM

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