Patient presented with a painful met head (2nd met). He is already wearing some custom molded orthotics and someone had added a met pad to the device. He removed it due to increased pain. What was the problem? What are your options?

Answer: I could still see the outline of the prior met pad location and it was too far distal on the device and created a dorsiflexion stress and therefore overload to the 2nd met head … You can simply explain this to the patient and place it in the correct location or, since this patient was not interested in the met pad at all anymore, I placed a cork forefoot extension on the orthotic beneath the top cover and cut out a slot beneath the 2nd met head. This is another way to offload the area and not create more bulk to the top of the device. The patients pain was reduced and we will see how he does.

You can perform similar adjustments to other painful metatarsal heads!!