A patient came in today with 5th toe pain. This is a patient who has functional hallux limitus with transfer metatarsalgia and associated pains. She presented with a pair of great custom molded functional foot orthotics, with a shell that supported and corrected her foot appropriately. A minor modification to the soft materials could make this orthotic more effective. I added a top cover and a 3mm cork reverse Morton’s extension. While this fit fine in the athletic shoes she had in the office, she headed out for a hike the following weekend in different footwear and reported back to the office the following week with new symptom of 5th toe pain.

Clearly the top cover with the added cork extension was too thick. A simple, quick fix for this is to leave the accommodation in place and simply mark the location of the 5th toe in weight bearing on the device. Next, thin the portion of cork below the marking with the grinding wheel. The patient loved it!

Before removing any modifications, stop and ask why it didn’t work. I troubleshoot orthotics frequently and many times a tiny adjustment to stop irritation can make all the difference.