What can you do to your orthotic rx to help decrease pain to this area!!
In addition to a well contoured, minimal arch fill, wide and deep heel cup device, I make sure I am holding the patient out of maximal pronation with a combination of inversion of the device and medial skiving.
Once this device is posted then I add a top cover (spenco,EVA, sport cover) is to the toes with a reverse morton extension using cork to the sulcus level.
Sometimes the patients will still have pain and I find relief in reinforcing the sub 1st met head region with poron for cushioning to the sulcus level. This is an easy addition in the office and your patients love you.
Also, evaluate the shoe you are placing the orthotic in and make sure it isn’t worn out or too flexible. The orthotic needs a nice stable flat base to function on.