In today's episode of Workshop Live, I am going to make a metatarsal pad orthotic modification for a B7 foot type customer with rigid, tough toes, a lot of bony areas, and a slightly flexible rearfoot. B7 foot types tend to have a high rigid arch, narrow gait, small rearfoot and forefoot valgus, and pronation. Her arch is dropping down and her toes are clawing up. There is also a lot of mobility primarily coming from the rearfoot alignment and midfoot joints. Her custom orthotics have been doing pretty well, but she has developed a hammer toe on the second toe of her left foot over the last year where we had placed a larger 30 durometer EVA standard metatarsal pad, which compresses over time. She's very active and says she likes doing 3 to 4 full yoga sessions a week. So, even if you're in great shape, weird stuff happens to the body and the feet and that's what we're here for.

She has been wearing her current orthotics for about 2.5 years now and wants 2 new sets. When we're making a new set of orthotics, it takes us about two weeks to manufacture new sets. I am going to make a new standard orthotic and a slim orthotic for dressier shoes. In 2022, she had a knee replacement and had some complications with it, which is the reason we made her first set of custom orthotics. When we look at the foot, we assign a foot type quadricep foot typing system. After reassessing her foot, there were not any major changes mechanically since 2022, so I am going to use the old molds. When we do see changes, it is most common to see a change in foot types, which is often due to fallen arches from weight gain.

I am going to remove the larger standard metatarsal pads with the grinder, clean them up, and place thicker and tapered standard metatarsal pads farther up than the previous ones to help offload the hammer toe. These pads will cover the second, third, and fourth metatarsals and are made with a thicker and firmer 45 durometer EVA material.

I am also going to add standard medial scaphoid pads right off the fifth metatarsal base to cover the scaphoid area of the midfoot to help build up the medial arch as well as provide more pronation control and midfoot stability for the navicular bone. If you want more rear foot control, you can go behind more and angle it farther back. If you want more forefoot control, you can move it farther forward. I am using 65 durometer J cork material for these pads, which is firmer compared to most other multi-corks out there. 

To complete this modification, I am going to glue both types of pads on to the orthotics and smooth them out with the grinder. I think this is going to be a winning solution. She's going to come in for two new sets soon, so I think she will be in good shape and feel better than ever.

References:

"19 Toe Stretches and Exercises to Try." Healthline.

"Hammer Toes: What It Is, Causes, Relief & Treatment." Cleveland Clinic.