The forefoot encompasses the area of the foot from the ball of the foot to the toes. Relatively speaking it is a small part of the foot but there are numerous conditions that occur in the ball of the foot that will respond to an orthotic. Even though toes in general terms will not benefit from the use of an orthotic, the device may be used at times to help straighten what is known as flexible hammertoes.
Actually an orthotic, rather than helping with toe issues may aggravate toe problems. How is this possible? Many orthotics both prescription and off the shelf as well as drug store bought arch supports are constructed as full length devices meaning they support the foot from the heel all the way to the end of the toes. The problem with orthotics that extend to the toes is that the extra length of orthotic does absolutely nothing in serving the needs of the patient and the particular foot problem being addressed. (The only argument for a full length orthotic would be in diabetic neuropathy or any neuropathy for that matter where we are trying to reduce friction against the skin.)
The reason a full length orthotic does more harm than good for the average person is because the extra length of the orthotic only ends up crowding the toes in the front of the shoes. Yes, if a person only wears sneakers and casual laced shoes or even work boots, this can be of a minor issue, but most people, particularly women wear shoes with a tight toebox which is bad enough for the toes, but then placing an orthotic cushion of some sort in that area, further reduces room for the toes.
Keep in mind that the control of an orthotic is from the heel to the ball of the foot; everything beyond that is just basically "filler". I would say that easily 98 percent of the prescription orthotics that I have had made for patients over the years have been to the sulcus, which means the orthotic topcover extends a little bit beyond the ball of the foot. The reason for this is that many people have trouble getting used to the "drop off" that occurs if the orthotic just ends at the ball of the foot. Having said that, I will also admit that a small percentage of patients have had trouble in adjusting to my orthotics that end before the toes. They just do not like feeling the end of the orthotic.
In instances where a patient comes to me with prescription full length orthotics from another doctor, I have always had the good sense to make their new pair full length as well because I know this is where their comfort level lies.
Orthotics that do not extend full length give the wearer more versatility in their shoe selection. Typically if you try a full length orthotic in a shoe that is too narrow or the toebox is not high enough, there is a good chance the patient will develop a corn on one or more of their toes as well as inflaming a bursitis on their toes, usually the fifth toe.
In this section I am going to discuss conditions of the forefoot that can be treated with an orthotic. This is not the only treatment available for these conditions but it is one which is safe and cost effective.
Some of foot conditions I will discuss include metatarsalgia, capsulitis, sesamoiditis, Morton's neuroma, hallux limitus, intractable plantar keratoma.