48 year old male, working as a farmer, presents to their Primary Care Provider with bilateral forefoot pain with the sensation of stepping on a stone, localized under the 2nd metatarsal head. They are then diagnosed with: 2nd MPJ capsulitis. The patient was referred to a Canadian Certified Pedorthist for evaluation and treatment. https://pedorthic.ca/find-a-pedorthist/

The Pedorthist conducts an extensive history and assessment including range of motion testing, gait analysis, and footwear evaluation. The Pedorthist finds:

  • ROM/ Non Weight Bearing Evaluation
    • Heavy callusing under metatarsal heads and heels. Callusing worse under the 2nd metatarsal heads bilateral
    • Mortons toe present bilateral (shortened first ray)
    • Prominent 2nd metatarsal head with palpating bilateral forefoot
    • ROM, tightness through talocrural joint dorsiflexion and midfoot inversion/eversion
  • Weight Bearing Evaluation
    • Bilateral pes cavus foot type
    • Bilateral dropped transverse arch
  • Gait analysis
    • Heavy heel strike
    • Supination during midstance and into toe off
    • Minor varus moment through knees during midstance
  • Current Footwear Evaluation
    • Above the ankle steel toe boots at work, fit well and well structured
    • Cowboy boots in leisure time
      • Inappropriate for foot condition due to tight toe box with no rocker sole at the forefoot
      • Advised to wear a shoe with a wider toe box and a rocker forefoot to offload the painful metatarsal heads

The Pedorthist educates the patient on their findings and the importance of Footcare/Foothealth.

The Pedorthist treats with:

  • Custom made orthotics fabricated from a 3D casting


  • EVA (rubber) material used for the shell of the orthotic
  • Heel cushion to aid in shock absorption at heel strike
  • Metatarsal pads to support the transverse arch
  • Excavation (removal of material) under 2nd metatarsal heads bilateral
  • Footwear education
    • Work footwear was suitable, but leisure footwear (cowboy boots) may be causing too much pressure on the forefoot, advised to limit use while standing.
  • Referrals to other health professionals
    • Refer to a physiotherapist for stretching for posterior chain musculature (to increase talocrural joint range of motion)
    • Referral to Chiropodist or Footcare nurse to pare down the heavy callusing on metatarsal heads and heels