41 year old female, working as an Educational Assistant, presents with pain during walking on the 1st,3rd and 5th metatarsal heads R>L. She has been a highland dancer for 30 years and has had a previous stress fracture on the left foot more than 5 years prior.

Previous treatments:

  • seen by General Physician X-ray taken unremarkable
  • seen by Sports Medicine Doctor MRI taken; was put in an off loading boot for the right foot for 8 weeks minimal effect
    • MRI results indicated edema at the site of the sesamoid of the right foot; edema at the site of the right navicular
  • Chiropractic Treatment: soft tissue and joint mobilization, still has chronic pain after 10 months of treatment

The Chiropractor referred the patient to the Pedorthist who conducted an extensive history and assessment including range of motion testing, gait analysis, and footwear evaluation:

  • ROM/Non weight bearing Evaluation
    • Pes Cavus (high arch) NWB foot structure
    • Limited motion at the Subtalar Joint (STJ) and Talocrural Joint (TCJ)
    • Normal Range of motion at all other major foot/ankle joints
    • Dropped transverse arch
    • 1st MPJ callusing medially with mild edema
  • Weight Bearing Evaluation
    • Neutral foot structure upon weight bearing, with mild abduction of the foot.
  • Gait analysis
    • Excessive distal lateral heel strike bilateral
    • Intermittent medial hallux toe off on the right
    • Abducted Gait Bilateral (“Too many toes”)
  • Current Footwear Evaluation
    • Asics GT 2000, currently worn out

The Pedorthist educates the patient on their findings and makes the following recommendations:

  • Footwear
    • Replace worn out footwear with a neutral cushioned runner with:
      • a firm rocker sole forefoot. The firm rocker sole alleviates pressure and reduces flexion at the painful metatarsal heads.
      • wide, deep toe box to avoid pressure on the metatarsal heads
      • Removable insole to accommodate an orthotic


  • Mechanical
    • Metatarsal support placed into current dance footwear to support the plantar aspect of the metatarsal heads.
    • Custom Foot Orthoses or Over the Counter Insoles advised for work shoes.
      • Fabricated from a 3D casting of the foot https://www.pedorthic.ca/insurance-providers/casting/
      • provide support to the medial longitudinal arch as well as the metatarsal arch (with a metatarsal pad) to offload the painful metatarsal heads.
      • Cushion under the painful metatarsal heads
    • Referrals to other Health Professionals
      • Reports back to the referring professional (Chiropractor)