1st Metatarsal Cut-Out

A cutout to the orthotic shell under the 1st metatarsal-phalangeal joint at the distal-medial aspect of the orthotic shell. This is designed to slightly plantarflex the 1st ray and pronate the forefoot.
Most commonly used with functional hallux limitus and supinators. A 1st metatarsal cut-out drops the first metatarsal down (into plantarflexion) and forces the forefoot into pronation,achieving a better toe-off and conversely a better heel strike.
Osteoarthritis in the 1st metatarsal, forefoot varus.
Under no circumstances should a 1st metatarsal cut-out be used on a patient with a pathological 1st toe, as this modification will act to aggravate any 1st toe pathology.