Loading, Please Wait... 1st Metatarsal Cut-Out Description  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. Uses 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. Contraindication Osteoarthritis in the 1st metatarsal, forefoot varus. Notes 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.