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Morton Foot Structure

Posted by Freddie N. on 9/13/00 at 20:00 (028150)

I have moderate flat feet along with a morton foot structure. My left foot is much worse than the right. My left first metataral doesn't bear any weight.
I have worn several pairs of orthotics for 12 years but no Dr. ever mentioned the morton foot structure. In the last pair of perscription orthotics the DPM even ordered a notch cut under the first metatarsal to aid walking. The orthotics were okay for 2 years, but immediately caused me problems after the DPM put a new thick cover on. This caused me much pain under and behind the 1st metatarsal bone.

Shouldn't these orthotic address the morton structure and possibly raise the padding under the 1st metatarsal so it will bear weight?

Re: Morton Foot Structure

Dr.Zuckerman on 9/13/00 at 21:01 (028159)

It sounds like there is too much bulk in that area of pain. A morton foot structure is very common. The first metatarsal bone is short.
The second metatarsal bone is excessively longer. All of the weight is placed on the 2nd met head. If the first met head is also elevated then you need what is called a morton extention placed into the orthosis. Think of it as a piece of material placed under the first
metatarsal bone. Much like a three legged chair with one leg shorter then the rest. You place a book under the short leg to balance and distribute the weight and stop the rocking of the other leg. I hope this is confusing you. I just though of another possible reason for the pain . It's possible that the morton extention is too much or the material is placed in addition to the first met bone it is also covering the medial cuneiform and maybe the navicular bone. Any way this can be fixed very with ease.

Re: Morton Foot Structure

Freddie N. on 9/14/00 at 08:35 (028198)

Thanks Doc for the speedy reply

Regarding the previous message, I never a Morton foot correction on my orthotic but I think it would probably help. I figure I could tap a small piece of Dr. Scholl pad onto the area of the orthotic.

I wonder about the effect of wearing an orthotic with a cutout under the first metatarsal bone which was suspended and weight bearing was completely upon the soft areas behind it. Do you think this may have damaged or strained the PFascia that connects to 1st met. Any ideas?

Re: Morton Foot Structure

Dr. Biehler on 9/14/00 at 14:13 (028215)

A cut out under the first met head is sometimes used with a plantar flexed first metatarsal or a functioal hallus limitus.It is suposed to let the first met head drop down. If your first ray in not bearing weight and doesn't drop, a mortons extention brings the ground up to the met head. If your met was suspended by support proximal to the met head and the a cut out was put under the met head, you are heading for painful problems.

Re: Morton Foot Structure

Feddie N. on 9/15/00 at 09:39 (028282)

Yes, the new orthotics did cause me achilles tendonitis, heel pain and terrible pain at 1st met.) I wore those orthotics from 2 1/2 yrs. w/o any significant problems but the cover got worn and the DPM put on this new really thick cover (3/16')which immediately caused me pain. The dpm stated my foot would break them in. I wore then wore these orthotics for (1 more month) At this point I was barely able to stand or walk with the use of a cane. I think the new covers pushed me over the edge because the cutout height increased and my whole big toe could not touch the ground. I have worn polysorbitane ultra graphite arch supports since 07/99 would good results but the pain under 1st met has resurfaced with out someone tinkering with it. Thats why I was thinking that I might need to support the 1st met.
---------------
Brief history follows:
1) 1988-1995 wore 1 rigid pair orthotic from DPM, felt fine but moved.
2) 1995 had achilles strain from exericse equip., went to see O.Surgeon. who instead blamed pain on my old orthotics. He sent me to pedorthist which proceeded to kill me with inappropriate shoes, buildups, heel wedges etc. All I wanted them to do is fill an RX for a semirigid orthotic.
3) 1995 went back to old rigid orthotics but they now hurt my sore left foot.
4) 05/1996 went to new Dpm who gave me rx for advanced pair of orthotics with a cutout. The ortitist fitted me personally and they felt good.
5) 03/1999 I went back to DPM because I wanted a new cover from ortitist but the dpm slapped one on it the office, it immediately felt bad and hurt my feet more than ever before. I was reduced to walking with a cane. The dpm stated that I go and experiment with over the counter devices.
6) 06/1999 I found polysorbitane ultra graphite arch. It was soft enough for my sore feet but still offered me some support.
7) 09/2000 the pain resurfaced without any tinkering so i'm considering a morton correction. WHAT DO YOU THINK?

Thank You so much for the feedback. It was so hard to go from an active person and dancer to the guy limping with the cane. I can't
really talk to my DPM about it. I blame myself for letting people hurt my feet.

Re: Morton Foot Structure

Dr. Biehler on 9/15/00 at 20:38 (028338)

Your feet change over the years. It would be good if you could go back to the orthotits that made the orthotics that felt good. I know once an individule finds a pair of ridgid orthotics that work, it is almost impossible to find anothe type that also do well. If orhtotics don't feel good, don't wear them. Even ones that need to be broken in feel good for the first few hours.

Re: Morton Foot Structure

Dr.Zuckerman on 9/13/00 at 21:01 (028159)

It sounds like there is too much bulk in that area of pain. A morton foot structure is very common. The first metatarsal bone is short.
The second metatarsal bone is excessively longer. All of the weight is placed on the 2nd met head. If the first met head is also elevated then you need what is called a morton extention placed into the orthosis. Think of it as a piece of material placed under the first
metatarsal bone. Much like a three legged chair with one leg shorter then the rest. You place a book under the short leg to balance and distribute the weight and stop the rocking of the other leg. I hope this is confusing you. I just though of another possible reason for the pain . It's possible that the morton extention is too much or the material is placed in addition to the first met bone it is also covering the medial cuneiform and maybe the navicular bone. Any way this can be fixed very with ease.

Re: Morton Foot Structure

Freddie N. on 9/14/00 at 08:35 (028198)

Thanks Doc for the speedy reply

Regarding the previous message, I never a Morton foot correction on my orthotic but I think it would probably help. I figure I could tap a small piece of Dr. Scholl pad onto the area of the orthotic.

I wonder about the effect of wearing an orthotic with a cutout under the first metatarsal bone which was suspended and weight bearing was completely upon the soft areas behind it. Do you think this may have damaged or strained the PFascia that connects to 1st met. Any ideas?

Re: Morton Foot Structure

Dr. Biehler on 9/14/00 at 14:13 (028215)

A cut out under the first met head is sometimes used with a plantar flexed first metatarsal or a functioal hallus limitus.It is suposed to let the first met head drop down. If your first ray in not bearing weight and doesn't drop, a mortons extention brings the ground up to the met head. If your met was suspended by support proximal to the met head and the a cut out was put under the met head, you are heading for painful problems.

Re: Morton Foot Structure

Feddie N. on 9/15/00 at 09:39 (028282)

Yes, the new orthotics did cause me achilles tendonitis, heel pain and terrible pain at 1st met.) I wore those orthotics from 2 1/2 yrs. w/o any significant problems but the cover got worn and the DPM put on this new really thick cover (3/16')which immediately caused me pain. The dpm stated my foot would break them in. I wore then wore these orthotics for (1 more month) At this point I was barely able to stand or walk with the use of a cane. I think the new covers pushed me over the edge because the cutout height increased and my whole big toe could not touch the ground. I have worn polysorbitane ultra graphite arch supports since 07/99 would good results but the pain under 1st met has resurfaced with out someone tinkering with it. Thats why I was thinking that I might need to support the 1st met.
---------------
Brief history follows:
1) 1988-1995 wore 1 rigid pair orthotic from DPM, felt fine but moved.
2) 1995 had achilles strain from exericse equip., went to see O.Surgeon. who instead blamed pain on my old orthotics. He sent me to pedorthist which proceeded to kill me with inappropriate shoes, buildups, heel wedges etc. All I wanted them to do is fill an RX for a semirigid orthotic.
3) 1995 went back to old rigid orthotics but they now hurt my sore left foot.
4) 05/1996 went to new Dpm who gave me rx for advanced pair of orthotics with a cutout. The ortitist fitted me personally and they felt good.
5) 03/1999 I went back to DPM because I wanted a new cover from ortitist but the dpm slapped one on it the office, it immediately felt bad and hurt my feet more than ever before. I was reduced to walking with a cane. The dpm stated that I go and experiment with over the counter devices.
6) 06/1999 I found polysorbitane ultra graphite arch. It was soft enough for my sore feet but still offered me some support.
7) 09/2000 the pain resurfaced without any tinkering so i'm considering a morton correction. WHAT DO YOU THINK?

Thank You so much for the feedback. It was so hard to go from an active person and dancer to the guy limping with the cane. I can't
really talk to my DPM about it. I blame myself for letting people hurt my feet.

Re: Morton Foot Structure

Dr. Biehler on 9/15/00 at 20:38 (028338)

Your feet change over the years. It would be good if you could go back to the orthotits that made the orthotics that felt good. I know once an individule finds a pair of ridgid orthotics that work, it is almost impossible to find anothe type that also do well. If orhtotics don't feel good, don't wear them. Even ones that need to be broken in feel good for the first few hours.