10/09/2026
Off-Loading the 1st Metatarsophalangeal Joint: A Practical and Targeted Orthotic Modification
Pain and excessive pressure around the first metatarsophalangeal joint can significantly affect a patient’s comfort, gait and everyday activities.
Effective offloading is not simply about adding more cushioning beneath the foot. It requires understanding where tissue stress is occurring and applying a modification that redistributes pressure away from the affected area.
In this video, we demonstrate one of our go-to techniques: creating a relief channel beneath the 1st MTPJ using a slow-recovery PORON® pad within a Slimflex device.
🔹 Accurate localisation is essential.
The joint must be precisely marked and referenced against the patient’s actual foot position. Even a well-designed modification may be ineffective if it does not correspond with the symptomatic or high-pressure area.
🔹 Material placement matters.
The PORON® pad is positioned within the orthotic construction and carefully shaped to provide localised cushioning and pressure redistribution.
🔹 Blending is as important as the cut.
A relief channel without smooth transitions and feathered edges may simply transfer pressure to adjacent structures. Careful grinding and finishing help create a modification that the patient can comfortably and consistently wear.
This technique should always form part of a broader biomechanical assessment that considers the patient’s presentation, gait, footwear, activity level and treatment objectives. The size, depth and position of the modification must be tailored to the individual.
For clinicians managing forefoot pathologies, small refinements like this can make the difference between an orthosis that is merely tolerated and one that is genuinely effective.
Have you used a similar approach to offload the 1st MTPJ, or do you prefer a different material or relief design?
