What modification would you make to an orthosis for a rigid plantar-flexed first ray deformity?

A first ray cut-out is an effective modification for addressing a rigid plantar-flexed first ray deformity. This modification involves creating a recess in the orthotic device beneath the first metatarsal to accommodate the plantar-flexed position. By doing so, it allows the first ray to function more normally during the gait cycle by reducing pressure on the metatarsal head and allowing better load distribution across the foot.

This adjustment promotes a more neutral alignment during weight-bearing activities, which can help alleviate discomfort and prevent further structural changes in the foot. It assists in redistributing plantar pressures so that the patient can achieve a more functional and pain-free gait.

The rationale behind this modification is that a rigid deformity indicates a lack of mobility in that area, and merely increasing heel height, adjusting ankle joint positioning, or adding lateral foot extensions might not effectively resolve the underlying issue of the rigid plantarflection. Hence, the first ray cut-out specifically addresses the anatomical and functional needs of the patient with this type of deformity.