What is the role of the functional foot orthosis in the management of bunion deformities?
Dr. Blake calls functional orthotics a “double-edged sword” when it comes to bunions. On the positive side, he notes they can shift weight laterally and proximally, unloading the first metatarsal head. On the negative side, he says functional orthoses can crowd shoes and place a dorsiflexory force on the first metatarsal, limiting propulsion and further jamming the first ray. Sometimes, functional devices act solely as an attachment for a reverse Morton’s extension. If the foot continues to pronate on a plastic orthotic, Dr. Blake says the first ray gets jammed. In cases like these, he says full pronation support is better than 70 or 80 percent support. When it comes to reducing joint pain associated with either hallux abducto valgus (HAV) or functional hallux limitus, Dr. Burns cites the efficacy of functional orthotic control. When the first ray is flexible, he feels it is helpful to plantarflex the ray a bit when taking the impression. As he notes, OTC supports are often not adequat
