When There Is Considerable Splay Of The Toes And Significant Toe Pain With Steel Toe Boots

A patient presented with painful fourth and fifth toes on the right foot in the steel toe boots he must wear for work. He had tried a number of brands and always developed rather severe pain by the end of the day. The left foot was fine.

He had an interesting foot with considerable splay of the toes. He had a hallux varus right along with adductovarus in the fourth and fifth metatarsals with lateral splay of the fifth metatarsal. The pain was coming from pressure on the fourth and fifth metatarsals both dorsally and laterally.

The patient’s boots were a size 14C. The use of a Brannock device confirmed that his feet measured a 14C. If the Brannock device could measure width at the toes, however, his shoe size would probably be a 14EEE. To relieve his pain, he would need more room in the toe box both in depth and width. To get a boot that would not put undue pressure on the toes of his right foot, however, could result in a boot that was too large for the left foot.

Our solution was to recommend the use of P.W. Minor super-depth steel toe work boots. The P.W. Minor Hercules ST has added depth and extra space added to the forefoot area to accommodate custom orthotics. It comes in widths up to 14EEE. I referred him to a local pedorthic shoe store that carries P.W. Minor boots. The store will likely have to order the boots after sizing him and then add some fillers to the left boot so it does not feel too large.

Editor’s note: This blog was first published at https://prolaborthotics.com/Blog/tabid/90/EntryID/209/Default.aspx and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com .