###### Abstract  
Background: This study examines the effect of two types of custom-made foot orthoses (CFOs) in patients with structural hallux limits (SHL). Methods: In this quasi-experimental, repeated measures study, 24 participants with SHL were sampled. Two CFOs--cut-out CFO and anterior stabilizer element (AFSE) CFO--were compared using minimalist SAGURO neoprene shoes: no foot orthoses (FO), cut-out CFO, and AFSE CFO. Plantar pressures and center of pressure (CoP) displacement were measured using a Podoprift(r) platform. Results: Both CFOs shifted the CoP medially during middance (\(p<0.001\) with AFSE CFO and \(p=0.0036\) with cut-out CFO). The AFSE CFO showed a more anterior CoP in middance, while the cut-out CFO affected anterior CoP in middance and pre-swing. The AFSE CFO significantly increased pressure in the second toe, lesser metatarsal heads (MTH), midfoot, and rearfoot. In contrast, the cut-out CFO decreased pressure in the second MTH and lesser toe regions, increasing pressure in the midfoot and heel. Both CFOs lowered the hallux/first MTH ratio compared to shed without CFO. Conclusions: The cut-out CFO led to medial and anterior CoP displacement, reducing lateral foot and hallux pressure while transferring loads to the first MTH. The AFSE CFO caused a similar shift by increasing loads on the first MTH. h +
Footnote †: journal: _Sciences_  
_Article_  
The Direct Impact Effect of Different Foot Orthotic Designs on the Plantar Loading of Patients with Structural Hallux Limits: A Quasi-Experimental Study  
[PERSON], [PERSON]-[PERSON]-S.  
This foot condition may have multiple etiologies [7; 8], however, in the case of an FHL, authors are pointing towards excessive pronatory forces across the joints of the rearfoot and midfoot affecting first ray function during propulsion [4]. Symptoms of HL, which may start mild, typically worsen over time. These symptoms include pain in the first metatarsophalangeal joint (MTPJ), anesthesia around the hallux, and changes in plantar loading during dynamic activities [1]. Understanding the distribution of plantar pressures is crucial in the evaluation of foot function during gait, as it provides valuable insights into how structural changes or pathologies affect the foot and ankle during dynamic activities such as walking [9]. The measurement of plantar pressures offers the ability to detect pathological patterns associated with various foot conditions, which in turn helps in diagnosing and treating them. The typical trajectory of the center of pressure has been established in healthy individuals [10], but deviations from this trajectory are often seen in patients with structural or biomechanical alterations of their foot [11; 12; 13]. Therefore, studying plantar pressures is essential, not only for understanding foot biomechanics, but also for identifying characteristic patterns associated with specific pathologies. Numerous studies have indicated that patients with HL exhibit altered plantar pressure distribution [5; 14; 15; 16; 17; 18; 19]. Previous research has shown that areas with higher pressures may lead to dermatological conditions such as the development of plantar callus or hyper-keratosis [19]. This alteration causes pain in patients due to overloading. Despite many patients reporting symptoms related to plantar overloading, such as metatarsalgia and plantar callus formation, the distribution of plantar pressure in patients with HL has not received as much attention compared to other forefoot conditions. The few studies that assessed the plantar pressure distribution reported an increase in the peak pressure and loading rate under the hallux and the central metatarsal heads (MTH) [18]. However, one study also reported increased peak pressures in the rest of the toes as well [14]. Because of these alterations, a reduced weight-bearing of the first MTH has been reported [18]. In the case of mild to moderate HL, therapists often apply conservative treatments, including functional taping [8], exercises, and manipulations [20; 21].