# Study of Force Changes Based on Orthotic Elements Under the First Ray
## 4 Discussion  
Although the first ray plays a fundamental role in the biomechanical stability and propulsion of the foot, especially during mid-stance and push-off, there is a lack of studies specifically addressing how different orthotic elements placed beneath this structure affect the ground reaction forces during gait. Most existing research has focused on the kinematic aspects or general effects of foot orthoses, without analyzing how targeted modifications under the first ray influence force vectors in the sagittal, frontal, and transverse planes. Understanding these effects is particularly relevant in individuals with flexible metatarsus \begin{table}
\begin{tabular}{l c c c} \hline
**Force Measurement** & **Fx** & **Fy** & **Fz** \\ \hline G1 (Mid-Stance) & 0.140 \({}^{2}\) & 0.004 \({}^{2}\) & 0.140 \({}^{2}\) \\ \hline L1 (Mid-Stance) & 0.480 \({}^{1}\) & 0.015 \({}^{2}\) & 0.107 \({}^{2}\) \\ \hline G2 (Propulsion) & 0.032 \({}^{2}\) & 0.640 \({}^{2}\) & 0.620 \({}^{2}\) \\ \hline L2 (Propulsion) & 0.436 \({}^{2}\) & 0.930 \({}^{2}\) & 0.411 \({}^{2}\) \\ \hline \end{tabular} Abbreviations: Fx, medio-lateral force; Fy, antero-posterior force; Fz, vertical force; G1: greatest values of forces during mid-stance phase; L1: lowest values of forces during mid-stance phase; G2: greatest values of forces during propulsion phase; L2: lowest values of forces during propulsion phase; \({}^{1}\) repeated-measures ANOVA; \({}^{2}\) [PERSON]’s test for related samples for a two-way analysis of variance by rank.  
\end{table} 
Table 6: Comparative analysis (\(p\)-values) of Fx, Fy, and Fz under different orthotic interventions. \begin{table}
\begin{tabular}{c c c c} \hline
**FX** & **WFO-E** & **WFO-F** & **A–D** & **A–F** \\ \hline G2 & 0.031 & \(>\)0.999 & \(>\)0.999 & \(>\)0.999 \\ \hline
**FY** & **WFO-F** & **A–E** & **A–F** & \\ \hline G1 & 0.040 & 0.490 & 0.057 & \\ \hline L1 & \(>\)0.999 & 0.031 & 0.025 & \\ \hline \end{tabular} Abbreviations: Fx, medio-lateral force; Fy, antero-posterior force; G1: greatest values of forces during mid-stance phase; L1: lowest values of forces during mid-stance phase; G2: greatest values of forces during propulsion phase; I2: lowest values of forces during propulsion phase; WFO, without foot orthosis; A, foot orthosis without elements; B, metatarsal elevation plus hallux; C, Morton’s extension; D, proprioceptive stimulation; E, a cut-out; F, a kinetic wedge.  
\end{table} 
Table 7: Post hoc tests; pairwise comparisons. \begin{table}
\begin{tabular}{c c c} \hline  & **FY** \\ \hline  & **p1** & **Effect Size** \\ \hline WFO-D G1 & 0.033 & 0.453 \\ \hline WFO-E G2 & 0.049 & 0.419 \\ \hline \end{tabular} Abbreviations: Fy, antero-posterior force; WFO, without foot orthosis; G1: greatest values of forces during mid-stance phase; G2: greatest values of forces during propulsion phase; D, proprioceptive stimulation; E, a cut-out.  
\end{table} 
Table 8: Effect size of Fy. primus elevatus, where the mechanical dysfunction of the first ray can lead to altered load distribution and an increased risk of a forefoot pathology. Therefore, this study sought to address this gap by quantifying changes in the medio-lateral (X-axis), antero-posterior (Y-axis), and vertical (Z-axis) ground reaction forces in response to different orthotic interventions applied under the first ray. The literature review [31; 32; 33; 34] highlighted the lack of podiatry studies using dynamometric platforms to analyze force vector variations in the three spatial directions with orthotics under the first ray. While some studies [35; 36; 37; 38] on human gait exist, they are not directly comparable to this research. Despite various treatments [39; 40; 41; 42; 43; 44; 45; 46] aimed at optimizing first-ray functionality and improving gait biomechanics, no classification based on force control during the gait cycle has been established, emphasizing the need for personalized interventions for metatarsus primus elevatus.