After wearing foot orthotics (3/4 length design) for 2 weeks, the patient complains that the orthotic is digging into the metatarsal heads; what is probably the issue?

The appropriate issue in this scenario is related to the length of the orthotic. When a 3/4 length orthotic is digging into the metatarsal heads, it suggests that it may be too long. Ideally, a 3/4 length orthotic should end before the metatarsal heads to provide proper support without causing pressure or discomfort in that area.

When orthotics extend past the forefoot or do not accommodate the proper length, they can cause direct pressure on the metatarsal heads, leading to discomfort or pain. Properly fitted orthotics should ensure that they allow enough space for the toes and forefoot to function without restriction, minimizing the risk of irritation.

In contrast, issues of being too short would typically result in a lack of support throughout the arch or heel, rather than discomfort specifically at the metatarsal heads. Concerns regarding width would relate to the orthotic compressing the foot laterally or not fitting properly into the shoe, while being too wide would generally not lead to heading pressure but could result in instability. Thus, the indication of the orthotic digging in directs to it being too long and causing misalignment in foot dynamics.