Sagittal Plane Facilitation in Orthotic Design

Late-Stance Optimization

Sagittal plane facilitation focuses on improving late-stance phase mechanics to enhance propulsive efficiency. Key considerations include hallux dorsiflexion range, first ray mobility, and the windlass mechanism function during terminal stance and pre-swing phases.

Hallux Dorsiflexion Requirements

Minimum 65° hallux dorsiflexion needed for normal gait progression and windlass mechanism activation

First Ray Considerations

First ray hypermobility or hypomobility affects propulsive efficiency and forefoot stability

Clinical Implementation Strategies

Morton's Extension

Carbon fiber plate extending under first ray to facilitate hallux dorsiflexion and improve propulsive mechanics. Particularly effective for functional hallux limitus.

First Ray Cutout

Removing material under first metatarsal head allows for plantarflexion and improved propulsive function when first ray hypermobility is present.

Rocker Sole Design

Apex placement at 65-70% of total foot length facilitates rollover and reduces dorsiflexion requirements at the first MPJ.

Key Indications & Contraindications

Feature	Use When	Avoid If
Morton's Extension	Functional hallux limitus, first ray hypermobility	Hallux rigidus, first ray hypomobility
First Ray Cutout	First ray hypermobility, excessive pronation	First ray hypomobility, hallux limitus
Rocker Sole	Hallux rigidus, diabetic foot, arthritic joints	Normal MPJ function, athletic activities

When to Escalate to In-Person Care

Consider referral for severe hallux rigidus requiring surgical intervention, complex multiplanar deformities, or when conservative sagittal plane modifications fail to improve function.