Short 1st metatarsal - is it the cause of specific foot pathology?

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Hi all

I have a patient who has very short 1st mets compared to the second met length.
I thought I would research the expected pathology of short 1st met. The reason I did this was that although both 1st mets were the same length i.e. short, and about the same stiffness to GRF, as far as a manual test can show, the left had a painful 2nd met head and the right did not and yet on the pressure mat the longer and higher pressure is on the left 2nd met as you might expect but the right has more pressure on the 1st met, which you might not expect if current theory on the short 1st met causing increased loadin gof the 2nd met head is correct. ref -http://www.latrobe.edu.au/podiatry/Metatarsallengthvariations.html.

Anyway I came across this paper by Harris and Beath (attached below) which is interesting, old but interesting and quite powerful in its sample population size, although only relevant to young males.

What do you think about their finding and conclusions. Should we rethink this or is this paper well known and explained.

When we see a painful 2nd mpj that is due to excessive pressure and we prop the 1st met with a mortons extension then that will tend to reduce 2nd mpj pressure but because the ray is short it does not tend to result in a FncHL. If we do the same to same length or a long 1st met then this will extend the medial arch excessively and tend to FncHL. So we use a different method to off load the 2nd mpj that is painful.

Do we then make the wrong conclusion, that the short 2nd met causes 2nd MPJ overload, because the intervention works as predicted?

Your thoughts please!

Regards Dave