Simple dimple: I have very few patients who complain of metetarsal head pain when I place a met pad on the orthotic. I have found that most who complain of a met pad usually have a "rock hard met pad " that is too high (akin to walking on a red indian rubber ball) Most met pads are too rigid.
Simple rule I found works: I always go small, low profile, soft (ppt like material) met pad and I place it just slightly distal to the shell and I always have great results. I find children usually under 16 usually dont like it unless they have severe pes cavus feet with dropped met heads and symptoms. If ball of foot hurts...met pad it...see what happens.....
Met pads get a "negative" rap as most are too high, too hard,
and placed in bizarre spots and patients will actually "tell you" NOT to put it on lol