Not sure I would recommend surgery without first exhausting all conservative options.

Most children adduct their feet when they learn to walk but the feet straighten out in time as their feet get stronger. If someone continues to have a hypermobile midtarsal/metatarsal joint the foot adduction continues as well. It's an avoidance of the great toe as it stops forward momentum. The foot is actually getting in the way of itself and causes a clumsy gait. The liner in the shoe will usually have a big pressure indent at the tip of the big toe.

I suggest you have him try running with a neutral Currex insole to lightly support his foot and a lighter low-stack shoe with better flexibility than the one he's wearing like the Saucony Kinvara/Brooks Hyperion. This should gently keep his foot from compressing but also unlock the front of his foot which allows a straighter foot position and fluid heel-toe follow through which will increase his knee/hip extension. Some psoas releasing and glut strengthening is also suggested to reverse his inward hip rotation from how he has been walking since he was a child.

Extended times walking barefoot on hard surfaces and shoes like soccer cleats usually aren't recommended for this issue.

Hope he feels better!

Bill Stone, CPed

Thank you, Riedinaustin. We met with a surgeon today and he encouraged us to explore the same things you recommended. We got a PT script so will see if he can assist with the gait/mechanics and we'll also give the new shoes a and some custom insoles a try.

That's great his doctor incorporates foot mechanics with the diagnosis. I have been making custom foot orthotics/insoles for 23 years and you may want to have the provider see if a 1st MTPJ accommodation built into the insole may further help.