It is common to have to make orthotic adjustments for a prominent fifth metatarsal base. However, it is important to note on the prescription form whether the styloid process is prominent laterally or plantarly. There is a distinct difference in accommodating for these two.
If the styloid is prominent plantarly, I recommend using a sweet spot. If it is prominent laterally, I would recommend adding extra lateral extension at the base of the fifth metatarsal. If it is prominent both laterally and plantarly, I would recommend both of those accommodations.
Regardless of which accommodation you recommend in this situation, it is best to prescribe that the cover be glued on the heel only, leaving the fifth metatarsal base easily accessible for any needed adjustments.
Editor's note: This blog was originally published at http://www.prolaborthotics.com/Blog/tabid/90/EntryID/513/Default.aspx  has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .