A patient presents with pain over the first two metatarsal heads and typically wears high-heeled shoes. What is the best intervention?

The best intervention for a patient experiencing pain over the first two metatarsal heads, particularly in the context of wearing high-heeled shoes, involves placing a pad proximal to the metatarsal heads. This approach aims to redistribute pressure away from the metatarsal heads by elevating the forefoot. It alleviates the excessive load placed on these structures due to the altered foot mechanics that high heels create. High-heeled shoes typically shift the body's center of gravity forward, increasing the stress on the forefoot. By utilizing a pad positioned proximal to the metatarsal heads, this intervention can help balance the pressure distribution across the foot, potentially reducing pain and discomfort during ambulation.

In contrast, other options like a pad placed distal to the metatarsal heads or using specialized support for the medial longitudinal arch may not effectively address the unique pressures caused by high-heeled shoes. These alternatives may fail to alleviate the specific metatarsal pain since they do not target the primary source of discomfort effectively.