The original series of custom pantarsal plates which resulted in the original ‘off the shelf plates’ always included a screw hole between the metatarsals and the talus so that a screw could be placed to pick up the central tarsal bone plus T4 laterally. When we made a study prior to producing the ‘off the shelf’ pantarsal plate we found that the position of this hole was not predictable and if the surgeon was unlucky the screw placed could find itself in a joint space. We took the view that this screw was not essential and omitted it. We are un- aware of any arthrodesis failures as a consequence.However, cadaver studies by Loic Dejardin have shown that the placement of the additional screw adds significantly to the stffness of the construct. Surgeons requesting custom plates seem to prefer plates with the extra hole.