Here's the secret to the CH Fightersticks:
It's all in how you put your hand on the stick.
The stick is molded from the real size and dimensions of an F-16 side control stick. However, in an F-16 it's at a low angle and based on the ergonomics of it you have no problems reaching all the buttons readily.
Here's the trick: Mount the stick on a platform level with your elbow. Make is so that your arm goes down from the shoulder, bends at the elbow, and is mostly parallel to the ground when you reach the handle (that means mounting the base lower to get the handle to that angle).
Now here's the hard part for most joystick users. Most of you are so used to grasping the stick very firmly with your palm flat along the surface. This is not how to use the Fighterstick line. You place your trigger finger on the trigger, you hug the body with your middle finger and partially with your ring finger. The palm does not hug the stick, rather you get the area right around your thumb (the webbing) and your middle/ring finger to keep the stick in play. There is air between the palm and the back of the stick.
From this angle your hand reaches the stick in such a way that your thumb easily manipulates the hat, and with a stress-free movement of the pinky you get your extra button.
Of course the only way to get this is by mounting the stick at a lower angle. Putting foam cuffs or rest pads won't help you any if your stick is still "above" the elbow point, necessitating your wrist to meet the stick at the wrong angle.
There you have it. I like mine, but I don't think I would if I couldn't have mounted it at elbow level. It makes all the difference.