Foot position while sitting can contribute to metatarsalgia

NewsBot · Oct 3, 2018

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Computer Foot: Foot position while sitting can contribute to metatarsalgia
Robert Vander Griend, MD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Metatarsalgia can result from both intrinsic and extrinsic causes of increased plantar pressure. The
index patient in this study was a college professor with bilateral metarsalgia (and failed Morton's neuroma surgeries). In clinic he
was noted to be sitting with both feet positioned under his chair (Figure shows example of this position). He indicated that he sat
in this position while using his computer for several hours at a time. He was counseled to sit with his feet flat and subsequently
noted much improvement in his symptoms. Other patients were then noted to have metatarsalgia and similar computer use foot
positions prompting this evaluation of forefoot plantar pressures in this sitting position.
Methods: Fifteen patients (eight with computer foot and seven without) were seated in a chair that they could adjust to their
normal sitting position. The patients wore socks of their choice but not shoes to avoid loading differences resulting from different
types foot wear. A plexiglass plate portable pressure sensor was placed ln the floor. The pressure and contact area was measured
for each foot with the foot flat and then the foot positioned with the foot directly under the edge of the chair.
Results: The plantar pressures in the seated foot flat position ranged from 8-18 kg (some correlation with leg size/weight and self
selected chair height). This pressure was fairly evenly distributed across the entire plantar foot. There were no right-left foot
differences. The plantar pressures in the computer foot position (foot directly under the edge of the chair) increased by 40-60%
while the contact area decreased by 50% or more. Positioning the foot as far under the chair as possible increased the pressures
by an additional 10+%.
Conclusion: Foot position while seated can result in increased loads on the plantar forefoot. Maintaining this position for long
periods of time-as when working on a computer-can contribute to metatarsalgia . While rarely the only cause of metatarsalgia
we have found that about 1/4 of patients with forefoot symptoms do acknowledge that they sit for periods of time in the
computer foot position. Change in foot position commonly improves their foot symptoms
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Damien Howell · Oct 15, 2018

In my experience this observation of contributing factor to metatarsalgia is more frequent in females shorter than 5"4" tall. Chairs and desk are made for individuals 5"4" or taller. To compensate short females wear high heel shoes, sit on the edge of the chair foot plantar flexed, MTPJ max dorsiflexion weight bearing into metatarsal head. Often ladies will sit with knees crossed so one MTPJ is subjected to more stress than the other.

NewsBot · Oct 12, 2023

Effects of plantar fascia stiffness on the internal mechanics of idiopathic pes cavus by finite element analysis: implications for metatarsalgia
Xuanzhen Cen et al
Comput Methods Biomech Biomed Engin. 2023 Oct 11:1-9

Metatarsalgia occurring in individuals with pes cavus is typically associated with abnormal loading patterns in the forefoot resulting from structural alterations. Simultaneously, the frequent overstress of the plantar fascia (PF) caused by the persistence of this foot deformity may further exacerbate the chronic pain induced by metatarsal overload. We aimed to investigate and quantify the effects of PF stiffness on the internal biomechanics of pes cavus using a computational modelling approach. A patient-specific finite element model of the foot-ankle complex using the actual three-dimensional geometry of idiopathic pes cavus bones and soft tissues was reconstructed. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the PF on the metatarsal stress distribution, and force transmission through the metatarsophalangeal (MTP) and tarsometatarsal (TMT) joints in the pes cavus. The results indicated that variations in PF stiffness led to stress redistribution in the metatarsal region. Peak stress gradually reduced with decreasing stiffness until the PF was released, eventually resulting in a reduction of 22.39% compared to the reference value of 350 MPa. Furthermore, adjusting the PF stiffness to twice the reference value (700 MPa) increased the contact forces through the TMT and MTP joints by up to 23% and 116%, respectively. The reduction of PF stiffness alleviated focal metatarsal loading, and therefore, surgical fascia release can be considered to alleviate metatarsalgia in patients with pes cavus.
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