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It has been suggested that met domes come in left and right models and that strategic placement on an orthotic device is required in order to adequately support of the transverse arch of the foot. Is this the case or are met domes manufactured as a standard uni lateral shape that can be used on either left or right sided orthotic work?

 

There is no anterior metatarsal arch that needs supporting. All metatarsal head share in the forefoot weight distribution.

 

They almost always come in one shape. Only occasionally have I seen a supplier with a left and right shape.

 

So what are met domes for DaVinci?

 

I have never used them in orthotic work as a designated left or right sided addition.

 

Form and structure of the metatarsal head arch in adults. Ultrasonographic and podometric studies[Article in German]
Hermann B.
Orthopädische Universitätsklinik und Poliklinik Hamburg-Eppendorf.
Z Orthop Ihre Grenzgeb. 1995 Jul-Aug;133(4):335-40.

Patterns of weight distribution under the metatarsal heads
E. J. Luger, M. Nissan, A. Karpf, E. L. Steinberg, and S. Dekel
J Bone Joint Surg Br 1999 81-B: 199-202.

Evaluation of the transverse metatarsal arch of the foot with gait analysis
Ulunay Kanatli, Haluk Yetkin, Selcuk Bolukbasi
Gazi University Medical Faculty, Orthopaedics and Traumatology Department
Journal Archives of Orthopaedic and Trauma Surgery Volume 123, Number 4 / May, 2003

Observations concerning the transverse metatarsal arch
D. Daentzer, N. Wülker and U. Zimmermann
Orthopaedic Department, Hannover Medical School, Hannover, Germany
Foot and Ankle Surgery Volume 3, Issue 1, 1997, Pages 15-20

 

Met domes do come in left and right from some suppliers, l dont know that they need too(?) but they can and do, l guess it is up to the supplier?

We use them for some of our clients, for example, a client with server Arthritis, to take the pressure off the often painful 2nd MP.

 

1. Increase digital purchase force
2. Off load metatarsal heads
3. Treat plantar plate and intermetatarsal head problems
4. Facilitate the windlass mechanism

Newsbot has done an awesome job (as usual) showing the evidence that there is no anterior metatarsal arch that needs supporting.

 

Absolutely! In the podiatric world I thought that this one had been put to bed around the turn of the previous (19th) century. There is a demonstrable anatomical metatarsal arch posteriory at and just distal to the MCJs but this simply does not exist in the weight bearing foot distally at the met. heads.

In certain orthopaedic texts the old mythology of the 1st & 5th mets. being thicker than the 2-3-4 mets is taken as 'proof' of increased weightbearing, hence an anterior metatarsal arch. Bad science and bad (or non) observation. Of course, in some pathological states eg. talipes, an anterior metatarsal arch has been observed.

Cynically, one wonders if the 'collapsed arch' is not an simply explained scenario resulting in the easy sale of met domes/insoles/OTC orthoses by pharmacies etc.

Bill Liggins

 

I buy left and right met domes from Leffler and sons in Melbourne. Use them quite a bit for rearranging GRF'S under forefoot, helping straighten slightly clawed toes, opening intermetatarsal spaces a bit, use them on non cast inserts, molded eva or cast plate devices....just one of the possible ingredients of the whole fruit salad.
regards Phill

 

I am a hack. I need to get with the program and get me some left and right sided met domes. Not to support any anterior or forefoot or transmetatarsal arch but to act in the treatment regimens outlined by daVinci.
Same deal for reduced fill 2-4 on orthotic precsriptions?

 

Greg:

The metatarsal pads (i.e. "met domes") that I use come in both left and right foot shapes, even though I sometimes use the left on the right and vice versa. I commonly will use metatarsal pads in patients with prescription foot orthoses (or over-ther-counter foot orthoses) for the following diagnoses:

1. Intermetatarsal neuromas
2. Plantar plate pathology of the metatarsophalangeal joints
3. Prevention and treatment of metatarsal stress fractures

What these devices accomplish is to locally increase the plantar pressure at the thickest part of the pad and decrease the plantar pressure in the areas proximal, distal and adjacent to the pad. In so doing they also likely decrease pressure on intermetatarsal neuromas, and also decrease the bending moments on the lesser metatarsal shafts during weightbearing activities. Judicious use of these pads on foot orthoses or the insoles of shoes should be a valuable therapeutic adjunct to any podiatric practice.

 

Kevin,
Great to hear from you mate, I believe you are some sort of guru on the podiatric thing, I recall texts written by you from Uni days. Excuse my ignorance if this is right.
We are on the same wavelength when it comes to met domes and their uses. Just used to have running debate as to whether they came in L and R sided ones and not just one style fits all.
I know a very good pod who places her left and right sided met domes with great precision and I wasn't sure if she was having a lend of me with the left and right sided thing. Just being a hack, I thought you plonk a generic met dome in the right spot and Robert's your father's brother.

 

I've been called much worse.....

 

May I get involved in this, just been reading the thread. We have been taught in lectures (I am year 2 student) that the foot stands in a 3 point arrangement, 1st met, 5th met and calcaneus, so one would expect pressure points to be evident here. Am i right in thinking that the pressure is evenly distributed over met heads when walking. What happens when people wear shoes with concave insoles, as most shoes these days appear to have. What happens to the met head pressures then? I am wearing a pair of fit flops with a slightly concave transverse metatarsal sole area, what will happen to my mets now? After a while will i need some arch support here due to the 2-4th met heads dropping to accommodate the space? would love to hear back from you all.

 

You were taught wrong and you need to challenge your lecturer on this. Just look at all the evidence in message 7 above posted by Newsbot (I think it was andy then). The evidence is unequivocal that all met heads share in the weightbearing. There is NO evidence to support what you were taught!

 

I certainly will challenge it. However, was I correct about the last bit of my previous post? Will my met heads eventually drop down (2-4th) if I wear a transverse concave insole? Would this be something that would need a met dome in the long run?
thanks
Clair

 

"fit flops with a slightly concave transverse metatarsal sole area"

It is interesting that your "fit flops" have a concave insole, the original reason for a concave insole/Last bottoms was to assist in the modern machine for toe lasting so that the wiper blades missed the feather edge of the insole this is why "Stitchdowns"/ Veltschoon have a flat bottom last as the upper is turned out at the feather edge not under.
It puzzles me why they would do it to a thong type construction where there is no toe lasting, maybe they forgot why the last was concave and just repeated it from the shoe to the "Fit Flop"?

 

Clair, Kevin, & Boots,

I comprehend the decrease in the plantarly directed met. bending moments, but wouldn't they increase the dorsally directed met. bending moments. Couldn't this exacerbate met. stress fractures?

I think this is a very good question, am looking forward to the pundits replies!

Nice post Boots, like Cameron / Toeslayer contributions.

I use met. domes (pads) all the time, the old girls love them!

 

hahaha love it!!!