Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study.
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Kang JH, Chen MD, Chen SC, Hsi WL.
BMC Musculoskelet Disord. 2006 Dec 5;7:95.
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Logically we knew that they worked,we just were not sure of the mechanism.
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Netizens
Still a very small study to draw too many conclusions from, despite overwhelming anidotal evidence to support it. Similar work was published in the Chiropodist (UK) in the early 80s. Work conducted by Ken Robertson (if memory serves) with preliminary work on the pedobaragraph He compared position of met pads and peak pressure and found the positon of the metatarsal pad on the foot had significant little bearing on the peak pressures recorded. All appeared to reduce peak pressures but no attempt was made to record pain as his subjects were all normals. Over the last two decades there has been work done by physical therapists and physiotherapists relating to metatarsal pads and their effects. Some studies were pretty dubious but others rather interesting with one examining the effects of water content in callus.
It would seem prudent to accept pressure alone would not account for metatarsalgia but likely to contribute as a variable.
What say you?
Cameron -
Along this topic...I've often wondered about the effects of mortons neuroma pads. I was taught in school to place the apex of this small dome pad (they are smaller than metatarsal pads) between the metatarsal necks of the affected interspace- with the hope of spreading the metatarsals having a reverse Mulders effect. I doubt this happens, and any positive effect is probably from the mechanisms discussed in this paper. Any thoughts??? Is it widely believed that a neuroma pad is designed to separate metatarsals???
Nick -
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Netizens
As I understand the etiology of neuroma, there appears to be compression and stretching of the nerve fibres which are cited as co-requisites. The idea metatarsal heads rubbing together is unlikely and physically separating them with soft padding on the sole of the foot, improbable. But I do share Kevin's experience with the benefit of stratigically placed pads. I always thought the critical increased bulk over the lateral aspect of the fourth met shaft may in some way reduce peak pressure as the foot goes into propulsion. This may 'rest the nerve', and break the pain cycle. I have also used silicone props to similar effect.
Cameron -
Now, if a fairly pinpoint GRF (e.g. from a metatarsal pad) focuses a substantial plantar force more between the metatarsal necks rather than directly plantar to the metatarsal heads, there would be an increase in 4th metatarsal abduction moment (relative to the 3rd metatarsal) especially at late midstance and early propulsion. This increased magnitude of 4th ray abduction moment would tend to increase the distance between the 3rd and 4th metatarsals and would also probably significantly reduce the magnitude of pressure on the intermetatarsal nerve during late midstance and early propulsion.
The mechanism here is similar to the mechanism that occurs when a splitting wedge/maul is swung onto the end of a round of wood Macho Man Splitting Wood. A relatively concentrated, pinpoint force between the grain of the piece of wood will easily split most wood rounds. A given kinetic energy, E, applied with a correctly shaped splitting maul into the wood grain on the round would result in the round being easily split. However, the same applied energy, E, from a blunt sledge-hammer, would distribute the weight to compress the multiple grains of wood on end which would only compress the wood face and would cause a dent to be formed in the end of the round from the impact.
It seems quite likely that a metatarsal pad not only significantly increases the 4th ray abduction moment relative to the 3rd metatarsal and significantly decreases the pressure on the intermetatarsal nerve, but also slightly separates the metatarsal necks due to increased 4th ray abduction moment that causes increased tensile force on the deep transverse ligament (and other intermetatarsal soft tissue structures). This "splitting wedge" effect would be most prominent during late midstance and early propulsion when the GRF plantar to the forefoot is of the greatest magnitude. -
Kevin
I would concur the most likely explanation does involve change in direction of GRFs but could be less sceptical if a rigid shaft was used (as in shoe modification). I am amazed all the more because of the very low resistance to compression within foams and felt and that these would offer sufficient lever to change in direction of GRFs. If indeed this is so then it may be even a short experience (matter of hours) can have long term effects.
Obviously conditons apply
Cheers
Cameron -
Dear All,
I have issue with the very low density of MP's used by many pods - there is no mention of the density of the polyurethane pads used in the afore-quoted study.
I have had some success with 'hapad' products as they can be half adhered and moved to ensure the most accurate placement after trial.
Has any attention been paid to MP densities?
Regards PR -
pretschko
>Has any attention been paid to MP densities?
To the best of my knowledge MP are usually made of standard (medium) density foams /polyurethans or semi compressed, as in felts. Orthotists will often dent the foot plate of BKFO to give the equivolent effect of a hard density MP. I am not aware of any evaluations to review the efficacy of the traditional modification.
Cameron -
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LuckyLisfranc said:Consequently, I often allow myself to be directed by patients as to where the pad should be placed on the the orthosis - more often than not, the area of greatest comfort corresponds to almost exactly *under* the neuroma (ie distal to the MTP joints). :confused:
Whenever I place the pad back at the metatatsal neck, they will frequently complain that is is too proximal and of limited benefit...
Anyone else with this experience?Click to expand...
I also found that by placing a met pad too far proximally, it would irritate the tight plantar fascia, resulting in aching pain as well as the sharp intermetatarsal pain. -
I often find 'placement' to be a very tricky operation. Whilst it is easy to place a pad directly onto the foot with adhesive tape, it becomes a lot loss predicatable when the foot has to position itself on top of the pad, attached to an orthosis, within a shoe...
Consequently, I often allow myself to be directed by patients as to where the pad should be placed on the the orthosis - more often than not, the area of greatest comfort corresponds to almost exactly *under* the neuroma (ie distal to the MTP joints). :confused:
Whenever I place the pad back at the metatatsal neck, they will frequently complain that is is too proximal and of limited benefit...
Anyone else with this experience?
LLClick to expand...
I use the same process as you do and have made the same observations regarding patient comfort. For placement of metatarsal pads on foot orthoses, I generally have the lab add the metatarsal pad to the device so that metatarsal pad protrudes 15 mm distal to the anterior edge of the orthosis. Over the years this has worked out very well for my patients as a good standard location of metatarsal pad placement on their orthoses.Cheers,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Website: www.KirbyPodiatry.com
FaceBook: www.facebook.com/kevinakirbydpm/
Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
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Hi Paul,
As far as I've observed, there is no uniformity amongst the pod community regarding the types of pads used (or, for that matter Cameron, amongst orthotists using them via cast modifications, since I've never done them that way and many of my colleagues are the same) as it usually depends on whether the individual pod is actually manufacturing the orthoses themselves and if so, where they buy their pads.
I have noticed frequent differences in placement position however, with a great many pods locating the apex beneath the MTPJs as they would do for a felt PMP that's adhered to the foot, rather than more proximally to load the shafts and decrease pressure on the met heads.
Been a while.
RichDr Richard Chasen
B.P.&O., B.Pod (Hons). M.A.Pod.A.
Master of Health Science (Pod)
Podiatrist
Foot & Ankle Orthotist -
PS, again, that was a generalisation, as amongst the pods I know who manufacture their own orthoses, there is comparatively little uniformity.
Dr Richard Chasen
B.P.&O., B.Pod (Hons). M.A.Pod.A.
Master of Health Science (Pod)
Podiatrist
Foot & Ankle Orthotist -
LL, just reading your post, I find the best area of placement to be when the apex is immediately proximal to the heads. I usually warn patients that this will feel too far back initially, but anything more distal will actually increase pressure beneath the MTPJs as the foot heads towards toe off, not doing the neuroma any favours. If it's blended into the device adequately at the posterior section, it shouldn't cause too much irritation to the plantar fascia slips
Dr Richard Chasen
B.P.&O., B.Pod (Hons). M.A.Pod.A.
Master of Health Science (Pod)
Podiatrist
Foot & Ankle Orthotist -
For what it's worth i usually place mine with the leading edge across the middle of the met heads (ie under half the wb area). I tend to find this works better with soft pads than having them more proximal. I also find they work much better on a casted device than on their own.
RobertRobert Isaacs
Specialist in Biomechanical Therapies
Semper in excretum sum sed alta variat
Never be a spectator of unfairness or stupidity. Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence. Suspect your own motives, and all excuses.
Christopher Hitchens -
Robert, it sounds like we're doing the same thing. I think the main difference is whether the devices are made from a cast or a direct mould, such as one of those rubber footboards.
RichardDr Richard Chasen
B.P.&O., B.Pod (Hons). M.A.Pod.A.
Master of Health Science (Pod)
Podiatrist
Foot & Ankle Orthotist -
Effect of metatarsal pad placement on plantar pressure in people with diabetes mellitus and peripheral neuropathy.
Hastings MK, Mueller MJ, Pilgram TK, Lott DJ, Commean PK, Johnson JE.
Foot Ankle Int. 2007 Jan;28(1):84-8
BACKGROUND: Standard prevention and treatment strategies to decrease peak plantar pressure include a total contact insert with a metatarsal pad, but no clear guidelines exist to determine optimal placement of the pad with respect to the metatarsal head. The purpose of this study was to determine the effect of metatarsal pad location on peak plantar pressure in subjects with diabetes mellitus and peripheral neuropathy.
METHODS: Twenty subjects with diabetes mellitus, peripheral neuropathy, and a history of forefoot plantar ulcers were studied (12 men and eight women, mean age=57+/-9 years). CT determined the position of the metatarsal pad relative to metatarsal head and peak plantar pressures were measured on subjects in three footwear conditions: extra-depth shoes and a 1) total contact insert, 2) total contact insert and a proximal metatarsal pad, and 3) total contact insert and a distal metatarsal pad. The change in peak plantar pressure between shoe conditions was plotted and compared to metatarsal pad position relative to the second metatarsal head.
RESULTS: Compared to the total contact insert, all metatarsal pad placements between 6.1 mm to 10.6 mm proximal to the metatarsal head line resulted in a pressure reduction (average reduction=32+/-16%). Metatarsal pad placements between 1.8 mm distal and 6.1 mm proximal and between 10.6 mm proximal and 16.8 mm proximal to the metatarsal head line resulted in variable peak plantar pressure reduction (average reduction=16+/-21%). Peak plantar pressure increased when the metatarsal pad was located more than 1.8 mm distal to the metatarsal head line.
CONCLUSIONS: Consistent peak plantar pressure reduction occurred when the metatarsal pad in this study was located between 6 to 11 mm proximal to the metatarsal head line. Pressure reduction lessened as the metatarsal pad moved outside of this range and actually increased if the pad was located too distal of this range. Computational models are needed to help predict optimal location of metatarsal pad with a variety of sizes, shapes, and material properties.Click to expand... -
The influence of metatarsal support height and longitudinal axis position on plantar foot loading
Thor-Henrik Brodtkor, Géza F. Kogler, Anton Arndt
Clinical Biomechanics (Articles in Press)
Background:
Metatarsal supports are effective at decreasing plantar foot pressures at the metatarsal heads, however, little is known about the dependence of this decrease upon height and position.
Methods:
Barefoot static stance pressure measurements were recorded during standing in single limb support (n=22). Two metatarsal support heights (5mm, 10mm) were evaluated in six positions at 5mm increments (0, 5, 10, 15, 20, 25mm) proximal to the metatarsal heads along the longitudinal axis of the foot. The barefoot condition with no metatarsal support served as the control. Mean force was measured for each test condition. The findings of this study are limited to the barefoot (unshod) condition.
Findings:
Mean plantar force decreased significantly under the second metatarsal head with both 5 and 10mm metatarsal supports compared to the control, and 10mm metatarsal support compared with 5mm metatarsal support (P<0.05) while no statistically significant differences were noted relative to longitudinal axis position.
Interpretation:
The results of this study suggest that the thickness of a metatarsal support is a determinant factor in regulating plantar loading. Surprisingly, the longitudinal axis location of a metatarsal support does not appear to be as important as clinically presumed since the data showed that the force decrease was similar for all positions from 5 to 25mm. Thus, the orthotic induced effect of a metatarsal support seems to have a sizable interaction range that has not previously been reported. We speculate that the metatarsal support’s fulcrum and lift effect can be sustained at a more proximal position due to the foot’s rigidity as a lever and the manner in which a metatarsal support interacts with the plantar aponeurosis.Click to expand... -
Kevin Kirby said: ↑LL:
I use the same process as you do and have made the same observations regarding patient comfort. For placement of metatarsal pads on foot orthoses, I generally have the lab add the metatarsal pad to the device so that metatarsal pad protrudes 15 mm distal to the anterior edge of the orthosis. Over the years this has worked out very well for my patients as a good standard location of metatarsal pad placement on their orthoses.Click to expand...
Does anyone find there are times when they have more success with a metatarsal bar? -
Effect of a Metatarsal Pad on the Forefoot During Gait
Koen L. M. Koenraadt, Niki M. Stolwijk, Dorine van den Wildenberg, Jaak Duysens, Noël L. W. Keijsers
JAPMA January/February 2012 vol. 102 no. 1 18-24
Background: Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head.
Methods: Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad.
Results: A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls.
Conclusions: The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal padClick to expand... -
Comparison of the pressure-relieving properties of various types of forefoot pads in older people with forefoot pain
Pei Y Lee, Karl B Landorf, Daniel R Bonanno and Hylton B Menz
Journal of Foot and Ankle Research 2014, 7:18 doi:10.1186/1757-1146-7-18
Background
Plantar forefoot pain is commonly experienced by older people and it is often treated with forefoot pads to offload the painful area. However, studies have found inconsistent effects for different forefoot pads on plantar pressure reduction, and optimum forefoot pad placement is still not clear. The aim of this study was to compare the effects of different forefoot pads on plantar pressure under the forefoot in older people with forefoot pain.
Methods
Thirty-seven adults (31 females, 6 males) with a mean age of 73.5 (SD 4.8) participated. Forefoot plantar pressure data were recorded using the pedar(R)-X in-shoe system while participants walked along an 8 m walkway. Five conditions were tested in a standardised shoe: (i) no padding (the control); (ii) a metatarsal dome positioned 10 mm proximal to the metatarsal heads, (iii) a metatarsal dome positioned 5 mm distal to the metatarsal heads, (iv) a metatarsal bar, and (v) a plantar cover.
Results
Compared to the shoe-only control condition, each of the forefoot pads significantly reduced forefoot peak pressure and maximum force. The metatarsal dome positioned 5 mm distal to the metatarsal heads and the plantar cover were most effective for reducing peak pressure (17%, p < 0.001 and 19%, p < 0.001, respectively).
Conclusions
These findings indicate that forefoot pads are effective for reducing forefoot pressures in older people with forefoot pain, and that the position of the pad relative to the metatarsal heads may be more important than the shape of the pad.Click to expand... -
Effect of the application of a metatarsal bar on pressure in the metatarsal bones of the foot
Se Won Yoon
Journal of Physical Therapy Science
Vol. 27 (2015) No. 7 July p. 2143-2146
[Purpose] The aim of this study was to determine the effect of application of a metatarsal bar on the pressure in the metatarsal bones of the foot using a foot analysis system (pressure on the forefoot, midfoot, and rearfoot).
[Subjects and Methods] Forty female university students in their twenties were selected for this study, and an experiment was conducted with them as the subjects, before and after application of a metatarsal bar. The static foot regions were divided into the forefoot, midfoot, and rearfoot, and then the maximum, average, and low pressures exerted at each region were measured, along with the static foot pressure distribution ratio. 1) Static foot pressure: The tips of both feet were aligned to match the vertical and horizontal lines of the foot pressure measuring plate. The subjects were told to look toward the front and not to wear shoes. 2) Distribution ratio: The distribution ratio was measured in four regions (front, back, left, and right) using the same method as used for static foot pressure measurement.
[Results] The results of this study showed that the maximum, average, and minimum static pressures in the forefoot were significantly decreased. The minimum static pressure in the midfoot was significantly increased, and the pressure in the other parts was significantly decreased. The maximum and average static pressures in the rearfoot were also significantly decreased.
[Conclusion] As reduction of foot pressure with a metatarsal bar results in lowering of the arch and an increased contact surface, the foot pressure was dispersed. These results suggest that wearing shoes with a bar that can decrease the foot pressure is therapeutically helpful for patients with a diabetic foot lesion or rheumatoid arthritis.Click to expand... -
Changes in Plantar Pressure Distribution in Response to Different Metatarsal Pad Designs and Placements during Walking - a Dynamic Finite Element Analysis
Chih-Kuang Chen et al
Prosthet Orthot Int June 2015 vol. 39 no. 1 suppl 2-608 (abstract 559)
Background (approx 70 words)
Forefoot pain and discomfort within the plantar soft tissue beneath the metatarsal (MT) heads is referred to metatarsalgia. The MT pad is commonly prescribed for patients with metatarsalgia in clinical practice. Although the effectiveness of MT pad on the plantar pressure reduction had been investigated in previous studies using plantar pressure measurement system, no clear conclusion on the MT pads design and placement that can achieve best effectiveness in plantar pressure reduction so far.
Aim:
This study aimed to investigate the effects of different placements and geometrical designs of MT pad on the plantar pressure distribution through dynamic finite element analysis.
Method:
A three-dimensional FE model of the foot-shoe complex, including the foot bony and ligamentous structure, soft tissue, MT pad, insole, outsole and shoe cover, was adopted in this study. The trajectory of the reflective markers and the kinematic data of the foot obtained from gait analysis were used to define the boundary condition in the FE analysis. After validation of the model, the effects of MT pad on the plantar pressure distribution beneath the metatarsus and the second MT head were investigated by changing five different placements, two different heights, and three different sizes of the MT pad.
Results:
When the pad was placed 10 mm proximal to the second MT head, better efficacy of pressure reduction than other placements was found. Under the appropriate placement, the efficacy would be further improved by raising the height of the pad from 5 mm to 10 mm, but causing high pressure concentration beneath the metatarsus. However, increasing the pad size by 10% would relieve the concentrated high pressure.
Discussion & Conclusion
According to the results, it is found that increasing the height as well as area of MT pad properly may enhance the efficacy of plantar pressure reduction beneath the second MT head, and relieve high pressure concentration beneath the metatarsus. More subjects with different size and structure of foot should be recruited in the future in order to provide a more comprehensive recommendation on the prescription of MT pad.Click to expand... -
The Effects of Metatarsal Pad on Plantar Pressure of the Forefoot in Individuals
with Diabetic Peripheral Neuropathy: A Randomized Crossover Study
Mohammad Jafarpisheh et al
source
Introduction: Foot insoles are widely used to reduce excessive pressure exerted on the plantar surface of the foot
and prevent diabetic foot ulceration. The objective of this study was to investigate the effects of the metatarsal pad on
pressure on the forefoot area.
Materials and Methods: This randomized crossover clinical trial was conducted on 18 volunteers (5 women and
13 men) with diabetic peripheral neuropathy. Plantar pressure was recorded while participants walked over a plantar
pressure platform in three random conditions of barefoot, with a placebo intervention, and with a metatarsal pad. The
processed variables were statistically analyzed using repeated measure one-way ANOVA.
Results: The metatarsal pad caused a significant reduction in mean pressure on the forefoot compared to the barefoot
and placebo conditions (P < 0.001). The metatarsal pad also significantly reduced the time-pressure integral in the
forefoot compared to the barefoot and placebo conditions (P < 0.001). There was no significant difference in the
time-pressure integral of the total plantar surface between the three conditions.
Conclusion: The metatarsal pad transfers the forefoot load to the midfoot area, thereby, reducing the pressure
exerted on the forefoot. This finding implies that using a metatarsal pad can be an effective intervention to prevent
diabetic foot ulceration.Click to expand... -
The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running
Michaela Hähni, Anja Hirschmüller and Heiner Baur
Journal of Foot and Ankle Research20169:44
Background
Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia). One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP) and forefoot cushioning (FC). The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running.
Methods
Twenty-three (13 female, 10 male) asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC) conditions and a control (C) condition on a treadmill (2.78 ms−1) for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome) and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100) after each running trial. The primary outcome was tested using the Friedman test (α = 0.05). Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR)).
Results
Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315) compared to both C (313 ± 69, 95%-CI: 283–343; p = .003) and MP (315 ± 80, 95%-CI: 280–350; p = .001). No significant difference was found between C and MP (p = .858). Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64.
Conclusions
In contrast to the metatarsal pad orthosis, the forefoot cushioning orthosis achieved a significant reduction of peak pressure in the forefoot of recreational runners. Consequently, the use of a prefabricated forefoot cushioning orthosis should be favoured over a prefabricated orthosis with an incorporated metatarsal pad in recreational runners with normal height arches.Click to expand... -
Effects of Metatarsal Pad length on Plantar Pressure and pressure time integral in diabetic foot
Mohammad Taghipourdarzinaghibi, Ebrahim Abdi & Mansour Eslami
Endocrine Abstracts (2016) 43 OC26 | DOI:10.1530/endoabs.43.OC26
Background: Plantar pressure and pressure-time integral are two important factors for creating foot ulcer in diabetic patients. Increasing foot contact area with a metatarsal pad has been reported as one of the best strategies to decrease the risk of ulcer; but there is no clear guideline to determine optimal length of metatarsal pad.
Objective: The purpose of present study was to determine the effects of metatarsal pad length on peak plantar pressure and pressure-time integral in diabetic foot.
Methods: A total of 15 diabetic patients aged between 57–63 years without foot ulcers participated. Peak plantar pressure and pressure-time integral data were recorded using the RS-scan system. The data has been gathered in five conditions: (i) bare foot, no padding (control), (ii) a metatarsal pad with %18 of foot length, (iii) a metatarsal pad with %20 of foot length, (iv) a metatarsal pad with %23 of foot length and (v) a metatarsal pad with %25 of foot length.
Results: The results demonstrated a significant reduction of peak plantar pressure and pressure-time integral in all metatarsal pad lengths compared to the control (P=0/05). Peak pressure significantly decreased in metatarsal areas 1,3 and 4 by increasing metatarsal pad length (P=0.001); but there were not significant differences for metatarsal areas 2(P=0.4) and 5(P=0.06). Significant difference was observed between five conditions for pressure-time integral (P=0.001). So, pressure-time integral significantly reduced in the metatarsals 1 and 2 by pad 18 and 20% and significantly increase by pads 23 and 25%. Moreover, pressure-time integral significantly increased in the metatarsals 3,4 and 5 by pad 18% and significantly decreased by pads 20, 23 and 25%.
Conclusions: These findings indicate that peak pressure on metatarsal heads decrease by increasing metatarsal pad length, but the effect of the pad on the plantar pressure-time integral depend on the metatarsal area and pad length. Considering pad length relative to foot length can be a step towards developing an evidence-based practice for constructing optimal insole in therapeutic shoe. According to present study, we recommend that a pad with 23% of foot length could be ideal.Click to expand... -
NewsBot said: ↑The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running
Michaela Hähni, Anja Hirschmüller and Heiner Baur
Journal of Foot and Ankle Research20169:44Click to expand...
Therapy options in running overuse injury: biomechanical studies have to be followed by clinical studies.
Hat tip: JFAR -
The Effect of Metatarsal Padding on Pain and Functional Ability in Metatarsalgia
K. Männikkö, J. Sahlman
Scandinavian Journal of Surgery March 1, 2017
Background and Aims:
Many kinds of insoles and pads are commonly used as a conservative treatment of metatarsalgia. However, earlier studies of insole treatment provide contradictory results, and the natural progression of metatarsalgia is still unknown. The aims of this study were to (1) determine whether simple custom-made metatarsal pad insoles reduce pain and improve functional ability, (2) find out patients’ satisfaction with padding treatment, and (3) investigate predisposing factors for metatarsalgia.
Material and Methods:
All metatarsalgia patients provided with metatarsal pad insoles during a 2-year period at Kuopio University Hospital (n = 45) were included in the study and observed at least a year. In all, 25 patients were interviewed about their situation before and after treatment. The Numeric Rating Scale for pain and American Orthopaedic Foot & Ankle Society forefoot questionnaire included questions about predisposing factors, other diseases, exercise, work, shoes, and satisfaction with insoles. Foot X-rays taken from 45 patients during treatment were analyzed.
Results:
The mean age of the patients was 56 years (range 34–84 years); 87% of them were women. In all, 47% of patients had osteoarthritic changes in the first metatarsophalangeal joint, and 42% had hallux valgus. In the interviewed subgroup (n = 25) body mass index was normal in 44%, and 36% were mildly overweight. High-heeled shoes were used by 40% daily, and 68% had done standing work for several years. Pain decreased significantly on the Numeric Rating Scale: 3.2 points in all patients (p < 0.001), 3.1 points among women, and 4.25 points among men. The American Orthopaedic Foot & Ankle Society score improved 24.2 points in all patients (p < 0.001, range 0–100), among women 19 points, and among men 29 points.
Conclusion:
Metatarsalgia affects mostly women and is often preceded by extensive use of high heels and standing work. Also, a high association of first metatarsophalangeal arthrosis and hallux valgus was found. Metatarsal pads reduce pain and improve the American Orthopaedic Foot & Ankle Society score. We recommend metatarsal padding as a safe and inexpensive alternative in treating metatarsalgia patientsClick to expand... -
Forefoot relief with shoe inserts : Effects of different construction strategies
Baur H et al
Z Rheumatol. 2017 Jul 7. doi: 10.1007/s00393-017-0347-8
BACKGROUND:
Shoe inserts and shoe modifications are used to reduce plantar peak pressure. The effects of different shoe inserts and shoe construction strategies for relief of the forefoot have not yet been sufficiently evaluated.
PURPOSE:
The aim of this study was to analyze the effects of shoe inserts and shoe construction strategies (e.g. metatarsal pad, forefoot cushioning and control) and shoe modifications (e.g. flexible or stiff) on the peak plantar pressure in the forefoot region.
MATERIAL AND METHODS:
In this study 15 healthy subjects were recruited. Plantar pressure distribution was measured using an in-shoe system during walking (3.5km∙h-1) on a treadmill and the average plantar peak pressure (kPa) in the forefoot was calculated. The statistics for testing the hypothesis were carried out using 2‑factorial ANOVA with repeat measurements (factors: shoe, insert; α = 0.05).
RESULTS:
The metatarsal pad and forefoot cushioning led to a reduction of peak pressure, which was statistically significant compared to the control condition (p = 0.009). No differences were observed between both shoe inserts (p > 0.05). A comparison between stiff and flexible shoes revealed a statistically significant pressure reduction in favor of stiff shoes (p = 0.0001). The metatarsal pad led to a peak pressure increase in the midfoot of 12% and by 21% compared to control and forefoot cushioning, respectively.
DISCUSSION:
A peak pressure reduction in the forefoot can be achieved with a metatarsal pad or with cushioning; however, the metatarsal pad resulted in a subsequent increase in midfoot pressure. Moreover, shoe construction is crucial because a stiff shoe contributes to a better peak pressure reduction compared to a flexible shoe. Prospective clinical studies should be carried out to prove whether this results in beneficial effects for patients with metatarsalgia.Click to expand... -
The Effect of Metatarsal Padding on Pain and Functional Ability in Metatarsalgia.
Männikkö K, Sahlman J.
Scand J Surg. 2017 Mar 1:1457496916683090. doi: 10.1177/1457496916683090.
BACKGROUND AND AIMS:
Many kinds of insoles and pads are commonly used as a conservative treatment of metatarsalgia. However, earlier studies of insole treatment provide contradictory results, and the natural progression of metatarsalgia is still unknown. The aims of this study were to (1) determine whether simple custom-made metatarsal pad insoles reduce pain and improve functional ability, (2) find out patients' satisfaction with padding treatment, and (3) investigate predisposing factors for metatarsalgia.
MATERIAL AND METHODS:
All metatarsalgia patients provided with metatarsal pad insoles during a 2-year period at Kuopio University Hospital (n = 45) were included in the study and observed at least a year. In all, 25 patients were interviewed about their situation before and after treatment. The Numeric Rating Scale for pain and American Orthopaedic Foot & Ankle Society forefoot questionnaire included questions about predisposing factors, other diseases, exercise, work, shoes, and satisfaction with insoles. Foot X-rays taken from 45 patients during treatment were analyzed.
RESULTS:
The mean age of the patients was 56 years (range 34-84 years); 87% of them were women. In all, 47% of patients had osteoarthritic changes in the first metatarsophalangeal joint, and 42% had hallux valgus. In the interviewed subgroup (n = 25) body mass index was normal in 44%, and 36% were mildly overweight. High-heeled shoes were used by 40% daily, and 68% had done standing work for several years. Pain decreased significantly on the Numeric Rating Scale: 3.2 points in all patients ( p < 0.001), 3.1 points among women, and 4.25 points among men. The American Orthopaedic Foot & Ankle Society score improved 24.2 points in all patients ( p < 0.001, range 0-100), among women 19 points, and among men 29 points.
CONCLUSION:
Metatarsalgia affects mostly women and is often preceded by extensive use of high heels and standing work. Also, a high association of first metatarsophalangeal arthrosis and hallux valgus was found. Metatarsal pads reduce pain and improve the American Orthopaedic Foot & Ankle Society score. We recommend metatarsal padding as a safe and inexpensive alternative in treating metatarsalgia patients.Click to expand... -
The Influence of Insole
with Metatarsal Retro-Capital on Posture,
Plantar Pressure and Body Segments Positions
in Runners.
Vermand, S., Duc,
S., Janin, M., Ferrari, F.-J., Vermand, M.
and Joly, P.
International Journal of Clinical Medicine, 10, 326-335.
Objectives. The aim of this study was to investigate the effects of orthopaedic
soles on the body posture. Methods. Forty-eight runners (21 men and 28
women) maintained a standing-up position on both feet with bare feet with
neutral soles and orthopedic soles which contained bilaterally a podiatrist
element of 3 mm height behind the metatarsal heads (Metatarsal Retro Capital Bar, MRCB). Stabilometric, plantar pressure and kinematic data in the sagittal plane on both sides were measured at 40 and 60 Hz, respectively. The
position of the center of pressure on the anteroposterior axis (YCoP), the forefoot plantar pressure (FPP) and the anteroposterior position of the knee (Yk),
the hip (YH), the shoulder (YS) and the ears (YE) with respect to the vertical
axis passing through the joint of the ankle were determined for each experimental condition. Findings. The addition of a MRCB orthopedic element induced in backward displacement of CoP, hip, shoulder and ears (p < 0.01).
YCoP and FPP changes were significantly correlated with YH, YS and YE
changes (p < 0.01). Conclusion. These results suggest that the addition of an
orthopedic element located behind the metatarsal heads influences the overall
position of the body and can help podiatrist in the care of their patients.Click to expand... -
Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain
Karl B. Landorf, Claire A. Ackland, Daniel R. Bonanno, Hylton B. Menz & Saeed Forghany
Journal of Foot and Ankle Research volume 13, Article number: 18 (2020)
Background
Forefoot pads such as metatarsal domes are commonly used in clinical practice for the treatment of pressure-related forefoot pain, however evidence for their effects is inconsistent. This study aimed to evaluate the effects on plantar pressures of metatarsal domes in different positions relative to the metatarsal heads.
Methods
Participants in this study included 36 community-dwelling adults aged 65 or older with a history of forefoot pain. Standardised footwear was used and plantar pressures were measured using the pedar®-X in-shoe plantar pressure measurement system. Peak pressure, maximum force and contact area were analysed using an anatomically-based masking protocol that included three forefoot mask sub-areas (proximal to, beneath, and distal to the metatarsal heads). Data were collected for two different types of prefabricated metatarsal domes of different densities (Emsold metatarsal dome and Langer PPT metatarsal pad) in three different positions relative to the metatarsal heads. Seven conditions were tested in this study: (i) control (no pad) condition, (ii) Emsold metatarsal dome positioned 5 mm proximal to the metatarsal heads, (iii) Emsold metatarsal dome positioned in-line with the metatarsal heads, (iv), Emsold metatarsal dome positioned 5 mm distal to the metatarsal heads, (v) Langer PPT metatarsal pad positioned 5 mm proximal to the metatarsal heads, (vi) Langer PPT metatarsal pad positioned in-line with the metatarsal heads, and (vii) Langer PPT metatarsal pad positioned 5 mm distal to the metatarsal heads.
Results
When analysed with the mask that was distal to the metatarsal heads, where the plantar pressure readings were at their highest, all metatarsal dome conditions led to significant reductions in plantar pressure at the forefoot compared to the control (no pad) condition (F3.9, 135.6 = 8.125, p < 0.001). The reductions in plantar pressure were in the order of 45–60 kPa. Both the Emsold metatarsal dome and the Langer PPT metatarsal pad, when positioned proximal to the metatarsal heads, managed to achieve this without adversely increasing plantar pressure proximally where the pad was positioned, however the Emsold metatarsal dome was most effective.
Conclusions
Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5 mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. In this proximal position, the Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad and we cautiously recommend this forefoot pad for alleviating forefoot pressure in older people with forefoot pain.Click to expand... -
Immediate, Short and Medium-Term Effects of Orthopedic Insoles With a Metatarsal Retro-Capital Bar on Biomechanical Variables, Plantar Pressures and Muscle Activity in Running
Stéphane Vermand et al
J Sports Med Phys Fitness. 2020 Jun;60(6):848-854
Background: The aim of this study was to evaluate the effect of 12 weeks of use of orthopedic insoles equipped with a metatarsal retro-capital bar (MRCB) on plantar pressure under the feet and lower limb kinematic variables during running.
Methods: Two groups of 10 runners used for 12 weeks while running orthopedic insoles without correction or equipped with a MRCB. All participants performed successively a standing posture (CoP displacement) test and a running test at 11 km.h-1 (lower limb kinematic variables) using with flat insoles and orthopedic neutral or MRCB insoles at the beginning (T0), after 4 (T4) and 12 weeks (T12) of use.
Results: For the MRCB group, CoP moved backwards while forefoot plantar pressure was decreased during standing position at T4 and T12 compared to T0. During running, the plantar pressure under the 2nd, 3rd and 4th metatarsal heads was reduced with MRCB at T0, T4 and T12. The one under the 1st metatarsal head was decreased at T4 and T12, when MRCB or flat insoles were used. The maximal extension and the total amplitude of ankle were slightly increased at T4 and T12 with or without wearing MRCB insoles. Similar changes in knee joint kinematics were observed but only at T12. Any significant changes were found in runners that used orthopedic insoles without correction.
Conclusions: Orthopedic insoles equipped with MRCB involve lower plantar pressure under the metatarsal heads, which may be of interest to treat forefoot injuries in runners.Click to expand... -
Immediate, short and medium-term effects of orthopedic insoles with a metatarsal retro-capital bar on biomechanical variables, plantar pressures and muscle activity in running
Stéphane Vermand et al
J Sports Med Phys Fitness. 2020 Jun;60(6):848-854
Background: The aim of this study was to evaluate the effect of 12 weeks of use of orthopedic insoles equipped with a metatarsal retro-capital bar (MRCB) on plantar pressure under the feet and lower limb kinematic variables during running.
Methods: Two groups of 10 runners used for 12 weeks while running orthopedic insoles without correction or equipped with a MRCB. All participants performed successively a standing posture (CoP displacement) test and a running test at 11 km.h-1 (lower limb kinematic variables) using with flat insoles and orthopedic neutral or MRCB insoles at the beginning (T0), after 4 (T4) and 12 weeks (T12) of use.
Results: For the MRCB group, CoP moved backwards while forefoot plantar pressure was decreased during standing position at T4 and T12 compared to T0. During running, the plantar pressure under the 2nd, 3rd and 4th metatarsal heads was reduced with MRCB at T0, T4 and T12. The one under the 1st metatarsal head was decreased at T4 and T12, when MRCB or flat insoles were used. The maximal extension and the total amplitude of ankle were slightly increased at T4 and T12 with or without wearing MRCB insoles. Similar changes in knee joint kinematics were observed but only at T12. Any significant changes were found in runners that used orthopedic insoles without correction.
Conclusions: Orthopedic insoles equipped with MRCB involve lower plantar pressure under the metatarsal heads, which may be of interest to treat forefoot injuries in runners.Click to expand... -
The Effects of Transverse Arch Insole Application on Body Stability in Subject with Flat Foot
Sung-hoon Jung et al
J Musculoskelet Sci Technol 2022; 6(2):80-84: Dec 31, 2022
Background
The most commonly applied therapeutic intervention is foot orthosis (insole or wedge) for arch support. However, the effect of these varies and remains controversial. Most of the studies were that investigated the muscle activity of insole application, and there was no information on what kind of recovery effect it had functionally.
Purpose
The purpose of this study was to investigate the effect of transverse arch insole on lower extremity kinematics in subject with flat feet during one-leg standing.
Study design
A cross-sectional study
Methods
Fifteen young women and five men participated in this study. Participants performed one leg standing between with and without transverse arch support. During one-leg standing, lower extremity movements (vertical/horizontal displacement of knee/ankle joints) were video-recorded and then analyzed using Kinovea software. A paired t-test was used to compare the characteristics between with and without the transverse arch insole.
Results
The use of a transverse arch insole significantly decreased the vertical and horizontal displacement of the knee and the vertical displacement of the ankle during one-leg standing in subject with flat foot (p<0.05).
Conclusions
Our study investigated the effects of transverse arch support on lower kinematics in subject with flat feet during one leg standing. During one-leg standing, there were significant differences between with and without transverse arch insole in lower extremities kinematics (vertical/horizontal displacement of knee/ankle joints). Therefore, it was confirmed that supporting the transverse arch when treating or managing subjects with flat feet can reduce unnecessary lower extremity movements and increase the stability of the body extremities.Click to expand...
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