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Where is the correct localization for transverse arch support on insole?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by memog, Jun 16, 2009.

  1. memog

    memog Welcome New Poster

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    Hello everyone,

    We try to make good correct insoles for patients with some kinds of arc problems. First of all, I examine them and take their pedobarographic data with Novel Emed-X System. After my evaluation exams and pedobarographic data, I suggest insoles.
    We get the shapes of their feet with plaster or foam and make insole with different a few techniques in our small workshop.
    We have generally (95%) high customer satisfaction about our insoles. Sometimes we get some confusing evaluation from other orthopaedic surgeons about transverse arc support location on insole.
    Could you give me some informations from your practice about that? Where is the correct location transverse arc in the foot? Where can we put the supports on insole? Why? How high or hard?
    I know that it is changeable according to the patient's problems, but I am wondering your opinion general practice for only supporting.

    Thanks a lot.
  2. Ella Hurrell

    Ella Hurrell Active Member

    Last edited: Jun 16, 2009
  3. Re: Where is the correct localization for transverse arc support on insole?

    The Transverse Arch as described by Kapandji (1970) existed under the metatarsal HEADS so that heads 2-4 were off the ground during stance phase so the foot rested on 3 points, heel, 1st and 5th. At heel lift the forefoot was said to expand causing all the mets to flatten and receive the load.

    This is not the case.

    Whilst there is obviously an arch shape at the proximal end of the mets this is not the arch defined in Kapandji's work as the metatarsal arch. There is no plantar metatarsal arch under the met heads. Evidence abounds.

    Metatarsal domes are a useful modification, I use them often, however I think this is one of those occasions where it is important not to allow the model to masquerade as the reality. A metatarsal dome is not a transverse metatarsal arch support.

    But to answer your question, I generally put them with the leading edge under the highest point of pressure. Sometimes I'll go further forward or further back depending on where I want to exert force. Likewise I use anything from a dome incorperated into a shell through to poron 92 or latex depending on what I'm shooting for.

    Kind regards
    Robert Isaacs

    Kapandji LA. The physiology of the joints. Edinburgh & London: E & S Livingstone, 1970.
  4. Craig Payne

    Craig Payne Moderator

    Re: Where is the correct localization for transverse arc support on insole?

    There is NO transverse metatarsal arch:

    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
  5. Admin2

    Admin2 Administrator Staff Member

  6. footdynamics

    footdynamics Welcome New Poster

    Regardless of any discussion of the existence of a transverse arch there is plenty of anecdotal evidence that met pads and bars are effective treatment of forefoot discomfort. Birkenstock certainly has demonstrated this. I place my met support with the distal edge just bearly under the met heads with the apex proximal to the heads. This location need to be determined in weightbearing as the arch length changes at midstance.

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