Due to the complex nature of forefoot pathology and pain, use of metatarsal pads and metatarsal bars is a common component in orthotic therapy. One of the consistent challenges concerns the exact placement of the pad. This challenge may increase as the orthotic prescription and cast need to convey the exact placement of the metatarsal pad. In addition to placement issues, a few other items should be considered as options when placing a metatarsal pad on an orthotic: 1) Order only the posterior 1/2 of topcover to be glued, therefore you can adjust placement of the pad if necessary; 2) Order a small or large metatarsal pad if the foot is very small or very large; 3) Order the metatarsal pad, but ask the lab to send it without adhering it to the plate, then you can glue it down once the patient's foot is on the device; 4) Mark the exact "X" location of the pain or prominence on the negative cast to insure that the lab knows the exact location of the issue; 5) Consider a metatarsal bar, instead of a metatarsal pad, if your goal is more diffuse offloading; 6) Set appopriate expectations for the patient as to shoe options, due to the increased thickness of the device.
Recent studies are detailing the best location for metatarsal pad placement for optimal off-loading. With this more quantified information, the success of metatarsal pad placement and use should improve.
One of the more recent studies regarding optimal metatarsal pad placement is the subject of our EJournal summary today: Kang 2006.