2/2/2012 1:29 PM
I found an interesting article in JAPMA this month.
Effect of a Metatarsal Pad on the Forefoot During Gait
KLM Koenraadt et al. JAPMA. Vol 102. No 1, Jan/Feb 2012. Pg 18-24.
Purpose: Determine the effect of a metatarsal pad on spreading the forefoot and its effect on plantar pressure distribution.
Hypothesis: A metatarsal pad causes an increase in the forefoot width therefore resulting in widening of the spaces between the metatarsal heads.
- Forefoot width widens during midstance and does so more with the addition of a metatarsal pad, but this is small, 0.60mm. This could simply be skin movement.
- The 2nd metatarsal was raised with the pad carefully placed and this could, in combination with pressure redistribution, result in decreased pain for the patients. However, placement of the pad is key.
- In the office, I use both metatarsal pads and bars. I find the bars far easier for patients to place following my instruction. I commonly see the pads too far proximally. I always give instructions to patients to place the pad just behind the metatarsal head of interest. I have patients stand on it in the office with it too far distal and too far proximal then we move to the correct location. I place them on top of orthotics or an insole for pressure offloading.
- This article used the pads without the addition of a functional foot orthotic. I do use these pads, and bars, with a functional foot orthotic to better redistribute plantar pressures and control the hindfoot motion.