Metatarsal dome / pad how it helps forefoot pain

Kinetic Changes in the Forefoot With Metatarsal Pad and Domes

There are many common forefoot conditions to prescribe a metatarsal pad or dome such as:

  • Metatarsalgia
  • Morton’s neuroma
  • Plantar plate tear / rupture
  • Synovitis of the MPJ’s
  • Capsulitis of the MPJ’s
  • Corn
  • Sesamoiditis
  • Stress fractures
  • Freiberg disease
  • Midfoot arthritis

Please read for a technical look at the reasons to prescribe a metatarsal dome and how they minimize forefoot pressures.

 

The effectiveness of a metatarsal dome to reduce plantar pressures depends on:

  1. Placement of the metatarsal dome relative to the metatarsal head
  2. Material density of the metatarsal dome
  3. Length of the metatarsal dome

 

For a metatarsal dome to alter plantar pressures under the forefoot it should alter:

  1. Force under the met head
  2. Surface area of contact

Picture1 Metatarsal dome / pad how it helps forefoot pain

Position or placement of metatarsal dome relative to metatarsal head: 1 and 2 are domes, 3 and 4 are met pad or met cover. The X is the location of met heads. 1 and 3 are placed proximal to the metatarsal head and 2 and 4 are distal to the metatarsal head. The metatarsal dome or even a metatarsal pad has two surfaces. The peak and the descent. The proximal location has the tip of the dome below the line of the metatarsal head. The distal location has the tip of the dome over the distal edge of the metatarsal head so that the apex of the dome sits at the neck of the metatarsal head.

Picture2-1 Metatarsal dome / pad how it helps forefoot pain

Metatarsal dome placed distally (fig 2) – Reduced peak plantar pressures under the forefoot (metatarsal heads up to midshaft) under the forefoot. But no change in the surface area of contact.

Metatarsal dome placed proximally, met bar and met cover – Increased surface area of contact more than distally placed dome. Reduced peak plantar pressures (PP) to a lesser extent than distally placed metatarsal dome. Both dome and pads irrespective of the location and shape significantly reduced maximum force under the forefoot.

Precisely, when the forefoot was divided into 3 regions, proximal to metatarsal head,  under the metatarsal head and  distal to metatarsal head the outcome measures were as follows:

Proximal placed met dome – Reduced peak PP and maximum force proximal to metatarsal head and underneath the metatarsal head. Softer pad was more effective than harder in reducing PP and force.

Distally placed met dome – Reduced peak PP and maximum force distal to the metatarsal head. Harder pad was more effective in reducing PP and force.

Interestingly, the contact area under these regions was significantly greater only in the region proximal to the metatarsal head. The dome located proximal to the metatarsal head had increased contact area than distal. So, if we are treating a corn under a met head and aim to increase surface area of contact under the corn, a proximally placed dome will be effective of any density.

The metatarsal dome and pad positioned distal to the metatarsal heads reduced maximum force and Peak pressures in the forefoot (Pressure = Force/Area). In other words pressure and force are inversely proportional to area; as surface area increases plantar pressures should reduce. However, the surface area with a distally placed met dome did not increase. So how did the peak pressure lowered in a distally placed metatarsal dome? Impulse = Force x Time. Distally placed metatarsal dome spent approx 10 ms longer than other conditions, this time difference was not statistically significant, but still 10 ms is long enough to consider the time factor. So, a metatarsal dome in fig 2 reduces peak pressures under the forefoot not by increasing the surface area of contact but by lowering impulse.

Since dome placement alters pressure and force distribution relative to metatarsal heads, consideration should be given to onset of symptoms to choose the optimal location of the dome. If symptoms are during early to late stance a proximal located dome is recommended, if the symptoms are towards the end of late stance a distally placed dome could be effective. If the plan is to reduce PP as in pts with fat pad atrophy consider a met cushioning pad (1 -5) and longer the better in reducing total pressures under the FF.

Finite element analysis reported using a metatarsal dome in an orthotic increases tensile forces in the plantar fascia but metatarsal pad or plantar cover or thick forefoot padding (12 mm) lowers the tensile forces in the plantar structures. something to consider in treating heel P. fasciitis.

This article was researched (comprehensive review of up to date research articles) and written by David Survepalli, one of our very talented podiatrists at Foot focus Podiatry.  Should you like to read the orignal articles please call 9258 4152 or email us.

How Do you Know If you Really Need Orthotics

Maybe you have tried orthotics before, but for some reason, they have just never been comfortable and you ended up never wearing them. You spent hundreds of dollars for something you don’t find useful nor comfortable and wondered if you really need them in the first place.  We are the place to come to clarify this for you.

At Foot Focus Podiatry in Perth, we as a practice value orthotics and their crucial role in addressing poor foot/leg posture/function and biomechanics. However, not everyone needs orthotics long term if their joints and muscles issues are assessed and treated accordingly. The important difference with Foot Focus Podiatry is that even if we believe you will benefit from custom-made orthotics, we like to trial semi-custom-made orthotics (which cost approximately $70) first to make sure.  This way you won’t end up wasting your money again!

 

How do you Know If your Joint and Muscles are Working as They Should be? Or Whether your Foot Type is Likely to Cause Problems?

At Foot Focus Podiatry we pride ourselves on treating you holistically.  Not only do we look at your feet, but we consider your knees, lower legs, pelvis, and back.  We are confident in assessing your muscles and joints to ensure things are working as they should be using advanced skills, such as soft-tissue techniques, manual techniques, joint mobilizationtrigger point therapy, and Strain-Counterstrain.  So, if after visiting us and there is no tightness, discomfort, or pain in your muscles and joints, and you have no signs of problems, such as arthritis, bunions, or hammertoes, then you probably don’t need orthoses.

So, you need orthotics, but which one do you get?

Depending on the issue and severity of the case, each person requires a different level of control. In most cases, semi-customized orthotics are all that is needed.  There are certain conditions that require specific features that can only be achieved through custom-made orthotics.

Why do we use semi-customized orthotics in most cases?

According to the research papers, there is no significant difference in using off-the-shelf or customized orthotics to treat certain conditions, as long as the orthotics have been adjusted accordingly.  Semi-customized orthotics are off-the-shelf orthotics, which can be adjusted to help any foot type and pain and can be dispensed to you on the day of your appointment. This allows for immediate intervention for your symptoms and provides significant biomechanical change when compared to strapping, which is often used for symptom relief.

With prices ranging from $70 to $139, it is a good way to trial orthotics before spending your money on fully customized orthotics. Semi-customized orthotics are more of a realistic prescription aid for casted customized orthotics. If you are going to wear orthotics for the rest of your life, we would like to ensure that they are of the correct fit, help your muscles and joints biomechanical functions, and comfortable for the long term.

When do we use customized orthotics?

Customized orthotics are made by taking an imprint of your feet (scan) and molding the orthotics based on the imprint. In other words, they are customized just for you. Generally, they are reserved for those that present with severe foot types (e.g. very flat-footed or very high arch), previous trauma to foot and leg (eg. motor vehicle accident), or for those who wear a certain type of footwear that make fitting into semi-customized orthotics tricky. They are also more durable than semi-customized orthotics.

As they can be expensive, with prices starting from $590 per pair, we generally prefer to trial semi-customized orthotics first. This way, you can be confident that your customized orthotics will be correct for many years to come and still be comfortable.

If you are unsure whether you really need orthotics or what type of orthotics suits you, call us to make an appointment and we can help you understand your gait and lower limbs. By seeing us you can be assured we will not put you into orthotics unless you need them, and in most cases, we will use affordable semi-customized orthotics.

Archies Support Orthotic Thongs

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They are not your typical thongs!

Archies Orthotic Thongs are designed by a Physiotherapist who saw the need for supportive thongs. They are great to wear when you are not wearing your orthotics, giving you a break from your standard shoes and some fresh air, while still giving some substantial support.

They are super comfy, supportive thongs made from a special foam that moulds to your feet. With arch support to help encourage good foot posture and body alignment. Being moulded in one piece, there are no “blow outs”! And the firm strap helps stop toe clawing which will help in turn help stop overuse of muscles and tendons in the feet. They are so light you will hardly know you are wearing them and come in a fantastic range of colours from size 5 through to size 13.

In December 2020 Archies are also introducing Kids Sizes!

Foot Focus Podiatry are proud to be Perth Stockists for Archies Supportive Thongs, retailing at $35 per pair.

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Article on the worst shoe advice parents receive, according to Podiatrist Gaby Tan

Have a read of the article in Kidspot on “the worst shoe advice parents receive”, according to our Podiatrist Gaby Tan.

Our Podiatrist Gaby Tan has helped write an informative article that covers important advice for when choosing shoes for your children.  The article also goes over some of the common mistakes and incorrect advice often given to parents when buying shoes for their children.  A very good article to help you choose the best possible shoes for your child and ther foot health!

Article by Leah Goulis at  kidspot_logo Metatarsal dome / pad how it helps forefoot pain on July 24, 2020 click here to read full article.

We are located in Perth (south of the river) in Wilson, which is neighboured by Curtin University, Como, Manning, South Perth, Victoria Park, Bentley, St James, Cannington / Carousel, Riverton, Shelley, Ferndale, Lynwood, Parkwood, Willetton and surrounding suburbs.

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