MULTISTEP MEASUREMENT OF PLANTAR PRESSURE ALTERATIONS USING METATARSAL PADS

Metatarsal pads are frequently prescribed for nonoperative management of metatarsalgia due to various etiologies. When appropriately placed, they are effective in reducing pressures under the metatarsal heads o n the plantar surface of the foot. Despite the positive clinical repor ts that have been cited, there are no quantitative studies documenting the load redistribution effects of these pads during multiple step us age within the shoe environment. The objective of this study was to as sess changes in plantar pressure metrics resulting from pad use. Ten n ormal adult male subjects were tested during a series of 400-step tria ls. Pressures were recorded from eight discrete plantar locations at t he hindfoot, midfoot, and forefoot regions of the insole. Significant increases in peak pressures, contact durations, and pressure-time inte grals were noted at the metatarsal shaft region with pad use (P greate r-than-or-equal-to .05). Statistically significant changes in metric v alues were not seen at the other plantar locations, although metatarsa l pad use resulted in mild decreases in mean peak pressures at the fir st and second metatarsal heads and slight increases laterally. Contact durations decreased at all metatarsal head locations, while pressure- time integrals decreased at the first, second, third, and fourth metat arsal heads. A slight increase in pressure-time integrals was seen at the fifth metatarsal head. The redistribution of plantar pressures ten ded to relate not only to the dimensions of the metatarsal pads, but a lso to foot size, anatomic foot configuration, and pad location. Knowl edge of these parameters, along with careful control of pad dimensions and placement, allows use of the metatarsal pad as an effective ortho tic device for redistributing forefoot plantar pressures.