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.