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Placement of metatarsal domes

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  #1  
Old 7th May 2012, 04:16 PM
markleigh markleigh is offline
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Default Placement of metatarsal domes

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Do you have a technique for determining the location for a met dome? I palpate for the met head & try to place the pad directly behind that. But is there a better way to determine the location? I am finding there is such variability in comfort level with met domes & shifting a millimetre proximal or distal makes a big difference. Is there also any rhyme or reason to the size of the met dome used? Lastly I received an email today from Prolab about research regards the effect of met domes & they suggested an alternative is a met bar made of 3mm Poron & ending at the distal edge of the device. Any comments?
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Old 8th May 2012, 01:28 PM
efuller efuller is online now
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Default Re: Placement of metatarsal domes

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Originally Posted by markleigh View Post
Do you have a technique for determining the location for a met dome? I palpate for the met head & try to place the pad directly behind that. But is there a better way to determine the location? I am finding there is such variability in comfort level with met domes & shifting a millimetre proximal or distal makes a big difference. Is there also any rhyme or reason to the size of the met dome used? Lastly I received an email today from Prolab about research regards the effect of met domes & they suggested an alternative is a met bar made of 3mm Poron & ending at the distal edge of the device. Any comments?

To me, it seems different patients prefer different locations. Some people really love met domes and others can't tolerate them at all. When I have a patient that needs/wants a met dome I don't glue the front half of the top cover and tape the dome down. When they find a spot they like, I will glue the cover down.


Eric
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Old 8th May 2012, 01:57 PM
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Default Re: Placement of metatarsal domes

Related Threads
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Old 9th May 2012, 07:14 AM
carolisus carolisus is offline
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Default Re: Placement of metatarsal domes

The function of a "met dome" or met lift is to reduce pressure/impact on the met head, right? So, find the place in the metatarsal arch (yes, it is separate and distinct from the transverse!) that when "pushed" lifts and separates the met heads.
That's where the dome goes. Experiment with your hand....notice that if you are too close to the "knuckle" it only adds pressure, and to far distal it does nothing....
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Old 9th May 2012, 07:49 AM
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Default Re: Placement of metatarsal domes

Quote:
Originally Posted by markleigh View Post
Do you have a technique for determining the location for a met dome? I palpate for the met head & try to place the pad directly behind that. But is there a better way to determine the location? I am finding there is such variability in comfort level with met domes & shifting a millimetre proximal or distal makes a big difference. Is there also any rhyme or reason to the size of the met dome used? Lastly I received an email today from Prolab about research regards the effect of met domes & they suggested an alternative is a met bar made of 3mm Poron & ending at the distal edge of the device. Any comments?
Mark:

After 27+ years of trial and error on hundreds of patients, I have come to the conclusion that patients generally find metatarsal pads to be most comfortably located with its distal edge being 15 mm distal to the anterior edge of the orthosis plate.

However, like Eric, I will not firmly glue down the pad until the patient has experimented with the best location by allowing them to move it a little bit on their own. One thing that does help is to glue only the heel cup portion of the orthosis topcover so that the metatarsal pad can be easily accessed and moved by the clinician or patient before final gluing.

In addition, once I have placed the metatarsal pad so that its anterior edge is 15 mm distal to the distal edge of the orthosis plate, I will then use a pen to trace the proximal border of the metatarsal pad on the orthosis plate so that this can be used as a reference for the patient (and for myself) as to where it was originally placed relative to the orthosis plate. It is also not uncommon that I grind down the thickness of the metatarsal pad to make it thinner since often even a small metatarsal pad on a well-made foot orthosis will feel like a very big "bump" to the patient.

I use metatarsal pads routinely for treating intermetatarsal neuromas and plantar plate tears (MPJ capsulitis). They often can mean the difference between orthosis success and orthosis failure.

Hope this helps.
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Old 9th May 2012, 09:13 AM
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Default Re: Placement of metatarsal domes

Hi

For use on simple insoles, I palpate the proximal border along the mets in question e.g. 2nd, 3rd and 4th and draw on the patients foot with a pen following the shape. This will then transfer onto the paper when the foot is placed on it.

With regards to the thickness, the thumb is a great indicator on how deep/much pressure it takes to reinstate the metatarsal arch shape/dorsiflex the particular metatarsals in question, slightly!

Regards

Barry
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Old 9th May 2012, 09:37 AM
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Default Re: Placement of metatarsal domes

Quote:
Originally Posted by markleigh View Post
Lastly I received an email today from Prolab about research regards the effect of met domes & they suggested an alternative is a met bar made of 3mm Poron & ending at the distal edge of the device. Any comments?
i have had some met bars come back in 3mm poron lately (in-house change of contractor, default standard changed, don't ask, we're working through it.........) and I can't quite see how a 3mm squishable met bar can work. i would normally specify in a firmer material.
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Old 10th May 2012, 07:12 AM
cdh1712 cdh1712 is offline
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Default Re: Placement of metatarsal domes

I place the met dome just posterior to the 2nd 3rd and 4th met heads and try to taper it off towards the 3rd and 4th mets, the depth depending on the anatomical appearence of the forefoot. However I'd like to make a comment about the met bar idea. I would be concerned that this would interfere with plantar flexion of the 1st ray during propulsion.
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