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I used to think it was all about facilitating a transverse arch, put pods don't talk about this much at all?

Do we use them to reduce weightbearing on the middle met heads (2/3/4)? Do we use them when callus exist here; or just on the basis of symptomology?

Do they have a role in Morton's....?

Other threads/posts suggest that it augments windlass, and this makes sense as pressure under adjacent rays, should reduce GRF's under the 1st met head; thereby lessening the dorsi-flexion/forces of the 1st ray.

>I used to think it was all about facilitating a transverse arch, put pods don't talk about this much at all?

The transverse arch was thought by latterday modernists to materialise only in morbid anatomy. In functinal anatomy the contact phase of the metatarsals was more like a garden rake with each metatarsal head touching the ground, as the body mass passed medially across the foot.

>Do we use them to reduce weightbearing on the middle met heads (2/3/4)? Do we use them when callus exist here; or just on the basis of symptomology?

If memory serves Ken Robertson (London) did some preliminary work many years ago with pressure plates and produced interesting data which he concluded confirmed it did not make any difference where 2-4 plantar felt metatarsal pads were placed on the foot ie. directly over the met/phalangeal joints, or proximal or distal to them, they all had the same effect in pressure distribution. Not sure whether they increased or decreased the plantar pressure. But based on that I would say met bars are no different to metatarsal pads in terms of effect. You can argue till the cows come home about how comfortable they are to stanfd on.

>Do they have a role in Morton's....?

If you are referring to Plantar digital neuritis see below.

>Other threads/posts suggest that it augments windlass, and this makes sense as pressure under adjacent rays, should reduce GRF's under the 1st met head; thereby lessening the dorsi-flexion/forces of the 1st ray.

I would agree any bulk or resitance to compression on the plantar surfaces (weightbearing) would assist in the windlass action. Whilst most concerns in literature relate to the first MPJ, I would think the same applies to all MPJs and collectively the turning effect these have, help resupinate the heel, once it leaves the ground. I believe silicone two props have exactly the same effect and have had remarkable success in symptom reduction with treating PDN with simple three toe props.

It is still not clearly established what the cause of this condition is and many cling to the idea it has something to do with late phase pronation. By encouraging resupination as above and witnessing reduction in symptoms would lead me to think the working diagnosis may hold water.

Cameron
Hey, what do I know

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Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

It sure is the windlass. Met domes are one of the more effective ways to lower the force to get the windlass established....(plus all the other things that CK mentioned)

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Thanks Cameron.

Here in the States we call them metatarsal pads or cookies.

Metatarsal pads, just like any in-shoe padding system and/or foot orthosis will change the location, magnitude and temporal pattern of ground reaction forces (GRF) acting on the plantar foot. They can be used in any instance where the patient will benefit therapeutically without causing other gait pathology or other symptoms.

I use metatarsal pads commonly in treating plantar metatarsal head (or MPJ) pain (e.g. IPKs, capsulitis, plantar plate tears, etc), intermetatarsal neuromas and in metatarsal stress fractures. In metatarsal stress fractures, the apex of the pad should be just behind the fracture site to decrease the bending moment on the affected metatarsal ray so that less pain occurs and more rapid healing occurs.

In addition, they can be used to increase the plantar loading forces on the lesser metatarsal rays so that the first ray may receive less plantar loading force from the ground. This reduces the resting tensile force within the medial fibers of the central component of the plantar aponeurosis which inserts onto the sesamoids, which will, in many feet, reduce the force required on the plantar hallux during propulsion to initiate the Windlass Effect of Hicks. In this fashion, an appropriately placed metatarsal pad may function similar to a 2-5 metatarsal head extension on an orthosis (i.e. Dancer's pad) to reduce the GRF plantar to the first metatarsal head in the late midstance and early propulsive periods of gait. However, I have preferred the 2-5 forefoot extension to accomplish this goal for the last 20 years since patients generally find it much more comfortable than a metatarsal pad.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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