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I have a question about the uses of the long and short shaft metatarsal pads, and would greatly appreciate any advice to help enlighten me as I am recently qualified and therefore finding my way through this fascinating subject. OK so here I go. Basically my understanding of the use of long shaft pads is in the symptomatic treatment of painful hallux limitus and their function is to increase the loading to the 1st mtpj and decrease motion at this joint, am I correct in this assumption.
Secondly, the short shaft pad that stops distal to the metatarsal head with the full thickness of the pad lying ovet the met head. In my understanding this will only serve to dorsiflex the metatarsal and therefore result in a functional hallux liomitus, am I correct , and if so what is the purpose of the short shaft pad.
Thanks to any one who takes the time to read this and cares to reply to my humble request to tap into your vast podiatric knowledge of which I am only just beginning to scratch the edge of. Thanks, Nick.
the short met pad is used when you have a short 1st metatarsal and you want to load the 1st met earlier in the loading of the forefoot...thus less pronation required to toe off....and toe off is then from the correct location..ie.the 1st MTP joint and not from the 1st ITP joint and 2 mtp joint..as you see in excessive pronation at the sub talar joint..
>I have a question about the uses of the long and short shaft metatarsal pads....snip ...and their function is to increase the loading to the 1st mtpj and decrease motion at this joint, am I correct in this assumption.
Two decades back someone published a piece in the UK journal about the position of metatarsal padding in relationship to the metatarsal phalangeal joints. They were using a pedobarograph and measuring peak pressures. If memory serves the positon of the pad made no difference to the distribution of peak pressure. I understood from that, metatarsal padding placed distal and proximal to the joint was no different to pads traditonally placed over the joint. If true this would certainly question the descriptions regularly given to support metatarsal padding.
As far as 'extended shafts ' such as Mortons extension. i.e long shaft running from the base of the first metatarsal (over the metatarsal head) to proximal to the interphalangeal joint I am not aware of any studies, As I understand the tradional explanation the bulk of the felt offered a better pivot to the MPJ (which would give a mechanical advantage to a joint with limited QOM). This migh only be for a very short period (as the material compressed) but would rest the part, break the pain cycle and account for reduced symptoms. The proximal cresent to the interphalangeal joint would protect the skin (lesion) without increasing the bulk. This gave the advantage of applying analgesics or whatever. Taking the extended shaft principle this could be converted into a shoe or foot orthotic modification. Thinking about it the increased bulk along the metatarsal and proximal shaft may have temporarily increased the windlass action reducing the tension on the long tendons by compressing the sesamoid mechanism. Whatever the reason the sagittal profile of the distal phalanx plantar flexes and I recommend the extended shaft to aid with painful nails.
>Secondly, the short shaft pad that stops distal to the metatarsal head with the full thickness of the pad lying ovet the met head. In my understanding this will only serve to dorsiflex the metatarsal and therefore result in a functional hallux liomitus, am I correct , and if so what is the purpose of the short shaft pad.
I would doubt it would have the compression bulk (resistance) to dorsiflex the first ray but it might offer a temporary ground reaction force which results in a plantar flexion.
The sagittal plane of the metatarsal shafts is an incline from the distal to proximal and most of the bulk of plantar padding probably does not make contact with the ground. Or at least the wear across these prescriptions will vary. Personally I do not consider metatarsal bars where the bulk of padding is behind (distal) to the metatarsal heads do anything other than give the impression of transverse metatarsal compression as the foot rolls lateral to medial from foot flat to take off. The same effect would be seen in an elasticated met brace. The bulk of padding may have a superficial effect by compression of the proprioceptive nerve endings and the person gains confidence in weightbearing as a result.