Metatarsal Domes Reduce Forefoot Pressure in Older Adults

Abstract

Background: Forefoot pads such as metatarsal domes are commonly used in clinical practice for the treatment of pressure-related forefoot pain, however evidence for their effects is inconsistent. This study aimed to evaluate the effects on plantar pressures of metatarsal domes in different positions relative to the metatarsal heads.

This study reviewed changes in plantar pressure around a variety of metatarsal domes and placement strategies in older subjects. Formthotic-made domes were not studied. Compared to a control- flat- insole, all variations (using standardised footwear) resulted in decreased forefoot pressures. Placement of the dome 5mm proximal to the metatarsal heads was shown to be the most effective positioning in terms of pressure. The Emsold(R) dome was less effective than PPT(R) domes.

Results: When analysed with the mask that was distal to the metatarsal heads, where the plantar pressure readings were at their highest, all metatarsal dome conditions led to significant reductions in plantar pressure at the forefoot compared to the control (no pad) condition (F_{3.9, 135.6} = 8.125, p < 0.001). The reductions in plantar pressure were in the order of 45–60 kPa. Both the Emsold metatarsal dome and the Langer PPT metatarsal pad, when positioned proximal to the metatarsal heads, managed to achieve this without adversely increasing plantar pressure proximally where the pad was positioned, however the Emsold metatarsal dome was most effective.

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