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Thursday, March 17, 2011

The Metatarsal Arch: A Biomechanical Waste Land

     When designing orthotic devices, the practitioner considers the symptoms, the patient's biomechanical makeup, and gait evaluation findings. The practitioner tells the lab by filling out an Rx sheet directly or indirectly how much support to give each of the 3 arches of your foot: medial (inside), lateral (outside), and metatarsal (ball of the foot). And this is tricky business. The biomechanist must compromise since many labs or products support these arches differently. If you look at the whole line of over the counter inserts, they vary immensely in how much they support each of these 3 arches. Among the various orthotic laboratories I have seen, the standard orthotic correction can vary for the same individual in these 3 arches. This is one reason podiatrists at least tend to stick to one laboratory since they get very familiar with their artistic flare. When you send an impression cast to a laboratory, you should know what it will look like when it comes back and whether it will do the job needed. This union between the practitioner and lab takes awhile.

     The Metatarsal Arch correction can be vital or not that important for each individual. Problems occur when the importance of the arch is not recognized. Most of the orthotic devices I see really have a poor to average metatarsal arch. I love the Your Sole OTC orthotic devices, but they have poor metatarsal arches and I should not use them when good metatarsal support is crucial. Hapad Arch Supports are all over my blog, and just support the metatarsal arch, ignoring the other 2 arches. I love Hapad company, their pads have a vital place in my practice when metatarsal support is needed. You can combine any orthotic with a Hapad metatarsal arch or Hapad Medial Longitudinal Arch (which I still use as a Metatarsal Arch).

    When podiatrists take impression casts, they are just capturing the skin impression of the arches. This is why it is not exact. When casts are taken weight bearing, these arches flatten out some, again not perfect. Someday I will understand the metatarsal arch better, and my help for my patients will improve immensely. For now, this is the most arty aspect of an orthotic device. If you have orthotic devices which do not a noticeable metatarsal arch, and you have pain in your foot, or continue to feel unstable, ask your practitioner if they think any more metatarsal arch can be experimented with.

Here is an additional metatarsal support being applied to a Good Feet Orthotic Device for metatarsal pain relief and stability. All three arches work together. By adding this metatarsal arch, the amount of foot pronation decreased.

Here is the same Metatarsal Arch from the side view. On the Good Feet Orthotic Devices, it is common to have to add medial and lateral arch reinforcements for extra stability.

This photo above demonstrates that when you add topcovers try to initially just glue the heel area. It makes it so much easier if further adjustments to the metatarsal arch are needed. This was first brought to my attention by ProLab USA.

Here is an example of a Spenco topcover before it is glued in place. It can make the pressure from the metatarsal pad more comfortable.

Here is the Hapad Metatarsal Pads. You need to move them around, turn them on their side (whatever works!!), to find the best place for each foot. Each foot may require a different design/placement.

Hapad Longitudinal Medial Arch Supports (normally, like the metatarsal arches, ordered small) can be shifted all the way to the outside border of the foot to work as a great metatarsal arch. This product can be used on an orthotic device or alone in a shoe or sandal.     

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.