The Applicability of Plantar Padding in Reducing Peak Plantar Pressure in the Forefeet of Healthy AdultsImplications for the Foot at Risk

The Management of Metatarsalgia in Rheumatoid Arthritis Using Simple Insoles: An Effective Concurrent Treatment to Drug Therapy

BACKGROUND

Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain.

METHOD

A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use.

RESULTS

Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively) Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied.

Effectiveness of the Fixtoe Device® in plantar pressure reduction: a preliminary study

Background

Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. ³⁵ The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study.

Methods

Maximal pressure (Kpa) and pressure–time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad.

Results

Mean second metatarsal head maximal pressure and mean pressure–time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure–time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure–time integral reduction.

Conclusions

The Fixtoe Device® reduces median maximal pressure and median pressure–time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

Socks with an U-shaped 3D discharge element are capable to reduce dynamic plantar pressures under the central forefoot

Cushioning for the central and plantar zone of the forefoot, integrated into the body of the sock, could reduce excess pressures in that zone. The objective of this study was to verify the capacity of a sock with a cushioning element to reduce forefoot plantar pressures relative to the same sock model without that element. Dynamic plantar pressures were measured in a sample of 38 participants (25 women and 13 men) using the FootScan plate system following the two-step protocol. Measurements were made in three situations selected at random - barefoot, wearing control socks, and wearing the experimental cushioned socks. Maximum pressures were analysed in seven zones of the forefoot (hallux, lesser toes, and 1st to 5th metatarsal heads). The zone of greatest plantar pressure was in all situations located under the 3rd metatarsal head. The pressure was lower (p = 0.009) under the 2nd metatarsal head with the experimental sock (10.2 ± 3.1 N/cm²) than with the other two conditions - barefoot (11.8 ± 3.7 N/cm²) and control sock (11.9 ± 4.9 N/cm²). The 3rd metatarsal head presented lower plantar pressures (p = 0.004) with the experimental sock (12.6 ± 3.8 N/cm²) than barefoot (14.5 ± 4.9 N/cm²). The experimental socks, with plantar cushioning, were able to effectively reduce the plantar pressures on the central part of the forefoot. This reduction may lead to less discomfort for subjects suffering pain in this area, It may also result in avoiding the appearance of possible skin lesions associated with excess pressure (such as calluses, corns, or blisters).

Effectiveness of a Central Discharge Element Sock for Plantar Temperature Reduction and Improving Comfort

U-shaped plantar cushions could help reduce stress affecting the central forefoot without the need for an orthosis, but they are yet to be integrated as an element in socks. The objective of this study was to verify the effectiveness of a sock with a central discharge element in terms of plantar temperature and comfort. The sample comprised 38 subjects (13 men and 25 women). Their plantar temperatures were measured with a thermographic camera in a basal situation and after each of two 10-minute walks around an indoor circuit during which they wore either control or experimental socks at random (the same design, weight, and fiber, but with the plantar cushioning element added). After the walks, each subject responded to a comfort questionnaire (five-point Likert scale), blindly scoring the two socks. The highest temperatures (28.3 ± 2.7 °C) were recorded in the zone of the second and third metatarsal heads. With the experimental socks, the observed temperature increase in the central forefoot zone was significantly less than with the control socks (31.6 vs. 30.6 °C, p = 0.001). The subjects found the experimental socks to be more comfortable than the controls (4.63 ± 0.5 vs. 4.03 ± 0.5, p < 0.001). The discharge element included in the experimental socks was effective since it reduced the contact zones and excess friction with the ground, thereby lessening overheating by more than 1 °C. Furthermore, the experimental socks were perceived as being more comfortable by the subjects who had mild and occasional foot discomfort.