One of the most common problems people consult me with for orthotic prescription, is metatarsal pain.
There are many variations of metatarsal irritation, eg dropped metatarsal heads, metatarsalgia, loss of fat padding from the metatarsals, and mortons neuroma.
If we look at the structure of the foot, we notice the relationship between the metatarsal heads and the heel, we see a "strut" that connects the heel to the metatarsal area, called the plantar aponeurosis.
It has been my finding that the individual rigidity factor of the plantar aponeurosis affects either / and the heel / metatarsals purely by the pull factors involved.
At the heel end, this can mean plantar fasciitis, and at the metatarsal end, this leads to the excessive pulling literally driving the metatarsals downward, leading to "dropped metatarsal heads.
This rigidity is what always leads me to prescribe semi rigid orthotics instead of rigid models.
There is also the problems associated with a rigid orthotic bruising the already inflamed and micro torn aponeurosis.
Some patients present with an anatomically shorter aponeurosis, eg the pes cavus ( or semi cavus ) type feet, and the constant pulling forces associated with a shorter aponeurosis greatly increase the likelihood of heel or metatarsal symptoms.
I have been professing for many years that orthotic prescription is so much more than merely foot shape alone, and always take the individuals plantar foot rise and fall into consideration, often even changing this for the shoe type also.
Looking at mortons neuroma, generally always see this condition in pronated feet, where the dropped foot causes the metatarsals to bunch together, irritating the heads until a growth develops inbetween them.
There is an operation available for advanced mortons, but if caught early, an orthotic will prevent worsening.
There is also the question of the mortons returning after the operation unless we correct the foot posture and take away the original cause of the problem in the first place by using orthotics.
Loss of foot padding under the metatarsals is a perennial problem in many people, and in my experience, i notice that this is a result of the pull of the aponeurosis driving the metatarsal heads downward, and literally driving through the soft tissue padding.
In these cases, I use an orthotic to re align the foot before adding padding under the metatarsal part , often with metatarsal accomodations to cushion the area directly.
I feel that if we understand this relationship between the aponeurosis rigidity, posture of the foot, rise and fall of the foot in motion, and of course, the shape of the foot, we can provide a much better orthotic and consequently, much better results in not only metatarsal pain, but also other conditions.
Copyright, Les Bailey 2012 ..Dr Les Bailey phd,DO,acopm,apta (int part )
About Dr Les Bailey phd,DO, acopm.apta(int part)
Direct phone number 07801418080
Dr Les Bailey began in physical therapies in 1981,qualifying in remedial massage,and later going on to qualify as an osteopath.
He gained his phd from OIUCM for a thesis on the treatment of plantar fasciitis.
He was awarded a teaching/lecturing diploma from the northern school of osteopaths in 1993.
He also holds a diploma in foot biomechanics .
Dr Les Bailey works from his clinic near woodmansterne, Banstead in surrey.
Les Bailey welcomes people to contact him for advice and help.