Background and aims: Many kinds of insoles and pads are commonly used as a conservative treatment of metatarsalgia. However, earlier studies of insole treatment provide contradictory results, and the natural progression of metatarsalgia is still unknown. The aims of this study were to (1) determine whether simple custom-made metatarsal pad insoles reduce pain and improve functional ability, (2) find out patients' satisfaction with padding treatment, and (3) investigate predisposing factors for metatarsalgia.
Material and methods: All metatarsalgia patients provided with metatarsal pad insoles during a 2-year period at Kuopio University Hospital (n = 45) were included in the study and observed at least a year. In all, 25 patients were interviewed about their situation before and after treatment. The Numeric Rating Scale for pain and American Orthopaedic Foot & Ankle Society forefoot questionnaire included questions about predisposing factors, other diseases, exercise, work, shoes, and satisfaction with insoles. Foot X-rays taken from 45 patients during treatment were analyzed.
Results: The mean age of the patients was 56 years (range 34-84 years); 87% of them were women. In all, 47% of patients had osteoarthritic changes in the first metatarsophalangeal joint, and 42% had hallux valgus. In the interviewed subgroup (n = 25) body mass index was normal in 44%, and 36% were mildly overweight. High-heeled shoes were used by 40% daily, and 68% had done standing work for several years. Pain decreased significantly on the Numeric Rating Scale: 3.2 points in all patients ( p < 0.001), 3.1 points among women, and 4.25 points among men. The American Orthopaedic Foot & Ankle Society score improved 24.2 points in all patients ( p < 0.001, range 0-100), among women 19 points, and among men 29 points.
Conclusion: Metatarsalgia affects mostly women and is often preceded by extensive use of high heels and standing work. Also, a high association of first metatarsophalangeal arthrosis and hallux valgus was found. Metatarsal pads reduce pain and improve the American Orthopaedic Foot & Ankle Society score. We recommend metatarsal padding as a safe and inexpensive alternative in treating metatarsalgia patients.
Keywords: Metatarsalgia; forefoot; gait; horizontal arch; insole; metatarsal pad; plantar pressure.