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A Technical Question about Orthotics

Posted by Darlene on 5/31/04 at 15:09 (151629)

I have a question about the met pads in custom orthotics. There are many different shapes and sizes. Does anyone know what shape does the best job of spreading the met heads?

Thank you.

Re: A Technical Question about Orthotics

Dr. Z on 5/31/04 at 16:21 (151635)

I like the classic met pad that forms under the 2-4 metatarsal heads.

Re: A Technical Question about Orthotics

Richard, C.Ped on 6/01/04 at 10:07 (151698)

The different shapes and sizes come into play as to what is needing the offloading.

Re: Richard - More Info.

Darlene on 6/01/04 at 11:52 (151712)

I need to offload the Morton's Neuroma in the 3rd interspace as well as an irritated nerve in the 2nd interspace resulting from the surgery to release the ligament.

When I'm standing with my orthotics in my running shoes, my toes rest on the orthotic. I read a post from someone who mentioned that the met pad made them feel like their toes were floating. What's the best way to spread those met heads?

Also, what would a media wedge do technically? I'm trying to understand how orthotics work. It seems to be part science and part art.

Thank you. :)

Re: Richard - More Info.

Richard, C.Ped on 6/03/04 at 07:46 (151863)

Hi Darlene,
sorry it took me so long to get back. Every time I tried to respond, something would come up at the office.

I have seen the pain go away with just basic orthotics before. I have also used the standard met pad Dr.Z mentioned. Those should work fine.

The wedge would help reduce stress and strain.

Re: Richard - More Again Please

Darlene on 6/03/04 at 08:24 (151871)

Thanks for taking the time to respond.
What does medial wedge mean? Is it a wedge on the inner part of the heel that would shift the weight more to the outer edge of the heal?

To further compound the matter, my 4th metatarsal head has dropped as a result of the surgery. Because the ligament has been cut there seems to be a lot of movement in the area. For example when I offload from this foot, I could feel the met head move down and when I step on the foot I could feel it move back up into alignment with the other heads. Because there is a neuroma in that interspace I really 'feel' it. I'm working with a good pedorthist, but we're running out of ideas.

Thanks again.


Re: Richard - More Again Please

Richard, C.Ped on 6/04/04 at 07:58 (151990)

Ok, I have been sitting here for about ten minutes trying to decide what to post. Every time I write something out, I change my mind and delete it...haha. Perhaps a metatarsal bar either on the bottom of the orthosis or the shoe might help.

This is a foot type I would really have to see in motion in order to know exactly what to do.

Another ten minutes just went by...lol

Perhaps extending the posting under the met heads, with a cut out for the 4th so that it does not move up and down, it just rests in basically one position.

Let me think a little more on this.

Re: Richard - More Info Today

Darlene on 6/04/04 at 09:54 (151998)

I went back for another orthotic adjustment yesterday. I spend more time with my pedorthist than I do with my husband. Luckily it's a woman or he might start to wonder.:)

The met pad in the orthotic was pretty mushy so she decided to make it firmer by going in from the underside of the orthotic and using a firmer material. It seemed to help in the office, but as the day went on I felt like the nerve was getting pinched. I've had a lot of luck in the past with the Birkenstock off the shelf 3/4 length orthotic which have a fairly firm met pad, but fairly small. What do you think of her adding more met support to a Birk orthotic?

Thanks for putting so much thought into this. Where are you located?

Re: Richard - More Info Today

Richard, C.Ped on 6/04/04 at 10:00 (151999)

I am in South Carolina...hot, muggy, South Carolina. lol

If the firmness seems to help more, she could make the met pad out of a more dense material such as 60 durometer EVA.

I personally would not add to the Birk footbed, unless the doctor ok's it.

Re: A Technical Question about Orthotics

Ed Davis, DPM on 6/08/04 at 16:51 (152444)

NW labs will actually place a met elevation into the shell of the graphite orthotic. Here is a little trick if you use graphite or polypro:
Heating the distal edge and incresing convexity of the distal edge. If that causes any 'edge' irritation, then add a soft pad just in front of the edge in order to taper it. This works on patients who often cannot tolerate the 'lump' effect from standard met pads.