Report of metatarsal pad intolerance in a cohort of 60 patients treated with customized foot orthotics

Abstract

Objectives A metatarsal pad is generally considered a useful addition to the orthotic prescription, but anecdotal reports suggest that this element is not prescribed because of patients' reports of excessive discomfort. The purpose of this study was to determine the occurrence of intolerance to metatarsal pads in a group of patients prescribed customized foot orthotics in a primary care setting. Methods Sixty consecutive patients presenting in a primary care clinic in Edmonton, Canada, with chronic (>3 months), nonspecific, low back pain and/or soft-tissue lower limb disorders were prescribed customized foot orthotics, which in each case included a large metatarsal pad as a routine measure. Patients were educated at the outset that the metatarsal pad may produce initial discomfort, but that this should subside within 1 week and that the pad should be retained if tolerable. All patients were assessed 6 weeks later for their tolerance of the metatarsal pad. Results All subjects completed the 6-week follow-up. The mean age of the sample was 52.6 ± 10.9 years, with 51% male and 49% female. Ten of the 60 subjects reported pain and/or discomfort that they related to the presence of the metatarsal pad beyond 1 week after initial use and requested adjustment or removal of the metatarsal pad. With reassessment and education, addressing problems of inadequate shoe size or a need for reassurance to persist with orthotic use, only 1 required adjustment to the metatarsal pad to continue orthotic use. Conclusions A group of primary care patients prescribed customized foot orthotics seemed to tolerate a large metatarsal pad. This suggests that metatarsal pads should not be avoided or immediately removed in customized orthotics because of initial discomfort, as this discomfort may be transient or responds to reassurance and education.