Search Results
Background:
Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head.
Methods:
Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad.
Results:
A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls.
Conclusions:
The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal pad. (J Am Podiatr Med Assoc 102(1): 18–24, 2012)
The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain. (J Am Podiatr Med Assoc 94(1): 47-52, 2004)
The width of the calcaneal fat pad during weightbearing differs from its width during nonweightbearing. In this study, the medial-to-lateral width of the calcaneal fat pad was measured during weightbearing as well as nonweightbearing, and the two measurements were compared. The difference between weightbearing width and nonweightbearing width was found to vary widely across individuals. This measurement has implications for the manufacture of functional foot orthoses, which are made from nonweightbearing impressions of the foot. The significance of the authors' findings with regard to patient comfort is discussed.
Abstract
Background: Fat pad atrophy is the loss of subcutaneous tissue in the plantar foot, inhibiting the cushioning function. Patients experience severe pain upon ambulation from high-pressure forces. Soft tissue augmentation or fat pad restoration is performed to improve the thickness and cushioning ability of the subcutaneous layer. A first-of-its-kind, allograft adipose matrix (AAM), which has been reported to support native fat pad restoration, was evaluated to address fat pad atrophy and the cushioning ability in the plantar foot.
Method: An IRB approved retrospective study review and analysis on 16 patients (21 feet) treated with AAM in the plantar foot was conducted. Adverse events and a patient subjective evaluation of percentage improvement were reported, sometimes supported by imaging.
Results: The average volume of AAM injected was 2.2±0.7cc (1.5-2.6cc range) with a follow-up time of 3-20 months, in patients aged 68.6±8.9 years. Overall minimal adverse events were observed and the percentage improvement, as per patient feedback, was 72.9±23.0% (100% corresponds to fully satisfied). The quality of skin improved with reduced presence of callus and patients resumed their daily activities.
Conclusion: AAM can support endogenous fat pad restoration by supplementing fat thickness and its natural cushioning ability. The early clinical observations in this retrospective study review demonstrated that patients could resume daily activities after treatment.
The publication of the Global Vascular Guidelines in 2019 provide evidence-based, best practice recommendations on the diagnosis and treatment of chronic limb-threatening ischemia (CLTI). Certainly, the multidisciplinary team, and more specifically one with collaborating podiatrists and vascular specialists, has been shown to be highly effective at improving the outcomes of limbs at risk for amputation. This article uses the Guidelines to answer key questions for podiatrists who are caring for the patient with CLTI.
We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome- and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (12% [33 kPa]) and the insole and bar pad design (21% [58 kPa]) compared with the shoe-only condition. A prefabricated insole design incorporating a bar metatarsal pad is recommended to manage high forefoot plantar pressures in patients with rheumatoid arthritis. (J Am Podiatr Med Assoc 94(3): 239-245, 2004)
Background:
A percutaneous antibiotic delivery technique (PAD-T) used for the adjunctive management of osteomyelitis is presented.
Methods:
This surgical technique incorporates a calcium sulfate and hydroxyapatite (calcium phosphate) bone void filler acting as a carrier vehicle with either an antibiotic or an antifungal medicine, delivering this combination directly into the area of osteomyelitis.
Results:
The benefit of the PAD-T is reviewed with a case presentation of a successfully treated calcaneal osteomyelitis.
Conclusions:
No previously reported PAD-T using a simple bone cortex incision in the adjunctive treatment of osteomyelitis has been reported. The PAD-T safely and effectively uses a calcium sulfate and hydroxyapatite bone void filler carrier vehicle to deliver either an antibiotic or an antifungal medicine directly into the area of osteomyelitis.
The Applicability of Plantar Padding in Reducing Peak Plantar Pressure in the Forefeet of Healthy Adults
Implications for the Foot at Risk
Background: We investigated the effectiveness and durability of two types of plantar padding, the plantar metatarsal pad and the single wing plantar cover, which are commonly used for reducing forefoot plantar pressures.
Methods: Mean peak plantar pressure and impulse at the hallux and at the first, second, third, and fourth metatarsophalangeal joints across both feet were recorded using the two-step method in 18 individuals with normal asymptomatic feet. Plantar paddings were retained for 5 days, and their durability and effectiveness were assessed by repeating the foot plantar measurement at baseline and after 3 and 5 days.
Results: The single wing plantar cover devised from 5-mm felt adhesive padding was effective and durable in reducing peak plantar pressure and impulse at the first metatarsophalangeal joint (P = .001 and P = .015, respectively); however, it was not found to be effective in reducing peak plantar pressure and impulse at the hallux (P = .782 and P = .845, respectively). The plantar metatarsal pad was not effective in reducing plantar forefoot pressure and impulse at the second, third, and fourth metatarsophalangeal joints (P = .310 and P = .174, respectively).
Conclusions: These results imply limited applicability of the single wing plantar cover and the plantar metatarsal pad in reducing hallux pressure and second through fourth metatarsophalangeal joint pressure, respectively. However, the single wing plantar cover remained durable for the 5 days of the trial and was effective in reducing the peak plantar pressure and impulse underneath the first metatarsophalangeal joint.
