In this article we discuss the metatarsal dome — a commonly prescribed addition for the treatment of forefoot pain (FFP).
FFP is associated with elevated plantar pressure in the forefoot region, and the metatarsal dome is used to redistribute plantar pressure away from the metatarsal heads and alleviate pain.
What do our prescribing podiatrists say?
Here we discuss the biomechanics efficacy of the metatarsal dome with a brief introduction and commentary from Matthew Mollica (Windy Hill Podiatry).
What does the research tells us?
A recent study from researchers at La Trobe University1 different forefoot pads on plantar pressures under the forefoot in 37 adults with current or previous forefoot pain. They compared a; (i) metatarsal dome positioned 10 mm proximal to the metatarsal heads, (ii) metatarsal dome positioned 5 mm distal to the metatarsal heads, (iii) metatarsal bar, and (iv) plantar cover. The plantar cover and the metatarsal dome positioned 5 mm distal to the metatarsal heads were most effective in reducing peak pressure (a reduction of 19% and 18%, respectively).
Another study from England2 in people with rheumatoid arthritis. Jackson and colleagues (2004) reported greater pressure reduction with a bar-shaped pad compared a dome-shaped pad.
In summary, the met dome is an effective orthotic addition for reducing plantar pressure under the metatarsal heads associated with forefoot pain. The metatarsal dome or bar, is best positioned approximately 5mm distal to the metatarsal heads.
What does Footwork offer?
Footwork generally uses the Rathgerber met domes but can manufacture all types of metatarsal domes for addition on the custom and Joey range. You can indicate the required position and density of the met-dome via the diagram on lower right side of the prescription form. For custom-design orthotics, another technique used to mimic the effect of a met-dome is to request ‘no plaster fill 1-5’. This modification should not be combined with a met-dome pad, as the orthotic forefoot will be excessively thick in the 1-5 orthotic region.
1. Lee PY, Landorf KB, Bonanno DR, Menz HB: Comparison of the pressure-relieving properties of various types of forefoot pads in older people with forefoot pain. Journal of Foot and Ankle Research 2013, 6 (Suppl 1). 2. Jackson L, Binning J, Potter J: Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. J Am Podiatr Med Assoc 2004, 94(3):239-245.