Article

Foot pain frequently reduces physical activity and increases the risk of falls in
older people. In current orthotic management of forefoot pain, metatarsal padding
is the main strategy to reduce metatarsal pressure. However, pressure reductions
are usually diverse and limited. The multi-step accommodative insole is
fabricated by sequential foam padding on Plastazote under dynamic accommodation
in daily walking. The aims of this study were to investigate the effectiveness
and mechanisms of accommodative insole on plantar pressure redistribution in
older people with metatarsalgia. The study was conducted on 21 old outpatients
with moderate to severe metatarsalgia, using the ethylene vinyl acetate control,
9-mm flat Plastazote, and accommodative insoles with and without metatarsal and
arch support. Outcome measures included pressure-related variables measured by a
Pedar-X system, and pain scores assessed with a 0-10 Visual Analog Scale. The
accommodative insole significantly decreased peak pressure under the metatarsal
heads by 47.2% (p<0.001) and the pain scores from 8.2 to 1.1 (p<0.001). Plantar
pressure analyses indicated that the effects of dynamic metatarsal contouring and
cushioning on reducing peak pressure were greater than those of metatarsal
padding. The temporo-spatial relationships between the toe and metatarsal head
can assist in explaining an elevated metatarsal pressure and higher risk of falls
in older people with toe deformities. The multi-step insole is simple in orthotic
fabrication and ensures an even distribution of plantar pressure loading in
walking. It can effectively relieve metatarsalgia and help to preserve regular
walking activity for older people with metatarsalgia.
CI - Copyright (c) 2013. Published by Elsevier B.V.

Langue : ANGLAIS