April 2009

Metatarsalgia and Stiff Shoes

Over the past few years, it has become increasingly more common for health

care professionals to refer patients for a “stiff forefoot shoe” in the management of

numerous ball-of-the-foot ailments.

Shoes, particularly athletic ones, are generally designed to be flexible across the

ball of the foot for an efficient toe-off. But every once in a while, and I suspect not by

design, the forefoot is very inflexible. We certainly don’t want all shoes to be this firm,

but a selection across activity groupings proves useful.

When a comfortable shoe or sandal cannot be found that is stiff enough, the

prescription may call for a spring plate to be added, either under the removable footbed

or permanently lodged in the midsole of the shoe. The former, otherwise known as a

transferable spring plate, can be moved from shoe to shoe as long as there is enough

depth to ensure ample room in the toe box. There must also be a removable insole to

put this contoured graphite plate under, keeping it away from direct contact with the foot.

When fit properly, the forefoot almost feels splinted and flex at the ball of the foot is

minimal.

Some individuals don’t take well to the insert under the footbed and will require it

to be permanently lodged in the midsole of the shoe. The disadvantages of the

permanent route are price and the inability to move the plate from shoe to shoe. The

advantage, however, is one can buy the shoe as is for fit and style, while almost

completely eliminating flexibility.

Remember that stiff shoes do have a greater chance of heel slippage. As the

foot tries to flex, the inflexible shoe is left behind. This is particularly prevalent with a

slip-on shoe, often referred to as “slip-offs” because the addition of a spring plate can

make them almost impossible to keep on.

Along with the request for stiffness, the prescription often comes with the request

for a rocker profile or a simple toe spring to aid in toe off. This turned-up toe feature or

toe spring has become a common feature in the design of many running shoes, as well

as some walking models. Customers often describe an unusual feeling of their “toes

falling off the end of the shoe” as they push off. True rocker soles can be added to most

shoes if desired, either by delaminating the outersole or by band sawing the midsole and

inserting it in the body of the shoe.

The following is a review of some of the stiffer shoes in a number of activity

categories that are used to fill prescriptions issued for stiff footwear in the management

of hallux limitus, forefoot neuromas and general metatarsalgia. Hopefully, this will spark

some discussion about the use of stiff shoes and spring plates in the care of those

suffering from pain in the forefoot area.

If you have any questions, comments or would like us to come by and show you

these items, please do not hesitate to call.

Note - The next lecture in the LadySport lecture series will be on February 2003 and will

be a new format clinical lecture with multidiscipline input.

Sponsered by http://www.ladysport.ca/