Metatarsal pads (or met pads for short) are small pads placed under the center of the foot that help to provide relief to the metatarsal heads in the ball of the foot. Met pads come in many shapes and sizes; they can be adhesive, elastic, or free-floating, and can be shaped like circles, triangles, or tear drops. Met pads don’t constrain the movement of your joints and muscles the way that many other support devices do but instead, work with the movement of your feet. After years of wearing conventional footwear with a narrow tapered toe box, many peoples’ toes and metatarsals become compressed together, causing pinching and increased pressure on the nerves, blood vessels, and other structures in the area, resulting in poor circulation and pain.
Metatarsals, much like your toes, are meant to spread out, helping to provide a wide and stable base for your body to stand upon. Conventional footwear often opposes this posture, which can lead to instability and painful metatarsalgia. Met pads in conjunction with natural footwear work together to correct issues such as this.
Toe Muscle Imbalances (Hammertoes)
Hammertoes are a relatively common condition in which the muscles that flex and extend the toes become unbalanced. Conventional footwear with a tapered toe box and toe spring will hold the toes in a lifted (extended) position, creating extensor dominance as the toe extensors become short and tight and the toe flexors become elongated. Placing a met pad in the center of the foot (just behind the ball of the foot) will support and spread the metatarsal shafts while easing pressure on the metatarsal heads. In a muscular sense, met pads help to shorten the toe flexors and lengthen the toe extensors, encouraging natural toe alignment with toes splayed and flat on the ground surface. Once toes are back in their natural position they can better participate in weight-bearing functions as they were originally intended.
Fat Pad Positioning
The metatarsal fat pad is the thick pad of connective tissue that runs across the entire ball of the foot. This fat pad is essential for protecting and cushioning the metatarsal heads and surrounding structures while weight-bearing. When active, walking, and running, the forefoot experiences the highest amount of force, so shock natural absorption here is incredibly important.
Many people that have spent significant time in conventional footwear may experience displacement of this fat pad. When shoes with toe spring lift the toes, the fat pad follows. Over time, the fat pad can migrate from its protective location directly beneath the metatarsal heads to a less-useful position beyond the metatarsal heads beneath the toes. A displaced fat pad leaves the metatarsal heads, nerves, tendons, and entire plantar ball of foot with only millimeters of skin for protection, exposing the area to excessive pressure which can lead to neuromas, sesamoiditis, capsulitis, and even plantar fasciosis over time (read more below on these conditions).
Met pads assist the foot’s function by supporting the metatarsal shafts (which reduces pressure on metatarsal heads) and encouraging a more neutral toe posture by addressing
toe muscle imbalances. Using met pads to position the forefoot and toes into a more natural alignment allows the plantar metatarsal fat pad to resume its role as protector and shock absorber of the forefoot.
What is the Difference Between Arch Support and Met Pads?
Arch support and met pads may appear to be similar on the surface, but they are actually quite different. External arch support for the medial longitudinal arch significantly limits the foot’s ability to pronate and supinate, which are pretty essential movements for walking and running. And because so many of the muscles in the foot are “supinators” and “pronators,” blocking these motions with arch support can lead to deficiencies and weaknesses in the associated muscles. Most cases of “overpronation” or low aches/flat foot are not an inherent structural problem to be solved with physical props, but actually a muscular problem due to lack of control of pronation. Met pads, however, don’t really limit much movement, but instead, encourage healthy fat pad placement and return the toes to a more natural and supportive position.
Can Met Pads Be Used for Foot Pain Prevention?
Yes! Although you may not have foot pain currently, met pads might still be a useful tool. One sign to evaluate for is tightness in the top of the foot: if while at rest and non-weight-bearing you notice your toes pulled back or lifted up and can visibly see the extensor tendons on the top of your foot, that might indicate the beginning of toe muscle imbalance. Of course, the toe extensor stretch will be helpful for this, but so too will using a metatarsal pad.
Painful foot conditions that may benefit from metatarsal pads:
*Always check with your doctor before implementing new treatment options*
Interdigital Neuroma (Morton’s Neuroma)
A neuroma is a painful enlargement of a nerve, commonly found in the forefoot between the metatarsal bones. This is the result of the area experiencing increased pressure and friction combined with reduced blood flow stemming from compressed metatarsals and toes. By supporting the metatarsal shafts, met pads allow compressed metatarsal heads to splay and relax, off-loading the area while naturally restoring more optimal blood flow.
Click here for more information about neuromas.
Sesamoiditis
The sesamoids are two small bones found beneath the first metatarsal head in the ball of the foot near the big toe. These bones are similar to the patella (knee cap) in that they do not articulate with other bones and reside within a muscle tendon (flexor hallucis brevis). If the big toe shifts laterally from being aligned with the first metatarsal (healthy position) to pointing towards the lesser toes (bunion formation), the flexor hallucis brevis muscle and the sesamoids within it will also shift laterally. Predictably, when the sesamoid bones are out of aligment, they rub and become irritated, resulting in sesamoiditis. Sesamoiditis is characterized by pain and swelling under the big toe or ball of your foot. Because met pads allow for healthy repositioning of the metatarsals and fat pad, they can be a useful tool for treating sesamoiditis.
Click here for more information about sesamoiditis.
Capsulitis
Capsulitis is characterized by pain and tenderness of a joint capsule. When it comes to the feet, we are mostly referring to the metatarsal-phalngeal joints (MTPJs) at the ball of the foot. Excess pressure through the ball of the foot with minimal fat pad protection leaves the joint capsules vulnerable to injury. Met pads can help remedy this condition by restoring the original position of the fat pad in the ball of the foot, shielding the joint capsule from further forces.
Click here for more information about capsulitis.
Plantar Fasciosis / Fasciitis
Plantar fasciosis is characterized by pain in the heel, often caused by recurrent micro-injuries to the planter fascia due to lack of muscular support, combined with impaired healing from inconsistent blood flow to the plantar fascia. Met pads can help improve plantar fasciosis by restoring the plantar fascia and plantar foot muscles to their more naturally arched neutral positions. This helps to take tension off of the plantar fascia while encouraging shortening and strengthening of the plantarflexor muscles that support the plantar fascia. Additionally reducing the crowding of the nerves and blood vessels between the metatarsals can help improve blood flow which helps with healing.
Click here for more information about plantar fasciosis.
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Written by: Dr. Andrew Wojciechowski, ND
If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.
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