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  1. #10
    Join Date
    Dec 2015
    Wilton Street Glasgow

    Re: Foot stiffness and footwear

    With regard to the previous posts the linked to paper below (1) may be of interest , especially "Other factors may be responsible for. the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues ".
    So looking at this phrase has started me wondering about increased stiffness in the feet of diabetic patients and the possible impact this might have on plantar pressures under met heads #2 and #3 in particular .
    Earlier in the thread I wrote "Metatarsal parabola + terminal stance = distal transverse arch . Can't be any other way . "

    For this to be true the met heads must be able to move relative to each other thus allowing a spread of pressure across the forefoot during gait . But what if diabetes induced stiffness prevents this from happening ? With the met heads unable to move relative the each other , then ,during late stance ,the pressure under head #2 in particular may cause repeated ulceration .

    So what can be done ? Professor Isabel Sacco has done a lot of work in the area of mobilizing foot and ankle tissues made stiffer by the effects of diabetes , and she has shown that these tissues respond well and become less stiff , using physiotherapy methods such as strengthening and stretching .

    So how can you stretch the forefoot across the met heads ,their associated capsules and the deep metatarsal ligament .

    Possibly as follows . First an extract from earlier in this thread -

    "First I found myself a suitable surface such as linoleum . Next I took off my shoes and socks and stood next to a wall for support . Then , taking most of my weight initially on the right foot which was kept flat on the ground ,I put my left foot into toe off position so that only the ball of the foot and the toes were in contact with the ground . Then I carefully transferred some weight onto the left foot and finally,with the ball of the foot and toes under some pressure , rotated the foot outwards producing torque . I found that the toes played an important part in resisting the outward rotation and that they also began to become spaced out from each other possibly engaging the adductors .( please note that I am not suggesting that anyone copy the above exercise sequence or injury may result )
    So perhaps the toes can significantly aid grip on a flat rigid surface ? "

    This stretch might work to mobilize the tissues in question allowing met head movement and the avoidance of very large pressure under #2 , causing ulceration . However the stretching method could easily cause tissue tears between the toes if not done under expert supervision , at least during a learning process for the patient , and so should not be attempted without supervision by a qualified health care professional (and even then only following proper trials ) .

    Can the risks eventually be reduced if the exercise is found to be beneficial ?
    This might be possible by only carrying out the exercise in a seated position to reduce the stretching forces involved . Also ,instead of a material like linoleum being used underfoot a suitable gel like material might be used ,the consistency of which would allow the gel to distort or even tear , if a patient ,perhaps with sensory neuropthy , is applying stretching forces likely to case tissue damage .
    Gerrard Farrell



    Plantar pressures and relative lesser metatarsal lengths in older people with and without forefoot pain


    • Hylton B. Menz,
    • Mohammad R. Fotoohabadi,
    • Shannon E. Munteanu,
    • Gerard V. Zammit,
    • Mark F. Gilheany

    • Conflicts of interest: None of the authors have any financial affiliations or competing interests to declare.


    Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan® system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation = 5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1–5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p = 0.032) greater peak plantar pressure under metatarsal heads 3–5 (1.93 ± 0.41 kg/cm2 vs. 1.74 ± 0.48 kg/cm2). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals Other factors may be responsible for. the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 427–433, 2013
    Gerrard Farrell


    scotfoot, Thursday at 9:07 PM

    Last edited by Gerrard Farrell; 09-16-2017 at 07:25 AM.

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