Check the appropriate length of metatarsal pad On the reduction of Diabetic foot ulcer mechanical parameters while walking

Background: Standard prevention and treatment strategies to decrease peak plantar pressure include a total contact insert with a metatarsal pad, but no clear guidelines exist to determine optimal length of the pad with respect to the metatarsal head. The purpose of this study was to Check the appropriate length of metatarsal pad On the reduction of Diabetic foot ulcer mechanical parameters while walking Methods: fifteen subjects with diabetes mellitus and without a history of forefoot plantar ulcers were studied (mean age = 57 ± 9 years). Forefoot plantar pressure and pressure-time integral data were recorded using the RS-scan system while participants walked along a 10 m walkway. Five conditions were tested: (i) bare foot, no padding (the control), (ii) a metatarsal dome with %18 of foot length, (iii) a metatarsal dome with %20 of foot length, (iv) a metatarsal dome with %23 of foot length, and (v) a metatarsal dome with %25 of foot length. Results: Compared to the control condition, each of the forefoot pads significantly reduced forefoot peak pressure and pressure-time integral. Peak pressure significantly decreased in metatarsal areas 1, 3 and 4 by increases the metatarsal pad (p =0.001). But in the metatarsal areas 2 and 5 in the differences were not observed statistically significant, respectively (p= 0.4) (p =0.05). The second parameter (pressure-time integral) significant difference between the five conditions was observed (0.001 = p). But the significant (increase or decrease) in between the pad and metatarsal area was different. In the metatarsals 1 and 2 on the pad at 18% and 20% of the time pressure to significantly was reduced, but in the pads 23% and 25%-time pressure to significantly increase was observed. In the metatarsals 3, 4 and 5 on the pad 18% of the time pressure increased and the pads 20%, 23% and 25% reduction in peak-time pressure was observed. Conclusions: These findings indicate that peak metatarsal head pressure decrease by increase of metatarsal pads length, but the effect of the pad on the plantar pressure time depend on the metatarsal area and pad length. Pad length relative to foot is a step towards developing an evidence-based algorithm for the construction of optimal insole in therapeutic shoe design; we recommended that pad 23% is optimal length.