An External Shoe Modification for Reducing Metatarsal Head Pressure in People With Metatarsalgia


One of the likely causes of metatarsalgia is repetitive high-pressure loading onto vulnerable metatarsal heads. This study investigated a shoe modification, the Hunt Metatarsal External Shoe Cut-out (HMESC), and its effectiveness in reducing pain and pressure on the symptomatic area, and improving function during weightbearing activities. Five patients (one of whom had bilateral symptoms) were referred to physical therapy for treatment of metatarsalgia. Treatment included plantarflexor muscle stretching and the application of the HMESC to the outsoles of their shoes. The HMESC was constructed from a sheet of compressible crepe 5 mm thick, with a portion 4-6 cm in diameter removed, so that there was no contact between the shoe outsole and the floor beneath the symptomatic metatarsal heads. The PEDAR insole foot pressure measurement system was used to measure pressure during walking between the patients' feet and the insoles of the shoes, with and without the HMESC, on the first day of physical and pedorthic therapy. Functional outcome was measured with the Lower Extremity Functional Scale (LEFS) at the beginning of treatment and after 38.2 ± 7.6 days. The average peak pressure per step measured under the metatarsal head region during walking decreased by a mean of 120.8 ± 69.0 kPascals with that HMESC, when compared with walking in the same shoes without the HMESC. All patients noted immediate reduction in pain with the application of the HMESC. The LEFS score improved during the treatment period by 13.3 ± 3.8 points. Paired t-tests applied to changes in dependent variables yielded significant probabilities for the decrease in peak pressure (p = 0.004), in pressure time integral (p = 0.016), and for the increase in LEFS score (p < 0.001). The findings of this study support the HMESC as a viable treatment option for individuals with metatarsalgia.


Physical Therapy

Document Type





metatarsalgia, plantar pressure, shoe modification

Publication Date


Journal Title

JPO: Journal of Prosthetics and Orthotics