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Introdução: A placa plantar do hálux, localizada na articulação metatarso falangeana(MTF) é o principal estabilizador estático e dinâmico dessa articulação, sua lesão traumática é de difícil diagnóstico e pode levar ao enfraquecimento e/ou lesão da cápsula, além de instabilidade articular, com subsequente deformidade do dedo e queixas álgicas importantes. Relato do Caso: O relato descreve o caso de paciente do sexo masculino, com 33 anos de idade, admitido na unidade de atendimento imediato do Hospital do Servidor Público Municipal (HSPM), com queixa de dor na região plantar do primeiro metatarso do pé direito há 2 dias, com história de trauma em hiperextensão do hálux direito ao descer de escada. Apresentou edema 2+/4+ na região plantar do primeiro raio, equimose região plantar do primeiro raio, dor a palpação dos sesamoides. Flexão ativa interfalangiana do hálux presente. Teste da gaveta dorso plantar positivo e instabilidade em varo e valgo com amplitude de movimento normal. No exame de Raio X (RX), foi evidenciado região sem fraturas, com assimetria do sesamoide lateral. Assim, como conduta complementar foi solicitado a realização Ressonância Magnética (RNM) para melhor elucidação e diagnóstico da lesão da placa plantar. O resultado da RNM apresentou "sinais de lesão da placa plantar e capsulo-ligamentar metatarsofalângicas do hálux, com rotura de espessura total do ligamento sesamoidefalângico medial e rotura parcial de alto grau do ligamento colateral medial, de aspecto recente (Turf Toe)". O paciente então foi encaminhado para procedimento cirúrgico(reparo da placa plantar com reinserção dos sesamoides) e após o procedimento e período pós cirúrgico para tratamento fisioterápico. Discussão: a placa plantar do primeiro raio é, portanto, a principal estrutura estabilizadora da articulação MTF devido à sua localização central e múltiplas fixações importantes, e as indicações cirúrgicas tem obtido resultados favoráveis aos pacientes. Assim, evitando complicações graves como instabilidade, metatarsalgia, artrose e até deformidade do primeiro raio. Conclusão: Paciente sem dor ou instabilidade, segue em acompanhamento fisioterapêutico. Palavras-chave: Articulação Metatarsofalângica. Metatarsalgia do primeiro raio. Placa Plantar. Turf Toe.

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Objetivo. Para el tratamiento de la dolencia metatarsal por sobrecarga, se emplean soportes plantares de distintos materiales con el fin de amortiguar las presiones plantares que se producen en esta región durante el periodo propulsivo de la marcha. El propósito de este estudio consistió en determinar las modificaciones de las presiones plantares en las cabezas metatarsales usando como amortiguación metatarsal palmillas de los siguientes materiales: Pedilastik(R), Poron Medical(R), Jogtene(R) y Confortene(R), habitualmente usados en el tratamiento ortopodológico conservador de las sobrecargas metatarsales. Método. Los valores de presión máxima de los metatarsianos se midieron en dinámica, usando el sistema de Rs-Scan Insole System(R) dentro del calzado, con los sujetos sin palmilla, y usando palmillas de diferentes materiales. La muestra de este estudio fueron 16 pies. Resultados. La mayoría de los valores de presión plantar experimentaron un ligero incremento en sus valores con la aplicación de diferentes palmillas, con todos los materiales usados en el presente estudio. Así, aunque no se obtuvieron diferencias significativas (p>0.05) en las diferentes mediciones, ni los resultados de la máxima presión plantar en cada cabeza metatarsal (excepto en el 5.o) ni los resultados de la máxima presión plantar en la zona de antepié, mostraron un decrecimiento en sus valores con el uso de diferentes materiales ensayados en este estudio. Conclusiones. El uso de almohadillas con materiales tradicionalmente usados seleccionados en este estudio tiene un ligero efecto negativo en la presión máxima plantar en la cabezas metatarsales y la presión máxima plantar en la zona de antepié durante la fase propulsiva (AU)

Objetivo. tratar a sobrecarga de doença metatarso, órteses de diferentes materiais, a fim de atenuar as pressões plantares que ocorrem nesta região durante o período de propulsão da marcha. O objetivo deste estudo é determinar as mudanças de pressões plantares na cabeça dos metatarsos utilizando palmilhas de amortecimento nos metatarsos com as seguintes órteses utilizadas no tratamento conservador da sobrecarga no metatarso: Pedilastik(R), Poron Medical(R), Jogtene(R) e Confortene(R). Método. Os valores máximos de pressão metatarso foram medidos de forma dinâmica, utilizando o sistema de Rs-Scan Palmilha System(R) dentro do sapato, com indivíduos sem palmilla, e usando diferentes palmilhas. A amostra deste estudo foram 16 pés. Resultados. A maioria dos valores de pressão plantar sofreram um ligeiro aumento nos seus valores com a aplicação de diferentes palmilhas, com todos os materiais utilizados no presente estudo. Assim, apesar de não haver diferenças significativas (p>0.05) foram obtidos em medições diferentes, ou os resultados da pressão máxima plantar em cada cabeça do metatarso (exceto quinto) ou os resultados da pressão máxima plantar no antepé mostrou uma diminuição dos seus valores com o uso de diferentes materiais testados neste estudo. Conclusões. O uso de almofadas com materiais selecionados tradicionalmente utilizada neste estudo tem um efeito negativo ligeiro na máxima pressão sobre as cabeças dos metatarsos plantares e na área do antepé máxima pressão plantar durante a fase de propulsão (AU)

Objective. For treatment of the metatarsal overload condition, plantar supports of different materials in order to reduce plantar pressures which occur in this region during the gait period propulsive are used. The purpose of this study has to determine the changes of plantar pressure under the metatarsal heads using as metatarsal cushioning soles of the following materials: Pedilastik(R), Poron Medical(R), Jogtene(R) y Confortene(R), habitually in the conservative treatment orthopodiatric of the metatarsal overload. Method. The values of maximum pressure of the metatarsal heads were obtained in dynamics conditions, using the Rs-Scan Insole System(R) inside the shoe. Measurements were taken without any cushioning insole, and using insoles of different materials. The sample used for this study was a set of 16 feet. Results. The majority of the variables of plantar pressure experienced a slight increase in their values with the application of different insoles, with all the materials used in the present study. Thus, although no significant differences (P>.05) during the propulsive phase were found with respect to the control group, neither in the maximum pressure at each metatarsal head (except for 5th) nor in the maximum plantar pressure at forefoot area, the results found have shown that no decrease in the values of the plantar pressures was reached with the use of the different materials tested in this study. Conclusions. The use of pads with the traditional materials used in the present study has a slight negative effect on the Maximum plantar pressure at the metatarsal heads and the maximum plantar pressure at the forefoot area during the propulsive phase (AU)

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Foot pain frequently reduces physical activity and increases the risk of falls in older people. In current orthotic management of forefoot pain, metatarsal padding is the main strategy to reduce metatarsal pressure. However, pressure reductions are usually diverse and limited. The multi-step accommodative insole is fabricated by sequential foam padding on Plastazote under dynamic accommodation in daily walking. The aims of this study were to investigate the effectiveness and mechanisms of accommodative insole on plantar pressure redistribution in older people with metatarsalgia. The study was conducted on 21 old outpatients with moderate to severe metatarsalgia, using the ethylene vinyl acetate control, 9-mm flat Plastazote, and accommodative insoles with and without metatarsal and arch support. Outcome measures included pressure-related variables measured by a Pedar-X system, and pain scores assessed with a 0-10 Visual Analog Scale. The accommodative insole significantly decreased peak pressure under the metatarsal heads by 47.2% (p<0.001) and the pain scores from 8.2 to 1.1 (p<0.001). Plantar pressure analyses indicated that the effects of dynamic metatarsal contouring and cushioning on reducing peak pressure were greater than those of metatarsal padding. The temporo-spatial relationships between the toe and metatarsal head can assist in explaining an elevated metatarsal pressure and higher risk of falls in older people with toe deformities. The multi-step insole is simple in orthotic fabrication and ensures an even distribution of plantar pressure loading in walking. It can effectively relieve metatarsalgia and help to preserve regular walking activity for older people with metatarsalgia.

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Propuesta. Objetivar la utilidad de las plantillas instrumentadas en una consulta hospitalaria para la correcta prescripción de plantillas conformadas y la necesidad de revisión de las mismas hasta su adaptación. Diseño. Estudio prospectivo. Material y métodos. Se estudiaron 59 pacientes (53,7±13 años y predominio femenino, 74,6%). De 103 pies analizados, 67 (65%) presentaban dolor en antepié y 36 (35%) en medio-retropié (talalgia y/o fascitis plantar). Mediante plantillas instrumentadas (Biofoot/IBV, Valencia) se valoraron las presiones plantares basales y tras colocación de plantillas conformadas (picos máximos, PM y presiones medias, Pm) así como el dolor mediante EVA. Resultados. Tras una media de dos revisiones, se consiguieron unas plantillas conformadas que lograban una disminución de todas las presiones, aportando un alivio sintomático significativo (EVA basal de 64±18, final de 31±20, p<0,05), mayor en la patología del retropié. En las metatarsalgias, se redujeron significativamente los picos de presión del antepié (PM de 1.851,0kPa), y en las talalgias del retropié (PM de 1.357,2kPa), en un 16 y 45% respectivamente. Se logró un descenso de todas las presiones medias, significativo en la zona externa, retropié y antepié. No existió correlación entre la disminución de las PM y la disminución del EVA. Conclusión. Mediante plantillas, es posible lograr una mejoría sintomática en las algias plantares, cuando están bien conformadas, siendo necesarias varias correcciones incluso cuando se realizan con ayuda de mapa de presiones. Las plantillas instrumentadas son una buena herramienta de trabajo en la consulta que facilita la correcta prescripción y chequeo de las mismas (AU)

Proposal. To objective the usefulness of instrumented insoles for the prescription of the custom-made insoles and need of control. Design. Prospective study. Material and methods. We studied 59 patients (53.7±13 years and female predominance, 74.6%). From 103 feet examined, 67 (65%) had pain in forefoot and 36 (35%) in mid-hindfoot (heel pain and/or plantar fascitis). Using instrumented insoles (Biofoot/IBV Valencia), plantar pressures were assessed at baseline and after placement of custom-made insoles (peak PM and mean pressure, Pm) and pain by VAS. Results. After an average of two reviews, we got a few insoles that achieve a reduction of all the pressure, providing significant symptomatic relief (VAS baseline of 64±18, end 31±20, p<0.05), higher in the pathology of hindfoot. In metatarsalgias, were significantly reduced peak forefoot pressure (PM of 1851.0kPa), and the hindfoot in the heel pain (PM of 1357.2kPa) for 16% and 45% respectively. There was a decrease in all mean pressures, significant in the hindfoot and forefoot. There was no correlation between the reduction of PM and the decline in EVA. Conclusion. Using custom-made insoles, can be achieved symptomatic improvement in plantar algias where these are well formed, still needed several corrections of the same, even when performed with the aid of pressure map. The instrumented insoles are a good tool that facilitates the correct manufacture of the same (AU)

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Propuesta: Correlacionar alivio sintomático, presiones plantares y fuerzas de reacción durante la deambulación de pacientes afectados de algias plantares tras colocación de plantillas conformadas. Material y métodos: Se estudiaron 35 pies afectados de metatarsalgia y 20 pies con talalgia (32 pacientes). Se utilizó la plataforma de marcha (NedAMH/Instituto de Biomecánica de Valencia [IBV]) y las plantillas instrumentadas (sistema Biofoot/IBV) de modo previo y posterior a la colocación de plantillas. Se obtuvieron las fuerzas anteroposteriores de frenado y propulsión, verticales de oscilación y despegue, y mediolaterales, así como los picos de presión máxima y presiones medias en cada zona. El dolor se valoró mediante la escala visual analógica (EVA). Se utilizó el paquete informático SPSS. 15 para el tratamiento de datos. Resultados: Las plantillas no consiguen una marcha más rápida o más estable, pero logran aumento de frenado y de propulsión. La significativa disminución del 30% en los picos de presión del antepié se correlaciona con la oscilación, el frenado y la propulsión. Igualmente se obtiene una disminución de las presiones medias de todas las zonas, que en la zona anterior se correlaciona con la diferencia en la fuerza de despegue. La EVA mejora significativamente (p<0,001), pasa de 67,4 a 32,2. En metatarsalgias, la variación de la EVA se correlaciona con los cambios en los picos de presión del retropié, el despegue y la propulsión. En las talalgias, también se relaciona con los cambios de presiones del antepié y el retropié y las variaciones en todas las fuerzas de reacción. Conclusión: Las plantillas logran una disminución efectiva de las presiones máximas del antepié en las metatarsalgias y del retropié en las talalgias, con aumento de las fuerzas de frenado y propulsión y una mejoría significativa de la EVA (AU)

Proposal: To correlate symptomatic relief, plantar pressures and ground reaction forces during ambulation in patients with painful plantar feet after placement of custom-made insoles. Material and methods: We studied 35 feet affected by metatarsalgia and 20 feet with painful heels (32 patients). We used a walking platform (NEDAMH/IBV) and instrumented insoles (Biofoot/IBV system) pre-and-post placement of custom-made insoles. Anteroposterior braking forces and propulsion, swing and vertical takeoff and medio lateral and peak maximum pressure (MP) and medium pressure (Pm) were obtained in each area. Pain was evaluated with the visual analogical scale (VAS). The SPSS software package 15 for data processing was used. Results: Insoles do not help to achieve a faster walk, or more stability, but they do achieve greater braking and propulsion forces. The significant decrease of 30% in forefoot peak pressures obtained is correlated with the swing, brake and propulsion forces. There is also a decrease in the average pressures for all areas, in which the forefoot's mean pressure is correlated with the take-off force's difference. Patients reported a significant relief of pain (p<0.001), in which the VAS significantly improved, changing from 67.4 to 32.2. In the metatarsalgias, the VAS variation correlates with the changes of the rearfoot pressure peaks, takeoff and propulsion. In painful heels, there is also a relationship between the pressures changes of the in the forefoot and heel and the variations in all ground reaction forces. Conclusion: Insoles achieve an effective reduction of peak pressures values in the forefoot metatarsalgias, and in the heel in painful heels, with an increase of brake and propulsion forces and a significant improvement in the VAS. The differences obtained in the VAS after the use of insoles maintained different correlations in metatarsalgias and painful heels, in peak pressures changes and in ground reaction forces variations (AU)

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OBJECTIVE: To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months. METHODS: Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response. RESULTS: With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution. CONCLUSIONS: Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.

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Inserts are orthopedic aids in the treatment of foot disorders that result from changes of the static or dynamic situation. Provision of appropriate orthopedic devices can relieve the pain caused by forefoot deformities either in lieu of surgical intervention or in rare cases also following surgical treatment to improve the symptoms of residual pain.Available materials provide support, padding, and cushioning. Inserts are custom-made to measure and/or based on a plaster impression. Determining the indication, prescribing the inlay, and checking the orthosis are the tasks of the physician. One treatment option for relieving the pain of forefoot deformities consists in conservative therapy with an insert combining features of padding and support as well as adjusting a ready-made shoe. The shoe and inlay should constitute a functional unit since often the optimal effect is only achieved with a combination of insert and orthopedic adjustment of the ready-made shoe.

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