What Are Metatarsal Pads?
Metatarsal pads are small, unobtrusive pads that sit on your shoe's insole or footbed and are positioned behind the ball of your foot, in the pocket of space that exists just behind your metatarsal heads.
Do Metatarsal Pads Work?
Metatarsal pads are one of the unsung heroes of natural foot health, and they represent a noninvasive and economical way to address a wide range of common foot and toe problems. Unlike conventional arch orthotics, which attempt to control the motion of your foot, metatarsal pads allow your foot to function the way nature intended; that is, flexing, bending, and articulating in a way that’s unconstrained by external factors or by forces acting upon it. Metatarsal pads work with your foot instead of trying to control it.
To understand why (and how) metatarsal pads are beneficial, it’s important to understand why they are even necessary in the first place.
The Effects of Conventional Footwear
If it weren’t for conventional footwear, with its heel elevation, toe spring, toe taper, and other injurious design elements, it’s likely that most people would not need to use metatarsal pads to rehabilitate their feet and restore optimal foot health. After all, individuals who have grown up in barefoot cultures do not experience the same kind of foot and toe problems that so commonly affect the shod. But, after many years of weight-bearing activity (e.g., standing, walking, running, etc.) in foot-deforming shoes, boots, sandals, and other footwear, most feet take on the shape of these constrictive foot coverings, with negative implications on the structure and function of the foot and toes. Unfortunately, most shoes that are touted as “wide” or “accommodating” are not sufficiently wide where you need the width the most: At the ends of your toes.
So, it’s conventional footwear—including casual, dress, and athletic footwear—that’s the underlying cause of most foot and toe problems and the main reason why metatarsal pads are required for most people (even for those who aren’t yet experiencing foot pain or problems). Indeed, almost everybody who has worn conventional footwear for prolonged periods can benefit in some way from adopting metatarsal pads.
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The Five Most Important Metatarsal Pad Benefits
Metatarsal pads offer you five distinct advantages or benefits. When properly placed (more on this topic below) within a completely flat shoe with a sufficiently wide toe box, metatarsal pads help:
- Enhance foot comfort
- Spread your metatarsal heads
- Straighten and realign crooked toes
- Restore optimal forefoot fat pad positioning
- Address and prevent common foot & toe problems
We’ll elaborate on each of these important potential benefits here.
1. Enhance Foot Comfort
For many people, the act of wearing shoes is a painful one. Many regard this experience as inevitable, but we here at Natural Footgear are here to say that it does not have to be this way. First of all, foot-shaped and foot-healthy footwear is now available to consumers. All the men's and women's footwear we feature on the Natural Footgear site gives your foot (including your toes) the room it needs to operate without feeling pinched or constricted.
Second, the simple act of adding a metatarsal pad to your shoe can (at the very least) significantly enhance your foot comfort. It does this by helping your foot make the most of its own built-in cushioning (more on this below in the section entitled Restore Optimal Forefoot Fat Pad Positioning). Metatarsal pads also ensure that your body weight is distributed evenly across the many points of your foot that are already designed or intended to bear weight, including all your metatarsal heads and toe bones. For some people, these metatarsal pad-related changes in the foot can make all the difference between a miserable footwear experience and a comfortable footwear experience.
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2. Spread Your Metatarsal Heads
The narrow toe boxes included in almost all conventional footwear are a major problem when it comes to the heads of your metatarsal bones—the bony prominences at the base of your toes that are also known as “toe knuckles.” Indeed, tapering toe boxes squeeze your toes and your metatarsal heads together. This is a problem because there are a number of sensitive structures that course between your metatarsal heads on their way to and from your toes, including nerves and blood vessels. Over time, too-narrow footwear squeezes your metatarsal heads closer together, which impinges the nerves and blood vessels, causing pain and problems.
Metatarsal pads, when used in conjunction with foot-shaped footwear, help separate or spread apart your metatarsal heads, creating more space for your interdigital nerves and blood vessels to pass. It’s the curved nature of the metatarsal pad's prominence (and where this raised part of the pad sits beneath your foot) that causes the beneficial splaying of your metatarsal heads. This is a natural, noninvasive way to combat the injurious forces of too-narrow footwear on your sensitive ball of foot structures.
3. Straighten & Realign Crooked Toes
Most people who wear—or who have worn—conventional footwear for any significant duration have at least one type of crooked toe. Indeed, crooked toes are caused by inappropriate footwear; that is, by footwear that possesses heel elevation, rigid soles, tapering toe boxes, and toe spring. Conventional footwear forces your toes into an unnatural configuration and encourages muscle and tendon imbalances in your foot and lower leg that result in crooked toes. Possible crooked toe problems include hammertoe, claw toe, mallet toe, adductovarus toe, overlapping toe, and curly toe.
If you use conventional footwear, you will most likely end up with toes that are chronically overextended (i.e., pointed upward) and tapered toward your foot’s midline. The muscles and tendons under your foot, your toe flexors, will become stretched and weak, while your toe extensors, the muscles and tendons on top of your foot, will become overly tight and strong. One of the great benefits of metatarsal pads is that they promote the return of overextended toes to their normal anatomical position.
In other words, by pressing upward into the sole of your foot just behind the ball of your foot, they cause a compensatory downward shifting of your toes so that your toes fully contact the ground. Over time, and with the consistent use of metatarsal pads and other helpful footgear, you can work out your crooked toe problem and achieve straighter, more naturally-aligned toes that fully participate in the act of weight bearing—something your toes are designed to do, and must do, in order for your foot to function optimally.
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4. Restore Optimal Forefoot Fat Pad Positioning
The forefoot fat pad, sometimes called the “pedal” fat pad, is a thick (~1-2 cm) layer of closely-packed fat cells surrounded by fibrous tissue that, under ideal conditions, is situated on the sole of your foot, beneath the ball of your foot. It is tasked with protecting sensitive ball of foot structures and tissues, including nerves, blood vessels, tendons, ligaments, and bone, and it does this by providing natural cushioning to minimize impact, pressure, friction, and shear forces on your foot. Your forefoot fat pad helps you comfortably perform a wide range of weight-bearing activities, such as walking, running, or even standing still.
If your toe extensor muscles and tendons are chronically tight, it’s most likely that your overextended toes have dragged your forefoot fat pad out of position; that is, up and away from the ball of your foot, further out toward the end of your foot. With no or relatively little padding left in place, the ball of foot structures and tissues mentioned above are left vulnerable to the forces of body weight, which can lead to a host of problems, including, but not limited to, neuromas, sesamoiditis, capsulitis, and plantar fasciosis.
Metatarsal pads are helpful, then, because they encourage the return of your forefoot fat pad to a place that supports your metatarsal heads. They do this through the same mechanism that leads to flatter and straighter toes; that is, by gently pushing upward into the space behind the ball of your foot, which causes a compensatory downward movement of your toes, and with them, your forefoot fat pad. With your fat pad now restored to its originally intended position, you have a natural, built-in cushioning mechanism to protect yourself from ball of foot pain and problems.
5. Address & Prevent Common Foot & Toe Problems
You can use metatarsal pads to prevent or address numerous ball of foot (and other foot) problems and to restore normal and natural foot anatomy and function. As mentioned above, four of the most common foot problems that metatarsal pads can be helpful for include:
Neuromas: A neuroma is an often painful enlargement of one of the body’s nerves, and neuromas frequently occur in the foot, between the metatarsals—the long bones of the foot. This is a ball of foot problem that can often be helped by metatarsal pads, which help spread out the heads of the metatarsal bones and bring the toes back down toward the ground, thereby reducing or eliminating the pinch and stretch forces on the nerves that are responsible for irritating this tissue and causing neuromas in the first place.
Morton's Neuromas: Morton’s neuromas are neuromas that develop specifically between the third and fourth metatarsal bones. If a neuroma develops between any of the other metatarsal bones, it is called an interdigital neuroma. Metatarsal foot pads can benefit sufferers of Morton’s neuromas in the same way as those suffering from other interdigital neuromas, as discussed above.
Sesamoiditis: Sesamoiditis is pain associated with the irritation or fracture of two small bones called sesamoids located on the underside of the big toe. This is a forefoot problem that can, in most cases, be helped with the use of metatarsal pads. Adding a metatarsal pad inside the shoe helps return the forefoot fat pad to a position that cushions and protects the sesamoids and prevents sesamoid bone irritation. Additionally, Correct Toes toe spacers can be used to realign the big toe and guide the sesamoids back to their rightful location, which is immensely helpful in addressing sesamoiditis.
Capsulitis: Capsulitis is the inflammation of a joint capsule, and it occurs quite frequently in those who wear conventional footwear. This is due to the shifting of the forefoot fat pad away from the metatarsophalangeal joints—the joints that connect the toe bones to their corresponding metatarsal bones. Metatarsal pads help address capsulitis because they promote the favorable repositioning of the forefoot fat pad beneath the foot's sensitive metatarsophalangeal joints.
Plantar Fasciosis: Plantar fasciosis is characterized by heel pain, typically due to compromised blood flow to and from the foot's plantar fascia and a corresponding buildup of metabolic byproducts. When used in combination with other natural footgear (e.g., Correct Toes, Injinji toe socks, and men’s or women’s foot-healthy shoes), metatarsal pads can help restore optimal foot and toe blood flow and address the pain associated with plantar fasciosis.
Note: Metatarsal pads alone can be very helpful in addressing or preventing the problems mentioned above, but all of these foot issues may also benefit from the use of additional helpful footgear. This footgear combination, which we discuss in greater detail below in the section entitled Other Complementary Natural Footgear, typically produces a synergistic effect that leads to speedier healing and even greater foot and toe comfort (for most people, most of the time).
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Metatarsal Pads for Runners
The benefits of metatarsal pads explained above are also relevant to runners or those who take part in athletic activity. Metatarsal pads for running shoes are no different in form or function than metatarsal pads designed for other footwear, but they perform even greater feats of rehabilitation in athletes due to the increased force being applied through the foot's joints and tissues. Indeed, one of the quickest and most effective ways to restore optimal foot structure and realign the toes is to use metatarsal pads in combination with other helpful footgear during weight-bearing athletic activity.
Orthotics with Metatarsal Pads
It’s important to note that metatarsal pads are not arch orthotics and function in a completely different way from these commonly-prescribed inserts that seek to limit your foot range of motion. There are several key differences between metatarsal pads and conventional arch orthotics, including the following:
- Arch orthotics are typically rigid and inflexible, whereas metatarsal pads are soft and pliable.
- Arch orthotics tend to be rather uncomfortable, whereas metatarsal pads typically feel good and usually offer users some immediate relief from ball of foot pain.
- Arch orthotics are positioned directly beneath your main foot arch and seek to (needlessly) “prop up” or “support” your foot, whereas metatarsal pads sit, unobtrusively, behind the ball of your foot and help restore normal and natural foot form and function.
- Arch orthotics are designed in such a way that your feet become increasingly reliant upon them (for the rest of your life), whereas metatarsal pads are designed in such a way that your feet ultimately become self-reliant. Thus, arch orthotics become more essential over time, whereas metatarsal pads become less essential over time.
Some people wonder if it's possible or helpful to use their conventional arch orthotics in combination with metatarsal pads. In our experience, we have not found this to be beneficial, as it results in crowding in the area beneath the sole of the foot and tends to be rather uncomfortable for users. Additionally, and perhaps most importantly, adopting foot-healthy footgear, such as metatarsal pads and Correct Toes toe spacers, often makes arch orthotics unnecessary.
For more information about conventional arch orthotics (and why they fail to address the root cause of foot and toe problems), please see our article entitled Who Should Use Orthotics?
Proper Metatarsal Pad Placement
Proper metatarsal pad placement is crucial for realizing the full benefit of the pad. Please see this short video tutorial that demonstrates how to properly place your metatarsal pads. Our article entitled Metatarsal Pad Placement is another excellent resource for dialing in the optimal location for your metatarsal pads within your shoes. Improper placement of metatarsal pads can be uncomfortable and could possibly worsen foot conditions in some cases, so, again, getting the placement of your metatarsal pads correct is vital. If you’re not confident in your ability to properly place your metatarsal pads, we recommend scheduling a visit with a foot care expert in your area who has familiarity with the pads and how to place them (this would include most podiatrists, chiropractors, physical therapists, naturopaths, and acupuncturists).
The Two Main Types of Metatarsal Pad
There are two main types of metatarsal pad available to consumers:
Mobile: The pads can be worn on your feet inside footwear
Stationary: The pads are permanently placed inside your shoes
Both kinds of metatarsal pad work great in alleviating ball of foot pain, addressing crooked toe problems, and rehabilitating your foot. Which one you choose mostly comes down to a matter of personal preference. Let's take a closer look at these two distinct types of metatarsal pad to learn more about the differences between them.
1. Strutz Foot Pads: A “Mobile” Metatarsal Pad
Strutz foot pads are an example of “mobile” metatarsal pads. Strutz foot pads incorporate a wide elastic band that wraps around your foot and a raised pad that tucks up into the sole of your foot. You can wear these pads on your bare feet, over Injinji toe socks, or within men's or women's foot-healthy footwear. Adjusting the location of these pads is simple: Just slide the band up or down your foot until you achieve the perfect positioning. Strutz foot pads come in just one size, which works well for most people, though if you want or need more nuanced sizing, Pedag metatarsal pads may be a better option for you, as they come in several distinct sizes. An upside of Strutz foot pads is that one pair is all you need, since you can use them in different sets of footwear or on your bare feet. Learn more about Strutz foot pads in this instructional guide.
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2. Pedag Metatarsal Pads: A “Set It & Forget It” Metatarsal Pad
Pedag metatarsal pads are an example of “stationary” metatarsal pads. These pads come with an adhesive backing and are permanently affixed on the liner or insole of your shoe—or, as in the case of sandals or shoes that do not possess an insole, directly on or inside the shoe. This is the more conventional style of metatarsal pad and the one most commonly used in doctors' offices to address the ball of foot and crooked toe problems discussed in this article.
Pedag metatarsal pads come in several distinct sizes and can be easily applied inside footwear using the protocol described (and linked to) in the section above. One pair of Pedag metatarsal pads is required per pair of shoes (i.e., the pads are not interchangeable between different pairs of footwear). Pedag metatarsal pads do not possess a visible band that encircles the foot (like Strutz foot pads do), and so those who wear sandals, ballet-style shoes, or other open-upper shoes may prefer using Pedag metatarsal pads over Strutz foot pads for this reason.
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Other Complementary Natural Footgear
Metatarsal pads are, by themselves, a great and useful tool for restoring optimal foot health, but they work even better for rehabilitating your feet and addressing or preventing common foot problems when you use them in combination with other natural footgear. Indeed, combining Pedag metatarsal pads or Strutz foot pads with Correct Toes toe spacers, Injinji toe socks, and men's or women's foot-shaped footwear is a potent way to build a strong, healthy, and resilient foot that looks and functions how nature intended. If you're looking to achieve optimal foot health through preventative and conservative means, consider adopting this unique combination of footgear for its powerful synergistic effects.
As with Correct Toes, it’s important to use metatarsal pads in shoes that are completely flat from heel to toe (i.e., shoes that have no heel elevation, no toe spring, and no padding under your arch) and are widest at the ends of your toes (i.e., shoes that have no toe box taper). This is the optimal environment in which to place your metatarsal pads, and you will get the most out of your pads by conforming to these helpful and important guidelines.
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Do you have any questions about the benefits of metatarsal pads? Join the discussion below this article.