Common plantar hyperkeratoses.

In general, metatarsal bars have provided a simple method of relieving pain and disability caused by plantar hyperkeratoses over metatarsal heads. By spanning the longitudinal arch, the bars effectively relieve pressure from the middle three metatarsal heads and elevate the distal portion of the metatarsal bones. This often results in favorable repositioning of displaced proximal phalanges and eliminates direct pressure exerted by metatarsal heads. Also, by giving more uniform support to the foot, metatarsal bars rearrange the weight-bearing surface in a more even way, which favors resolution of hyperkeratoses by removal of pressure points. The prescription for metatarsal bars must be written for both shoes. Dual bars provide balanced walking surfaces and do not induce asymmetric motion of the lower spine as a single bar would. They can be applied to moderately high-heeled shoes for women and regular oxfords for men. The leading edge of the bar must be properly skived and tapered to provide an even surface with the forward part of the soles of the shoes. If this is not done properly, the bars may strike against uneven surfaces as the foot slides forward in walking or running. The patient should return to the prescribing physician in two or three weeks after the bars have been worn constantly. By analyzing the scuffed surfaces of the metatarsal bars, the physician can determine whether or not the bars are firm and thick enough and in the proper position to relieve and divert pressure from the metatarsal heads. Perhaps two pair of shoes should be thus altered to provide a change of foot gear for ordinary purposes. Unaltered dress shoes may be worn for short periods of time as party or formal occasions demand. Eventually, when the painful processes have subsided, the patient may resume wearing ordinary shoes and use the modified shoes if symptoms recur from time to time.