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Purpose: Metatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad place-ment location remains a debated issue. We aimed to identify the most effective insole design that reduces forefoot plantar pres-sure and determine the optimal position for metatarsal pad placement. Materials and Methods: We recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking whileusing an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control),1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole(P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking pro-tocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proxi-mal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale. Results: The SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the locationof the metatarsal pad placement. Conclusion: Considering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shockabsorption may be more clinically useful.
