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The effect of arch supports on foot alignment in patients with metatarsalgia based on weight-bearing computed

Atta Taseh¹, Samir Ghandour¹, Bedri Karaismailoglu¹

¹Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Acta Orthopaedica Et Traumatologica Turcica

|January 24, 2026

Abstract

Objective:

Arch support insoles are among the first-line conservative treatments for patients with metatarsalgia. This study aims to exam ine the clinical effect, along with the associated radiologic changes in foot alignment, among metatarsalgia patients with and without the use of arch support insoles.

Methods:

In this clinical trial, 14 patients with metatarsalgia aged 18 to 65 years were recruited. Pain intensity was obtained at the first visit and after 4, 8, and 12 weeks. All participants underwent bilateral weight-bearing computed tomography (WBCT) and weight-bearing (WB) radiographs of their feet while standing barefoot and on non-custom-made insoles. Several linear and angular radiological measure ments were conducted and compared between the barefoot and insole conditions. Interobserver reliability was calculated (intraclass correlation coefficient [ICC]), and the groups were compared using P < .05 as the statistical significance threshold.

Results:

A total of 14 patients, consisting of 6 females and 8 males, participated in the study. Patient Reported Outcomes Measurement Information System Pain Intensity scores showed significant improvement starting from the 8th week (P = .04). Weight-bearing radio graphic measurements showed significant decreases in the M2-M3 and M2-M5 tangent angles (P = .04 and .03, respectively). Similarly, the M4-M5 intermetatarsal angle decreased when wearing insoles (P = .01). There were no significant changes in the WBCT measurements.

Conclusion:

Arch support insoles significantly improved pain in patients with metatarsalgia. This symptomatic relief coincides with immediate radiologic changes, mainly in the forefoot area. Future prospective studies with larger populations are suggested to investigate the effects of these insoles on metatarsalgia with various foot types. Cite this article as: Taseh A, Ghandour S, Karaismailoglu B, Toy K, Ashkani-Esfahani S, Landsman A. The effect of arch supports on foot alignment in patients with metatarsalgia based on weight-bearing computed tomography and radiographic parameters. Acta Orthop Traumatol Turc., 2025;59(6):374-378.

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