Metatarsalgia is a general medical term for pain that arises in the mid-foot area, often related to loading, when the second to the fifth metatarsals (toes and related mid-foot bones) are affected. Disorders involving the first metatarsal are dealt with separately.

For a differential diagnosis, a distinction must be made between primary metatarsalgia with a local cause in the mid-foot area and secondary metatarsalgia associated with systematic symptoms (rheumatism, gout, arterial circulation disorders).

Possible causes:

• foot malpositions or weak foot musculature: ‘Flatfoot’, ‘forefoot muscle weakness’, ‘flattened transverse arch’, ‘splayfoot’
• Splayfoot deformity is clearly the most common in practice and can trigger various disorders in bones, joints and soft tissue.
• Disorders of the bones of the middle and front of the foot, the toe joints, the soft tissue and the toenails
• weak connective tissue
• high heels
• narrow, sturdy shoes
• severe loading
• being significantly overweight
• neurological: ‘Morton’s neuroma’, ‘forefoot neuralgia’

Possible causes of front-foot/mid-foot pain in the kybun shoe:

• Initial reactions in the kybun shoe: Overtaxation of the forefoot musculature or the transverse arch
• muscle tension: ‘clenching the toes’ (usually done unconsciously to stabilise the foot)

If no active therapy is undertaken to correct the foot malposition, it will become increasingly pronounced, leading to pain and complaints in other joints, such as the knees or hips, or the back.

• orthopaedic shoes with broad toe box
• special insoles
• truss pads (elevation at the forefoot built into the shoe)
• injection of a local anaesthetic and/or cortisone treatment
• regular foot physiotherapy exercises
• therapy
• operation

Foot malpositions are usually treated conventionally with orthopaedic insoles, which sometimes improve the symptoms in the short term, but weaken the foot musculature and make the foot malposition more pronounced in the long term.

The primary purpose of the kyBoot is to shift the forces that would otherwise be exerted on the back, hips and knees onto the feet. This relieves the back and the joints and relaxes tense muscles and increases the load on the feet. This is the correct thing to do because the primary forces should be in the feet when standing and walking.
In the kybun shoe, your foot can move naturally in all directions, training the core, stabilising musculature of each foot equally and improving foot mobility. The foot becomes more robust and stable, and foot malpositions that have arisen due to weak musculature are improved or corrected completely.

Only active, frequent foot training can counteract front-foot/mid-foot pain in the long term. Orthopaedic insoles provide only short-term improvement because they passively support the feet. They do not strengthen the feet; on the contrary, they continuously weaken them while overtaxing other joints.

• For those with greatly flattened transverse arches, we recommend using stiff, thin insoles for the forefoot area in the kybun shoe if pain develops. This reduces the softness of the kybun shoe sole slightly and gives the front of your foot a little added support.
• If the hard insole for the front of the foot from a shoe shop does not improve things, we recommend alternating between wearing the kybun shoe and ‘normal, hard shoes with orthopaedic insoles’ as your ‘active shoe’. This allows your foot to recover from active training in the kybun shoe before front-foot pain develops.
• Be sure to maintain an upright body posture and foot position in the kybun shoe/on the kybun mat. Look straight ahead and correct any lateral/medial rolling in the kybun shoe.
• Your feet should be able to move freely in the kybun shoe! Shoe size and model can make a critical difference. It is normal to feel less stable in the kybun shoe than you would in ‘normal’ shoes at first. Take your time when trying the kybun shoe on; your local kybun specialists will be pleased to assist you.
  Relax your toes in the kybun shoe/on the kybun mat (it is common to unconsciously clench them)
• Roll forward naturally over the entire foot (from the heel to the push-off with the big toe).
• Avoid taking steps that are too long so as to ensure that the joints bear a more correct axial load, which is less taxing. This also makes it easier to balance on the kybun shoe sole.
• Some people feel too unstable in the kybun shoe. In this case, we advise you to try various kybun shoe models; some models have a higher cut and provide more stability. We also recommend a kybun shoe model with a lower rebound effect to these customers. It is a little wider in the mid-foot area, making you feel safer while walking (ask for advice in a specialised kybun shop).
• If you still feel too unsafe walking in the kybun shoe, we advise using the kybun mat. The kybun mat is available in three different thicknesses. This allows you to choose the thickness that is most comfortable for you (the thicker, the less stable, and the more intensive the training).
  You can also hold on to a fixed object if you need additional support when using the kybun mat.