Postural stability and foot orthoses

NewsBot · Apr 27, 2007

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Effect of Orthoses on Postural Stability in Asymptomatic Subjects With Rearfoot Malalignment During a 6-Week Acclimation Period
Mattacola CG, Dwyer MK, Miller AK, Uhl TL, McCrory JL, Malone TR.
Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 5, May 2007, Pages 653-660

Objective
To determine the effect of custom-fitted orthoses on postural sway over a 6-week acclimation period.

Design
Repeated-measures analysis of variance on postural sway measures with factors being group (control, malaligned), time (initial, 2wk, 4wk, 6wk postintervention), and condition (with orthoses, without orthoses). For single-limb stance, side (right, left) was analyzed to determine bilateral differences.

Setting
Biodynamics laboratory.

Participants
Twenty-one subjects, 11 asymptomatic with rearfoot malalignment and 10 asymptomatic with normal rearfoot alignment.

Interventions
Orthoses were prescribed and worn for 6 weeks. Balance testing was performed on 4 different dates with each subject tested in both orthotic conditions. Postural control was measured with three 10-second eyes-closed trials for single-limb stance, one 20-second eyes-closed bilateral stance with the platform moving, and one 20-second eyes-open bilateral stance with the platform and surroundings moving.

Main Outcome Measures
Sway velocity (in deg/s) for single-limb stance and equilibrium score for bilateral stance.

Results
Postural sway measures were significantly decreased during single-limb testing with orthoses versus without orthoses, regardless of group. The orthotic intervention significantly improved bilateral stance equilibrium score in the malaligned group at weeks 2, 4, and 6 when compared with measures at the initial week. Equilibrium score of the malaligned group with orthoses at initial week was significantly lower (worse) than the control group with orthoses at initial week; however, these results were not repeated during measurements taken at weeks 2, 4, or 6.

Conclusions
The application of orthoses decreased sway velocity for single-limb stance, improving postural stability regardless of group when visual feedback was removed. During bilateral stance, postural stability was initially worse for the malaligned group with and without orthoses when compared with the control group; however, improvements were seen by week 2 and continued throughout the remainder of testing. Clinically, the application of orthoses appears to improve postural control in people with rearfoot malalignment, particularly when vision is removed.
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Admin2 · Apr 27, 2007

Related threads:
Cutaneous reflexes contribute to stability during walking
Plantar feedback contributes to the regulation of leg stiffness
Sensory effects of foot orthoses
Central control mechanisms of the foot

Effect of textured foot orthotics postural stability
Foot type and balance
Absent pedal pulse and balance problems
Foot orthotics and postural stability
Foot characteristics and balance
What a buzz! Vibration therapy improves strength and balance
Maintenance of Balance in Relaxed Bipedal Standing
Assessment of Gait and Balance
Gait instability and hallux valgus

NewsBot · Aug 8, 2008

Arch support use for improving balance and reducing pain in older adults.
Mulford D, Taggart HM, Nivens A, Payrie C.
Appl Nurs Res. 2008 Aug;21(3):153-8

PURPOSE: The purpose of this study was to examine the effects of arch supports on balance, functional mobility, and pain in the back and lower extremity joints among older adults.

DESIGN: A single-factor within-subjects design was used. METHOD: A convenience sample of older adults formed a single group for fitting with arch supports. Balance, functional mobility, and self-reported pain in the back and lower extremities were measured without the arch supports, immediately after the insertion of the supports in the subjects' shoes, and after 6 weeks of arch support use.

FINDINGS: Sixty-seven older adults completed the study. The measures used indicated statistically significant improvements in scores for the Berg Balance Scale [Berg, K., Williams-Dauphinee, S., & Williams, J. I., (1995). The Balance Scale: Reliability assessment for elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27, 27-31] and functional mobility [Timed Up and Go test; Podsiadlo, D., & Richardson, S. (1991). The Timed "Up and Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148] as well as reduced back, foot, knee, and hip pain (p < .05). There was no statistically significant change in ankle pain (p > .05).

IMPLICATIONS: Knowledge of interventions that enhance health and well-being is essential for nurses. Arch supports may provide improved balance and functional mobility while reducing back and lower extremity joint pains. Further research is needed to support evidence-based practice.
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NewsBot · May 21, 2010

Do ankle orthoses improve ankle proprioceptive thresholds or unipedal balance in older persons with peripheral neuropathy?
Son J, Ashton-Miller JA, Richardson JK.
Am J Phys Med Rehabil. 2010 May;89(5):369-75.

OBJECTIVE: To determine whether ankle orthoses that provide medial and lateral support, and have been found to decrease gait variability in older persons with peripheral neuropathy, decrease (improve) frontal plane ankle proprioceptive thresholds or increase unipedal stance time in that same population.

DESIGN: Observational study in which unipedal stance time was determined with a stopwatch, and frontal plane ankle (inversion and eversion) proprioceptive thresholds were quantified during bipedal stance using a foot cradle system and a series of 100 rotational stimuli, in 11 older neuropathic subjects (8 men; age 72 +/- 7.1 yr) with and without ankle orthoses.

RESULTS: The subjects demonstrated no change in combined frontal plane (inversion + eversion) proprioceptive thresholds or unipedal stance time with vs. without the orthoses (1.06 +/- 0.56 vs. 1.13 +/- 0.39 degrees, respectively; P = 0.955 and 6.1 +/- 6.5 vs. 6.2 +/- 5.4 secs, respectively; P = 0.922).

CONCLUSION: Ankle orthoses that provide medial-lateral support do not seem to change ankle inversion/eversion proprioceptive thresholds or unipedal stance time in older persons with diabetic peripheral neuropathy. Previously identified improvements in gait variability using orthoses in this population are therefore likely related to an orthotically induced stiffening of the ankle rather than a change in ankle afferent function.
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LER · Jul 7, 2010

Postural control deficits: the role of foot orthoses

The mechanism by which foot orthoses improve postural control remains uncertain, but research suggests that it may stem from improvements in sensory feedback or changes in center of pressure that in turn affect joint moments. http://www.lowerextremityreview.com...al-control-deficits-the-role-of-foot-orthoses

NewsBot · Jan 28, 2012

Effects of Foot Orthoses on Balance in Older Adults.
Gross MT, Mercer VS, Lin FC.
J Orthop Sports Phys Ther. 2012 Jan 25

STUDY DESIGN:
Controlled laboratory study using a single cohort design.

OBJECTIVES:
To determine if balance in older adults could be significantly improved with foot orthotic intervention.

BACKGROUND:
Poor balance has been associated with risk for falls. Limited evidence exists indicating that foot orthoses influence balance.

METHODS:
Thirteen individuals older than 65 who reported at least 1 unexplained fall during the past year and who demonstrated poor balance participated in the study. Subjects were tested for one-leg stance, tandem stance, tandem gait, and alternating step tests during the first (SCREEN) and second (PRE) sessions prior to foot orthotic intervention. Tests were repeated during the second testing session immediately after custom foot orthotic intervention (POST), and 2 weeks following foot orthotic use (FU). SCREEN and PRE measures were compared for stability using absolute difference computations and Friedman's rank test. PRE, POST, and FU data were analyzed using the Friedman's rank test (alpha = 0.05) with Bonferroni correction for multiple post-hoc comparisons.

RESULTS:
Each balance measure was statistically equivalent between the SCREEN and PRE measurements. One-leg stance times for PRE were significantly less than POST (P = .002) and FU (P = .013) measurements. Tandem stance times for PRE were significantly less than POST (P = .013) and FU (P = .013) measurements. Steps taken for the tandem gait test during the PRE measurements were significantly fewer than steps taken for the FU test (P = .007). Steps taken during the alternating step test for the PRE test were significantly fewer than steps taken during the POST (P = .002) and FU (P =.001) tests. POST and FU measurements were not significantly different for any of the 4 outcome measures.

CONCLUSIONS:
The results provide preliminary evidence that foot orthoses can effect improvement in balance measures for older adults
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NewsBot · Jul 21, 2012

Changes of Postural Steadiness Following Use of Prefabricated Orthotic Insole.
Bateni H.
J Appl Biomech. 2012 Jul 5

Orthoses are designed to assist a mal-aligned foot in adapting to the environment and reduce the frequency of injury. Literature is divided on the benefits of orthotics insoles for postural stability. The current study was conducted to determine the effect of prefabricated orthotic arch supports on postural stabilization. Twelve healthy young adults participated in this study and were tested with and without prefabricated orthotics. Different variables were computed from movement of center of pressure (COP) during orthotic use as suggested in the literature. The mean position of COP was significantly shifted forward and toward the dominant side. Neither the COP movement nor the velocity changes following the use of orthotics revealed significant differences. Mediolateral range of COP movement and the 95% confidence circle area of sway was significantly reduced (p=0.022 and 0.048 respectively), but changes in 95% confidence circle and ellipse areas of fractal dimension were not significant (p=.053 and p=.057 respectively). In conclusion, orthotic insoles significantly improved postural sway initially by reducing mediolateral range of postural sway and 95% confidence circle area of sway at the cost of increased fractal dimension area variables and power.
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NewsBot · Jul 21, 2012

Effects of Foot Orthoses on Balance in Older Adults
Michael T. Gross, Vicki S. Mercer, Feng-Chang Lin
J Orthop Sports Phys Ther 2012;42(7):649-657

STUDY DESIGN: Controlled laboratory study using a single-cohort design. OBJECTIVES: To determine if balance in older adults could be significantly improved with foot-orthotic intervention.

BACKGROUND: Poor balance has been associated with risk for falls. Limited evidence exists indicating that foot orthoses influence balance.

METHODS: Thirteen individuals older than 65 years, who reported at least 1 unexplained fall during the past year and demonstrated poor balance, participated in the study. Subjects were tested for 1-leg stance, tandem stance, tandem gait, and alternating step tests during the first (SCREEN) and second (PRE) sessions prior to foot-orthotic intervention. Tests were repeated during the second testing session immediately after custom foot-orthotic intervention (POST) and 2 weeks following foot-orthotic use (FU). SCREEN and PRE measures were compared for stability using absolute difference computations and the Friedman rank test. PRE, POST, and FU data were analyzed using the Friedman rank test (α = .05), with Bonferroni correction for multiple post hoc comparisons.

RESULTS: Each balance measure was statistically equivalent between the SCREEN and PRE measurements. One-leg stance times for PRE were significantly less than POST (P = .002) and FU (P = .013) measurements. Tandem stance times for PRE were significantly less than POST (P = .013) and FU (P = .013) measurements. Steps taken for the tandem gait test during the PRE measurements were significantly fewer than steps taken for the FU test (P = .007). Steps taken during the alternating step test for the PRE test were significantly fewer than steps taken during the POST (P = .002) and FU (P =.001) tests. POST and FU measurements were not significantly different for any of the 4 outcome measures.

CONCLUSIONS: The results provide preliminary evidence that foot orthoses can effect improvement in balance measures for older adults.
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NewsBot · May 7, 2013

Changes of postural steadiness following use of prefabricated orthotic insoles.
Bateni H.
J Appl Biomech. 2013 Apr;29(2):174-9.

Orthoses are designed to assist a malaligned foot in adapting to the environment and reduce the frequency of injury. Literature is divided on the benefits of orthotics insoles for postural stability. The current study was conducted to determine the effect of prefabricated orthotic arch supports on postural stabilization. Twelve healthy young adults participated in this study and were tested with and without prefabricated orthotics. Different variables were computed from movement of center of pressure (COP) during orthotic use as suggested in the literature. The mean position of COP was significantly shifted forward and toward the dominant side. Neither the COP movement nor the velocity changes following the use of orthotics revealed significant differences. Mediolateral range of COP movement and the 95% confidence circle area of sway was significantly reduced (P = .022 and 0.048 respectively), but changes in 95% confidence circle and ellipse areas of fractal dimension were not significant (P = .053 and P = .057 respectively). In conclusion, orthotic insoles significantly improved postural sway initially by reducing mediolateral range of postural sway and 95% confidence circle area of sway at the cost of increased fractal dimension area variables and power.
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Brian A. Rothbart · May 8, 2013

Postural Distortions leading to chronic musculoskeletal pain is the basic tenant behind proprioceptive therapy. Current studies linking insoles to changes in postural permutations tend to validate (in my opinion) this basic tenant.

The fact that proprioceptive insoles dramatically change postural alignments is evident when one reviews the changes in posture - pre vs post proprioceptive Tx. What is not so apparent to many healthcare providers, are the visceral changes that accompany the postural corrections.

Professor Brian

davidh · May 9, 2013

Brian A. Rothbart said: ↑

Postural Distortions leading to chronic musculoskeletal pain is the basic tenant behind proprioceptive therapy. Current studies linking insoles to changes in postural permutations tend to validate (in my opinion) this basic tenant.

The fact that proprioceptive insoles dramatically change postural alignments is evident when one reviews the changes in posture - pre vs post proprioceptive Tx. What is not so apparent to many healthcare providers, are the visceral changes that accompany the postural corrections.

Professor Brian
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This is a strange thread Brian (btw, do you mean tenet rather than tenant?).

From where I'm sitting the explanation is very simple:
The foot is designed to conform and provide a stable platform for ambulation on all kinds of surfaces, but as we age some joints stiffen and others stop working altogether.
This will affect stability in some subjects.

Anything which cradles the plantar foot profile on the upper surface, and provides a flat under-surface to conform to the flat,hard surface which the study was undoubtedly carried out on, is bound to help overall stability in some subjects.

Sicknote · May 9, 2013

Doesn't postural stability begin with spinal/pelvic stabilisation?.

Sicknote · May 10, 2013

davidh said: ↑

but as we age some joints stiffen and others stop working altogether.
This will affect stability in some subjects.
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^ Fix this first.

davidh said: ↑

Anything which cradles the plantar foot profile on the upper surface, and provides a flat under-surface to conform to the flat,hard surface which the study was undoubtedly carried out on, is bound to help overall stability in some subjects.
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But there joints are still stiff & immobile.

Lets not gloss over a serious problem with a pat solution.

davidh · May 10, 2013

Sicknote said: ↑

^ Fix this first.

But there joints are still stiff & immobile.

Lets not gloss over a serious problem with a pat solution.
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It was an explanation, not a solution. The solution is orthotics, suitable footwear, and, depending on the level of instability or infirmity, a walker on wheels, or a frame.

Sicknote · May 10, 2013

davidh said: ↑

The solution is orthotics, suitable footwear, and, depending on the level of instability or infirmity, a walker on wheels, or a frame.
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Where referring to poor joint health.

You have totally overlooked the most important factor.

How do your solutions go about getting to the core of the problem when the patient is constantly feeding (degrading/calcifying/inflaming) the joint problems?.

N.Smith · May 12, 2013

If poor foot posture and bad mechanics are causing the postural problem, having a Kinematic effect on foot posture will effect the stability of the body as it will feel more stable.
Neil

David Wedemeyer · May 13, 2013

davidh said: ↑

Anything which cradles the plantar foot profile on the upper surface, and provides a flat under-surface to conform to the flat,hard surface which the study was undoubtedly carried out on, is bound to help overall stability in some subjects.
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Yes!

I rather like Dr. Richie's definition of Postural Control:

The term balance describes a person’s ability to remain upright in stance.14 Postural control is the ability to maintain the body’s center of gravity (CoG) within the borders of support.15 Postural control, therefore, is a strategy to maintain balance. Balance occurs during static stance and dynamic gait. Postural control is typically measured during quiet static stance and can be evaluated during either single- or double-limb support.
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Sicknote said: ↑

Doesn't postural stability begin with spinal/pelvic stabilisation?.
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No, it can be independent of the hemipelvis. Sicknote you're obviously a chiropractor and I'd bet dollars to donuts you dispense Foot Levelers (you are reciting their mantra are you not)? I feel the hemipelvis is not often the genesis of foot and/or balance problems.

Podiatrists tend to look to the feet first and chiropractors to the spine.

Everything we believe and do is as a result of the lens through which we view the world.

I wish you would just post under your real name so that we could have an adult discussion as colleagues.

Best

David Wedemeyer · May 14, 2013

http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=244336&postcount=61

Influence of foot positions on the spine and pelvis.
Betsch M, Schneppendahl J, Dor L, Jungbluth P, Grassmann JP, Windolf J, Thelen S, Hakimi M, Rapp W, Wild M.
Arthritis Care Res (Hoboken). 2011 Dec;63(12):1758-65.

OBJECTIVE:
The management of knee osteoarthritis includes the use of wedged shoe insoles to unload the affected knee compartment. Although the biomechanical effects of shoe insoles on the knee joint are known and described, only little is known about their influence on the pelvis and spine. Therefore, the purpose of this study was to evaluate the effects of different foot positions, such as how they could be achieved by shoe insoles, on pelvic position and spinal posture.

METHODS:
A total of 51 test subjects were measured for this study. The different foot positions (inner and outer margin increase, positive and negative heel height) were simulated with a specially designed stand platform. A rasterstereographic device was used to measure the immediate effects of the simulated foot positions on the pelvic position and spinal posture.

RESULTS:
Positive and negative heel heights as well as an increase of the outer margin of the platform led to significant changes of the pelvic tilt. The pelvic torsion also changed significantly during positive heel height changes of 10 and 15 mm and increases of the outer margin of the foot. No significant changes were found between foot position and spinal parameters.

CONCLUSION:
The results of our study support the existence of a kinematic chain, where changes of foot position also led to significant alterations of the pelvic position. Whether these changes could lead to long-term pathologic alterations still needs to be evaluated. However, in our setting, no correlation between foot position and spinal posture changes was found.
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:rolleyes:

I'd like to see evidence to the contrary, takers?

NewsBot · Dec 23, 2013

The effect of lateral or medial wedges on control of postural sway in standing
Mohan Ganesan, Yun-Ju Lee, Alexander S. Aruin
Gait & Posture; Article in Press

The objective of this study was to evaluate the effects of lateral and medial wedges on postural sway. Twenty healthy volunteers (mean age range of 28.45±3.34) participated in the study. They stood barefoot with eyes open or closed on each of the three surfaces: 10° lateral wedges, 10° medial wedges, and no wedges. Force platform data were collected and the mean and root mean square (RMS) distance, range, and velocity and the mean frequency of the center of pressure (COP) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Standing on both lateral and medial wedges was associated with improved postural stability seen through the decreased mean and RMS distance of COP displacement in ML direction. The results of this study suggest that standing on either lateral or medial wedges might enhance postural control in standing.
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Highlights
•We studied the role of bilateral wedges on body sway.
•Standing on lateral and medial wedges improved postural stability.
•Standing on wedges might be helpful while performing tasks requiring precision.
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NewsBot · Mar 1, 2014

Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly
Chen TH, Chou LW, Tsai MW, Lo MJ, Kao MJ
Clinical Interventions in Aging; February 2014 Volume 2014:9 Pages 351 - 356

Background: The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly.
Methods: The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex® Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant.
Results: Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.244±0.688 versus 3.064±0.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.764±0.546 versus 2.592±0.538) and the poor-stability group (3.845±0.188 versus 3.655±0.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups.
Conclusion: The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls.
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NewsBot · Apr 9, 2014

The effects of pronated foot posture and medial heel and forefoot wedge orthoses on static balance in older people
Fateme Hemmati, Saeed Forghany and Christopher Nester
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A17 doi:10.1186/1757-1146-7-S1-A17

Background
Aging has been associated with increasing foot pronation [1] and changes in foot mobility and posture which may influence standing balance [2,3]. Orthotic interventions change foot posture [4] and load distribution under the foot [5] and therefore may have important effects on balance in older people.

Objective
To investigate whether a pronated foot posture is associated with poorer standing balance in older people and whether medial heel and forefoot wedge orthoses affect their standing balance.

Design
Between groups, repeated-measures design.

Methods
Ten healthy older people with a pronated foot posture (age 67.1± 5.5 years) and sixteen healthy elderly with normal foot posture (age 67.1± 5.9 years) were recruited.The Foot Posture Index (FPI) was used to determine pronated and normal foot posture. Static balance in double limb stance was assessed using Kistler force plate measures during four shod conditions: 1) 5° medial heel and forefoot wedge (W5); 2) 8° medial heel and forefoot wedge (W8); 3) Control insole for W5 (flat EVA base with the same thickness as W5 (NW5)); 4) Control insole for W8 (flat EVA base with the same thickness as W8 (NW8)). Each of the four cases was completed with eyes open and eyes closed. The center-of-pressure (COP) total excursion and mean velocity and area of 95% confidence ellipse were derived as measures of standing balance.

Results
Participants with a pronated foot type (Mean FPI: 7.5) demonstrated greater total excursion (298.19±28.59mm versus 262.69±22.92mm) and total mean velocity (11.78±1.41mm.s-1 versus 10.41±1.13mm.s-1), and larger ellipse area (630.81±244.19mm2 versus 298.15±195.79 mm2), compared with participants with normal foot type (Mean FPI: 3.8) during normal standing, but this did not reach statistical significance (p>0.05) (Figure 1). There was a significant main effect for eyes open (p<0.05) with the total excursion (290.0 ± 14.7mm versus 321.9 ± 14.1mm) and mean velocity of COP in ML (8.9 ± 0.5mm.s-1 versus 10.2 ± 0.6mm.s-1) being significantly lower.

There were no statistically significant effects from the four orthoses in the pronated nor the normal foot types (p<0.05). There were no significant differences in interaction of all conditions (foot posture × eye condition × orthoses) (p<0.05).

Conclusion
A trend towards less stable balance was observed in pronated foot type but this was not significant. Use of orthoses had no effect on balance parameters including negating the effects of eyes closed. Orthoses showed no negative effects on standing balance and therefore do not pose a threat to balance (e.g. if they are used for another purpose).
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NewsBot · Jun 26, 2014

Comparing the immediate effects of UCBL and modified foot orthoses on postural sway in people with flexible flatfoot
Somaieh Payehdar et al
Prosthet Orthot Int June 18, 2014

Background: Different types of foot orthoses have been prescribed for patients with flatfoot. Results of several studies have shown that orthoses were able to change balance parameters in people with flatfoot. However, the possible effect of orthosis flexibility on balance has not yet been investigated.

Objectives: The aim of the current study was to investigate the immediate effect of a rigid University of California Berkeley Laboratory (UCBL) foot orthosis, a modified foot orthosis, and a normal shoe on the postural sway of people with flexible flatfoot.

Study design: Quasi-experimental.

Methods: In all, 20 young adults with flatfoot (aged 23.5 ± 2.8 years) were invited to participate in this study. The Biodex Stability System was employed to perform standing balance tests under three testing conditions, namely, shoe only, UCBL, and modified foot orthosis. Total, medial–lateral, and anterior–posterior sway were evaluated for each condition.

Results: The results of this study revealed no statistical difference in the medial–lateral and anterior–posterior stability indices between foot orthoses and shoed conditions. The overall stability index with the UCBL foot orthosis, however, was significantly lower than that with the modified foot orthosis.

Conclusion: The UCBL foot orthosis was able to decrease total sway and improve balance in people with flexible flatfoot.

Clinical relevance Results of previous studies have indicated that foot orthoses were able to affect the balance of people with flatfeet.However, the possible effects of flexible orthoses on balance have not been examined. The results of this study may provide new insight into material selection for those people with balance disorders.
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NewsBot · Sep 30, 2014

Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly.
Chen TH, Chou LW, Tsai MW, Lo MJ, Kao MJ.
Clin Interv Aging. 2014 Feb 20;9:351-6.

BACKGROUND:
The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly.
METHODS:
The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex® Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant.
RESULTS:
Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.244±0.688 versus 3.064±0.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.764±0.546 versus 2.592±0.538) and the poor-stability group (3.845±0.188 versus 3.655±0.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups.
CONCLUSION:
The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls.
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NewsBot · May 21, 2015

Balance and Pressure Distribution under the Foot during Standing and Walking with no Orthotics Compared to Custom and off the Shelf Orthotics, A Pilot Study
Jerrold Petrofsky, Iman Akef Khowailed, Brittney N Burtnett, Marina R Korkar and Brittany M Kinney
Clin Res Foot Ankle

Objective: Potential pain relief from foot pain can come from a shoe insert foot orthotic. This study assessed foot pressure distribution and balance in off the shelf foot orthotics versus a custom made foot orthotic compared to no orthotic.
Methods: The subjects (8) were both men and women. The average age was 25.1 ± 2.8 years, the average weight was 68.8 ± 13.7 kg, and BMI 24.5 ± 6.4. Each patient was fit for both off the shelf and custom shoe insert foot orthotics and needed orthotics to reduce pain. Once fit, they were evaluated by standing and then walking 12 meters on a level surface while being monitored by a Tactilus Pressure Mapping system. Balance was also evaluated with a pressure platform during 8 balance tests.
Results: With the subjects accomplishing quiet standing, the average pressure and peak pressure was shifted from the hind foot and forefoot to the mid foot when wearing foot inserts (p<0.05). During walking, the average pressure was significantly shifted from the forefoot and hind foot to the mid foot in both orthotic groups with the greatest reduction in forefoot pressure in the off the shelf orthotic group (p<0.05). This is especially seen when measuring the peak pressures on the foot, where, during standing the peak pressures on the fore foot were 20% higher with no orthotic than seen for the 2 orthotics tested here. Balance was best in the custom orthotic group while both orthotic groups had better balance than the no orthotic studies for the most difficult balance tests. Conclusion: At least in this small group of subjects, off the shelf foot orthotics help gait or balance but custom orthotics are better.
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NewsBot · Jun 26, 2015

A systematic review of the effect of foot orthoses and shoe characteristics on balance in healthy older subjects
Atefeh Aboutorabi et al
Prosthet Orthot Int June 25, 2015

Background: Foot orthoses are used to optimize lower extremity function and can improve postural stability by enhancing the afferent somatosensory feedback available to the central nervous system.
Objective: The aim of this review was to evaluate the effect of foot orthoses on balance control in older subjects.
Study design: Systematic review.
Methods: The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases by using selected keywords. A total of 22 articles were selected for final evaluation.
Results: The results demonstrated that older people should be advised to wear thin, hard-soled footwear with high collars to reduce the risk of falling. The findings for insoles demonstrated an increase in balance control via vibratory or magnetic insoles, but textured insoles do not appear to be beneficial for balance improvement.
Conclusion: Foot orthoses improve postural stability via a somatosensory or biomechanical effect. Use of footwear with the proper features can be an appropriate intervention in order to increase the balance in the older population and reduce falls.
Clinical relevance Loss of balance is an important factor in increasing the risk of falling in older subjects. Foot orthoses can improve functional measures of stability in older adults. In this review, results from studies suggest a number of recommendations regarding the optimal footwear for older people to reduce the risk of falling.
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NewsBot · Sep 7, 2015

A study of the immediate effects of glycerine-filled insoles, contoured prefabricated orthoses and flat insoles on single-leg balance, gait patterns and perceived comfort in healthy adults
Anna L. Hatton, Fran?ois Hug, Brooke C. M. Brown, Leon P. Green, Jacob R. Hughes, Jarrad King, Emma J. Orgar, Kate Surman and Bill Vicenzino
Journal of Foot and Ankle Research 2015, 8:47 doi:10.1186/s13047-015-0107-4

Background
Footwear interventions are often prescribed to assist with the management of lower limb pain, injury and disease. Commercially available shoe insoles and orthoses are increasingly incorporating novel design features to alleviate foot and lower limb symptoms, but this may be at a cost to optimal functional performance. This study compared the immediate effects of wearing glycerine-filled insoles, contoured prefabricated orthoses, and flat insoles, on balance and gait measures.

Methods
Thirty healthy adults (17 men, 13 women; mean [SD] age: 24.3 [2.5] years) performed tests of single-leg standing with eyes open (Kistler force platform), star excursion balance test, and level-ground walking (GAITRite? walkway system), under three randomised conditions: wearing glycerine-filled insoles, prefabricated orthoses, and flat (control) insoles, within their own footwear. Centre of pressure movement (anterior-posterior and mediolateral range and standard deviation, total path velocity), star excursion balance test reach distance, and temporospatial gait variables were collected. Perceived comfort of the inserts was scored immediately after use on a 100 mm visual analogue rating scale. After trialling all inserts each participant ranked their level of comfort from least to most.

Results
Centre of pressure measures, star excursion balance test reach distance, or temporospatial gait variables did not differ between the three inserts (all P values >0.088). Significant between-condition differences were reported for comfort ranking (P = 0.031), but not rating scores (P = 0.638). Weak to moderate negative correlations (r values ranged between −0.368 and −0.406) were observed between visual analogue scale comfort rating for the flat insoles and prefabricated orthoses, star excursion balance test and gait measures.

Conclusions
Single-leg standing balance, star excursion balance test performance, and level-ground walking patterns in asymptomatic adults do not appear to differ when wearing glycerine-filled insoles, contoured prefabricated orthoses, or flat insoles. Perceived comfort may be related to the biomechanical or clinical effectiveness of novel footwear interventions, and requires further investigation. Importantly, these findings are specific to a healthy population and further research is needed to determine the long-term effects of glycerine-filled insoles in patients with known balance impairments.
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NewsBot · May 5, 2016

Effects of insoles contact on static balance
Ju Yong Shin, Young Uk Ryu, Chae Woo Yi
Journal of Physical Therapy Science; Vol. 28 (2016) No. 4 April p. 1241-1244

[Purpose] This study examined the effect of the degree of the contact area between the insoles and soles on static balance.
[Subjects and Methods] Thirteen healthy male and female adults voluntarily participated. All of the subjects wore three different types of insoles (no orthotic insole, partial contact, full contact) in the present experiment. The subjects were instructed to place both feet parallel to each other and maintain static balance for 30 seconds. Center of pressure parameters (range, total distance, and mean velocity) were analyzed.
[Results] The results show that the anteroposterior range and mediolateral (ML) total distance and velocity decreased when orthotic insoles with partial contact or full contact were used in comparison to when a flat insole (no orthotic insole) was used. Also, the ML range and total distance were lower with full contact than in the other two conditions. These results indicate that static balance improves as the degree of contact between the soles and insoles increases.
[Conclusion] The results of this study suggests that using insoles with increased sole contact area would improve static balance ability.
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NewsBot · Jun 19, 2016

Immediate effects of insole on dynamic balance in the individuals with flat feet
Reza Salehi , Sara Habibian, Maryam Saadat , Mohammad Mehravar
Razi Journal of Medical Sciences

Background: One of the most common foot problems is flat foot, which causes pain in the leg complex and postural control deficits. One way to treat flat foot is the use of insoles. Insoles can reduce forces to the ankle and decreases pain. The aim of this study was to (1) comparison dynamic balance of individuals with flat feet and healthy subjects (2) the effect of insoles on dynamic balance in people with flat feet. Methods: The participants in this study 20 patients with flat foot and 20 healthy volunteers. The Star Excursion Balance Test was used to assess the dynamic balance. To statistics analysis T-independent and pair T-test was used. Results: The results showed that people with flat foot achieve in the Star Excursion Balance Test significantly lower than healthy controls. The use of insoles in people with flat feet cause a significant increase in the rate of achieving in Star Excursion Balance Test. (p<0.05) Conclusion: The decrease of medial longitudinal arch imposed inappropriate stresses on the plantar fascia, joints and ligaments of the foot and ankle structures and as a result will be the postural dysfunction in people with flat feet. Use of insoles can improve dynamic balance index in people with flat feet
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NewsBot · May 6, 2018

IMMEDIATE EFFECTS OF SEMI-RIGID FOOT INSOLES ON
POSTURAL STABILITY IN INDIVIDUALS WITH FLAT FOOT
Sara Habibian et al
Pharmacophore, 8(6S), e-1173602.

One of the standard treatment protocol for Flat foot is the use of therapeutic insoles. Far too little
attention has been paid on the effect of insoles on postural stability. Therefore, the aim of this study
is to examine postural stability regarding pre and post use of therapeutic insole in individuals with
flat foot deformity. Twenty subjects (5 men, 15 women) with flexible flat foot deformity and 20
matched control participated in this study. Center of pressure (COP) data was assessed under 2
measurement conditions with and without insoles. Mean velocity and standard deviation of
amplitude and velocity of the center of pressure sway. The results of this study showed that flat foot
subjects had greater postural sway compared with control group. Center of pressure parameters in
flat foot subjects were significantly different when they wear an insole and this effect was more
obvious in the eyes closed conditions. The effect of cognition loading was not significantly different
between the 2 groups. The results of this study showed greater postural sway in flat foot subjects.
Use of insoles improved postural stability especially in closed eye conditions. Therefore, the use of
insoles may be a beneficial modality to improve stability in these patients, particularly in conditions
that sensory information is limited.
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Brian A. Rothbart · May 28, 2021

davidh said: ↑

This is a strange thread Brian (btw, do you mean tenet rather than tenant?).

From where I'm sitting the explanation is very simple:
The foot is designed to conform and provide a stable platform for ambulation on all kinds of surfaces, but as we age some joints stiffen and others stop working altogether.
This will affect stability in some subjects.

Anything which cradles the plantar foot profile on the upper surface, and provides a flat under-surface to conform to the flat,hard surface which the study was undoubtedly carried out on, is bound to help overall stability in some subjects.
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Actually, hypothesis would be the best term to use.

Using tenant was a Freudian slip.

NewsBot · Jan 3, 2022

Analysis of the use of insoles in the dynamic stability of the lower limbs in recreational runners: An exploratory study.
Bruna E.B.Hilário et al
Gait & Posture; Volume 92, February 2022, Pages 435-441

Highlights
•Insoles with forefoot elements can promote changes in static and dynamic variables.
•Neutral insoles can improve static balance.
•Insoles can increase the activation of the gluteus medius during the run.
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Background
The use of insoles, which is increasingly widespread, can promote changes in biomechanics during running.

Research question
Can the use of insoles with various patterns of infracapital support influence factors related to the dynamic stability of the lower limbs during running on a treadmill in recreational runners?

Methods
This is controlled single-blind repeated measures. Static baropodometric data were collected, as well as kinematic data for the lower limbs and electromyographic data for the gluteus maximus and gluteus medius muscles, for twelve recreational runners on a treadmill using four models of insoles (neutral and with forefoot elements - infracapital bar).

Results
Neutral insoles were able to reduce laterolateral displacement, increase the displacement of the mass to the posterior, and increase the lateral rotation of the left knee and medial rotation of the right hip. Insoles with a 2 mm total infracapital bar were able to move the mass to the posterior, increase laterolateral displacement and activate the gluteus medius. Insoles with a 2 mm medial infracapital bar were able to increase the displacement of the mass to the posterior, increase the adduction of left hip and the medial rotation of right hip, and activate the gluteus medius. Insoles with a 4 mm medial infracapital element were able to move the body mass to the posterior and to the left, increase laterolateral displacement, increase the adduction of left hip, the medial rotation of right hip and the abduction of right knee.

Significance
The insoles evaluated in the present study were able to modify biomechanical variables of recreational runners related to dynamic stability during running on a treadmill and static baropodometric variables.
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NewsBot · Jul 27, 2023

PREFABRICATED ORTHOTICS WITH AND WITHOUT A METATARSAL PAD TO DECREASE PAIN AND FEAR OF FALLING IN OLDER ADULTS
J LaCourse, J Sims, M Bharadwaj, G Ampat
Age and Ageing, Volume 52, Issue Supplement_2, July 2023, afad104.071, https://doi.org/10.1093/ageing/afad104.071

Background
Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability.

Objective
Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad. At baseline and 6-week follow-up, musculoskeletal pain was reported via Numerical Rating Scales (NRS), foot pain and functionality via the Foot Health Status Questionnaire (FHSQ), and fear of falling via the Short Falls Efficacy Scale International.

Results
Both groups reported significant improvements in pain in the back, hips, knees, ankles, and feet using the NRS (P < 0.001). Using the FHSQ, foot pain significantly improved in both the intervention (x-= 18.47 ±20.58, P < 0.001) and control group (x-= 17.21 ±18.74, P < 0.001). Function also improved significantly in both groups (x-= 18.35 ±20.67, P < 0.001 and x- = 15.07 ±20.15, P < 0.001, respectively), as did fear of falling (x-= 1.55 ±3.79, P < 0.001 and x-= 1.23 ±3.53, P < 0.001, respectively). No statistically significant difference was observed between groups for any outcome (P > 0.05).

Conclusion
Aetrex orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.
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