Impacts of different types of insoles on postural stability in older adults

Footwear, Orthoses, and Insoles and Their Effects on Balance in Older Adults: A Scoping Review

BACKGROUND

Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported.

SUMMARY

A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance.

KEY MESSAGES

There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.

Enhancing Footwear Safety for Fall Prevention in Older Adults: A Comprehensive Review of Design Features

BACKGROUND

Falls are a global concern affecting people of all ages; however, older adults are particularly vulnerable to age-related factors and foot-related issues. Footwear is critical for preventing falls, as it provides stability and protection against slips, trips, and falls (STFs). However, a significant gap exists in the systematic exploration of the safety aspects of footwear design for fall prevention in older adults.

METHODS

This comprehensive review applied a meticulous search strategy encompassing prominent databases, including Google Scholar, ScienceDirect, SCOPUS, MEDLINE, ResearchGate, and PubMed. This review synthesized and analyzed existing research to bridge knowledge gaps and provide insights into optimal footwear choices for older adults in terms of design features such as fit, fixation, heel height, collar height, slip resistance, and sole/insole hardness.

RESULTS

The results underscore the importance of specific design features for preventing falls among older adults. A proper fit, secure fixation, appropriate heel and collar heights, slip resistance, and sole/insole hardness significantly contributed to fall prevention. These findings offer valuable guidance for optimizing footwear designs to enhance comfort, stability, and safety in the daily lives of older individuals.

CONCLUSION

This comprehensive review fills a critical knowledge gap regarding the safety of footwear designs for fall prevention in older adults. The identified design features play a vital role in reducing the risk of falls and offer practical recommendations for the development of safer footwear. Ultimately, this study contributes to the existing knowledge base and supports efforts to prevent STFs in older adults through improved footwear design.

A comparison of the efficacy of textured insoles on balance performance in older people with versus without plantar callosities

BACKGROUND

Textured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied.

RESEARCH QUESTION

Firstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group.

METHODS

Thirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions.

RESULTS

Older people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples' feet. The insole-callosity interaction was not significant for any study outcome.

SIGNIFICANCE

Textured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility.

Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review

Patients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.

The effect of age, sex and a firm-textured surface on postural control

In previous studies, the influence of plantar sensation has been examined using various textured surfaces with different stiffness materials to assess static balance. This study investigated the effects of a Firm Textured Surface (FTS) along with age and sex-related influences on postural control under different visual conditions. Forty subjects (20 elderly, 10 males, mean age 68.30, 10 females, mean age 68.00, and 20 young people, 10 males, mean age 25.45, 10 females, mean age 27.30) participated in this study maintained a quiet standing on FTS, foam and firm surfaces with eyes open and closed. The center of pressure displacement (CoP_DISP), CoP velocity (CoP_VEL), and sway velocity of the CoP in anteroposterior (AP) and mediolateral (ML) direction (V_A/P and V_M/L) were measured. FTS was associated with lower postural sway measures in both the groups with eyes open and closed. However, the foam surface showed the worst results in all postural parameters under all experimental conditions. Separate four-way ANOVAs were applied to each dependent variable. The main effects of surface (p < 0.0001), vision (p < 0.0001) and age (p < 0.0001 for CoP_DISP, CoP_VEL and V_A/P; p = 0.0003 for V_M/L) were significant in each of the four fitted models. Sex was never significant, either as a main effect or an interaction with other experimental factors. Eyes open were able to reduce the negative effects of the foam surfaces but without vision the proprioceptive sensory system cues of the body state become more important for maintaining balance. A good stimulation with rigid texture should be considered as relief to reduce the physiological-related decline of afferent information with age.

Can Insoles Be Used to Improve Static and Dynamic Balance of Community-Dwelling Older Adults? A Systematic Review on Recent Advances and Future Perspectives

This systematic review investigated the effects of orthopedic, vibrating, and textured insoles on the postural balance of community-dwelling older adults. Articles published in English from 1999 to 2019 investigating the effects of (a) orthopedic, (b) vibrating, and (c) textured insoles on static and dynamic balance in community-dwelling older adults were considered. Twenty-four trials with a total of 634 older adults were identified. The information gathered generally supported the balance-improving effects of orthopedic, vibrating, and textured insoles in both static and dynamic conditions among community-dwelling older adults. Further examination found that rigidity, texture patterns, vibration thresholds, and components like arch supports and heel cups are important factors in determining whether insoles can improve balance. This review highlights the potential of insoles for improving the static and dynamic balance of community-dwelling older adults. Good knowledge in insole designs and an understanding of medical conditions of older adults are required when attempts are made to improve postural balance using insoles.

Effects of Using Insoles of Different Thicknesses in Older Adults: Which Thickness Has the Best Effect on Postural Stability and Risk of Falling?

BACKGROUND

Postural stability (PS) problems arise as individuals grow older, and as a result, risk of falling (RoF) increases in older adults. We sought to examine the effects of insoles of various thicknesses on PS and RoF in older adults.

METHODS

Fifty-six study participants had PS and RoF evaluated statically and dynamically under five different conditions: barefoot, only-shoes, with 5-mm insoles, with 10-mm insoles, and with 15-mm insoles. Standard shoes with identical features were used. To avoid time-dependent problems, these assessments were performed under the same conditions in 3 consecutive weeks. The average of these three values was recorded.

RESULTS

Insoles of different thicknesses significantly affected static PS (overall: P =.003; mediolateral [ML]: P =.021; anteroposterior [AP]: P =.006), static RoF (overall, ML, and AP: P < .001), dynamic RoF (overall: P = .003; ML: P = .042; AP: P = .050), and dynamic PS (overall: P = .034; AP: P = .041) but not dynamic PS ML (P = .071). For static PS overall, dynamic PS AP, static RoF overall and ML, and dynamic RoF overall and ML, the highest PS scores and the lowest RoF were recorded when using 10-mm insoles (P < .05).

CONCLUSIONS

The use of insoles of different thicknesses has been shown to be effective on all RoF and PS measurements except dynamic PS ML. The 10-mm-thick insole was a better option for elderly individuals to increase PS and reduce RoF compared. For older adults, 10-mm-thick insoles made of medium-density Plastozote may be recommended to help improve PS and reduce RoF.

Effects of Arch Support Insoles on Single- and Dual-Task Gait Performance Among Community-Dwelling Older Adults

Purpose

To explore the immediate and prolonged effects of arch support insoles on single- and dual-task gait performance among community-dwelling older adults.

Methods

Twenty women performed single- and dual-task walking for 10 m at self-selected comfortable and fast paces while performing serial subtractions (cognitive interference) or carrying a tray (motor interference). Spatiotemporal gait parameters were measured and compared with measurements without arch support immediately after the insertion of the insoles and at 1-week follow-up.

Results

Some effects were noted, with small-to-medium effect sizes. During comfortable-paced single-task walking, stride length and walk ratio (step length/cadence) increased after arch support use. During comfortable-paced motor dual-task walking, arch support use increased cadence, stride length, and speed and decreased dual-task costs (DTCs) on cadence and speed. During fast-paced motor dual-task walking, cadence increased and the DTC on cadence decreased after arch support use at the 1-week follow-up. During comfortable-paced cognitive dual-task walking, cadence increased and the walk ratio decreased following arch support use. At the 1-week follow-up, DTCs on cadence reduced, but those on stride length and speed increased. During fast-paced cognitive dual-task walking, the speed and stride length demonstrated immediate decreases followed by increases at the 1-week follow-up.

Conclusion

The study results indicate that the use of arch support improves single- and motor dual-task gait performance, which may contribute to gait and balance training in older adults.

Shape Memory Polyurethane-Based Smart Polymer Substrates for Physiologically Responsive, Dynamic Pressure (Re)Distribution

Shape memory polymers (SMPs) are an exciting class of stimuli-responsive smart materials that demonstrate reactive and reversible changes in mechanical property, usually by switching between different states due to external stimuli. We report on the development of a polyurethane-based SMP foam for effective pressure redistribution that demonstrates controllable changes in dynamic pressure redistribution capability at a low transition temperature (∼24 °C)-ideally suited to matching modulations in body contact pressure for dynamic pressure relief (e.g., for alleviation or pressure ulcer effects). The resultant SMP material has been extensively characterized by a series of tests including stress-strain testing, compression testing, dynamic mechanical analysis, optical microscopy, UV-visible absorbance spectroscopy, variable-temperature areal pressure distribution, Fourier transform infrared spectroscopy, Raman spectroscopy, X-ray diffraction, differential scanning calorimetry, dynamic thermogravimetric analysis, and 1H nuclear magnetic resonance spectroscopy. The foam system exhibits high responsivity when tested for plantar pressure modulation with significant potential in pressure ulcers treatment. Efficient pressure redistribution (∼80% reduction in interface pressure), high stress response (∼30% applied stress is stored in fixity and released on recovery), and excellent deformation recovery (∼100%) are demonstrated in addition to significant cycling ability without performance loss. By providing highly effective pressure redistribution and modulation when in contact with the body's surface, this SMP foam offers novel mechanisms for alleviating the risk of pressure ulcers.

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear

Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.

The effects of textured materials on static balance in healthy young and older adults: A systematic review with meta-analysis

BACKGROUND

Standing on textured materials can improve static balance, potentially by modulating somatosensory inputs from the soles of the feet.

RESEARCH QUESTION

To synthesise and quantify the immediate effects of textured materials on static balance in healthy young and older adults.

METHODS

Primary outcomes were the centre of pressure (COP) displacement and velocity, during eyes open and eyes closed conditions. Ten crossover studies (n = 318, 58% female) met the inclusion criteria. A random effects meta-analysis model derived pooled standardised mean differences (SMD; Hedges g) to quantify the effects of textured materials. Heterogeneity was quantified with the tau-statistic (τ). A 95% prediction interval quantified the likely range of true effects on COP outcomes in similar future studies.

RESULTS

There was a small to moderate beneficial effect for textured materials vs control conditions in: COP displacement during both eyes open (SMD: 0.29; 95% CI -0.06 to 0.64; τ = 0.32) and eyes closed (SMD: 0.75; 95% CI 0.18 to 1.33; τ = 0.55). A trivial to small beneficial effect was observed in COP velocity during eyes open (SMD: 0.14; 95% CI -0.14 to 0.43; τ = 0.18) and eyes closed (SMD: 0.20; 95% CI 0.01 to 0.40; τ = 0.18) for textured materials. The 95% prediction intervals showed texture may not consistently provide beneficial results across studies for all outcomes: COP displacement EC (-0.61 to 2.12), EO (-0.54 to 1.12), COP velocity EC (-0.27 to 0.68) and EO (-0.44 to 0.73).

SIGNIFICANCE

Overall, textured materials improved balance, but these effects were heterogeneous. This research may therefore inform applied investigations into balance improvements for healthy populations, for example, in functional movements and sports.

The effects of textured insoles on quiet standing balance in four stance types with and without vision

Background

Wearing a textured shoe insole can decrease postural sway during static balance. Previous studies assessed bipedal and/or unipedal standing. In contrast, we aimed to investigate if textured insoles modulated postural sway during four stance types (bipedal, standard Romberg, tandem Romberg, and unipedal), with and without vision.

Methods

The repeated measures design involved 28 healthy young adults (13 females; mean age = 26.86 ± 6.6 yrs) performing quiet standing in the four stance types on a force platform, under two different insole conditions (textured insole; TI vs. smooth insole; SI), with eyes open and eyes closed. Postural sway was assessed via the range and standard deviation of the COP excursions in the anterior-posterior and medial-lateral sway, and overall mean velocity.

Results

The main effect of insole type was statistically significant at the alpha p = 0.05 level (p = 0.045). Compared to smooth insoles, textured insoles reduced the standard deviation of anterior-posterior excursions (APSD). While simple main effect analyses revealed this was most pronounced during eyes closed bipedal standing, insole type did not provide a statistically significant interaction with either stance or vision in this measure, or any other. Postural sway showed statistically significant increases across both stance type (bipedal < standard Romberg < tandem Romberg < unipedal), and vision (eyes closed < eyes open), in almost all measures. Stance and vision did have a statistically significant interaction in each measure, reflecting greater postural disturbances with eyes closed when stance stability decreased.

Conclusions

Overall, these results support textured insole use in healthy young adults to reduce postural sway measures. This is because APSD is an index of spatial variability, where a decrease is associated with improved balance and possibly translates to reduced falls risk. Placing a novel texture in the shoe presumably modulated somatosensory inputs. It is important to understand the underlying mechanisms by which textured insoles influence postural sway. As such, utilising a healthy adult group allows us to investigate possible mechanisms of textured insoles. Future research could investigate the potential underlying mechanisms of textured insole effects at a neuromuscular and cortical level, in healthy young adults.

The effect of flat and textured insoles on the balance of primary care elderly people: a randomized controlled clinical trial

BACKGROUND

Aging is associated with reduced postural stability and increased fall risk. Foot orthoses have been reported as an adjuvant intervention to improve balance by stimulating foot plantar mechanical receptors and thus increasing somatosensory input.

PURPOSE

The aim of this study is to evaluate the effect of flat and textured insoles on the balance of primary care elderly people.

DESIGN

Prospective, parallel, randomized, and single-blind trial.

METHODS

A total of 100 subjects from a primary care unit, aged ≥65 years, were randomly assigned to intervention groups with flat insoles (n=33), textured insoles (n=33), or control group (n=34) without insoles. The Berg Balance Scale and the Timed Up and Go test were assessed at baseline and after 4 weeks.

RESULTS

Improvements in the Berg Balance Scale and the Timed Up and Go test were noted only in intervention groups with insoles but not in control group. No significant difference was found between flat and textured insoles. Minor adverse effects were noted only in the group with textured insoles.

CONCLUSION

The results suggest that foot orthoses (both flat and textured insoles) are effective in improving balance in primary care elderly people. They may represent a low-cost and high-availability adjuvant strategy to improve balance and prevent falls in this population.

Textured insoles affect the plantar pressure distribution while elite rowers perform on an indoor rowing machine

INTRODUCTION

During rowing, foot positioning on the foot stretcher is critical to optimise muscle force transmission and boat propulsion. Following the beneficial effects of textured insoles on gait and balance, this study aims at investigating whether passive stimulation of foot mechanoreceptors induced by these insoles may contribute to improving foot loading pattern and symmetry during indoor rowing.

METHODS

Eleven elite rowers were assessed during controlled training on a standard rowing machine while wearing control, low-density or high-density textured insoles. Plantar pressure and knee and trunk kinematics were measured; performance data were recorded from the machine. Insole effect on kinematic parameters, peak and average values of foot force, contact area and position of centre of pressure was assessed with ANOVA and Bonferroni correction for pair-wise comparisons.

RESULTS

A main effect was observed for force and contact area, with the high-density insoles providing greatest values (P<0.035). No interaction was observed between side and insole (P>0.190), even though symmetry was higher with high-density insoles. Kinematics (P = 0.800) and rowing performance were not affected by insole type; a consistent though not statistically significant increase in mean travelled distance was observed for denser insoles (P>0.21).

CONCLUSION

The high-density textured insoles affected foot loading distribution during indoor rowing. Rowers applied greater foot force and over a greater foot stretcher area with the high-density than the low-density and control insoles. These findings and the methodology applied may be relevant for the understanding and monitoring of rowing performance.

Effects of Slipper Features and Properties on Walking and Sit-to-Stand Tasks of Older Women

Indoor slippers with a strap across the dorsal forefoot are popular with older women. However, their influence on the foot motion has not been reported. This study evaluated the range of movement in the knee and ankle joints during walking and changes in trunk displacement during sit-to-stand when 10 healthy older women wore two types of slippers and were barefoot. Compared to barefeet, walking in slippers results in significant increases in the knee flexion angle in the swing phase. However, there is nonsignificant differences in the ankle angle in any phase across all conditions. During the sit-stand transition when slippers are worn, there is a significant reduction in the peak trunk tilt angle and range, as well as the duration of the weight shift when motion is initiated. The findings therefore provide a better understanding of slipper features and designs associated with changes in foot kinematics in older women.

How Arch Support Insoles Help Persons with Flatfoot on Uphill and Downhill Walking

The main purpose of this study was to investigate the effect of arch support insoles on uphill and downhill walking of persons with flatfoot. Sixteen healthy college students with flatfoot were recruited in this study. Their heart rate, peak oxygen uptake (VO₂), and median frequency (MDF) of surface electromyogram were recorded and analyzed. Nonparametric Wilcoxon signed-rank test was used for statistical analysis. The main results were as follows: (a) peak VO₂ significantly decreased with arch support insoles compared with flat insoles during uphill and downhill walking (arch support insole versus flat insole: uphill walking, 20.7 ± 3.6 versus 31.6 ± 5.5; downhill walking, 10.9 ± 2.3 versus 16.9 ± 4.2); (b) arch support insoles could reduce the fatigue of the rectus femoris muscle during downhill walking (MDF slope of arch support insole: 0.03 ± 1.17, flat insole: −6.56 ± 23.07); (c) insole hardness would increase not only the physical sensory input but also the fatigue of lower-limb muscles particularly for the rectus femoris muscle (MDF slope of arch support insole: −1.90 ± 1.60, flat insole: −0.83 ± 1.10) in persons with flatfoot during uphill walking. The research results show that arch support insoles could effectively be applied to persons with flatfoot to aid them during uphill and downhill walking.

Effects of different lower-limb sensory stimulation strategies on postural regulation-A systematic review and meta-analysis

Systematic reviews of balance control have tended to only focus on the effects of single lower-limb stimulation strategies, and a current limitation is the lack of comparison between different relevant stimulation strategies. The aim of this systematic review and meta-analysis was to examine evidence of effects of different lower-limb sensory stimulation strategies on postural regulation and stability. Moderate- to high- pooled effect sizes (Unbiased (Hedges’ g) standardized mean differences (SMD) = 0.31–0.66) were observed with the addition of noise in a Stochastic Resonance Stimulation Strategy (SRSS), in three populations (i.e., healthy young adults, older adults, and individuals with lower-limb injuries), and under different task constraints (i.e., unipedal, bipedal, and eyes open). A Textured Material Stimulation Strategy (TMSS) enhanced postural control in the most challenging condition—eyes-closed on a stable surface (SMD = 0.61), and in older adults (SMD = 0.30). The Wearable Garments Stimulation Strategy (WGSS) showed no or adverse effects (SMD = -0.68–0.05) under all task constraints and in all populations, except in individuals with lower-limb injuries (SMD = 0.20). Results of our systematic review and meta-analysis revealed that future research could consider combining two or more stimulation strategies in intervention treatments for postural regulation and balance problems, depending on individual needs.

Should Ballet Dancers Vary Postures and Underfoot Surfaces When Practicing Postural Balance?

BACKGROUND

Postural balance (PB) is an important component skill for professional dancers. However, the effects of different types of postures and different underfoot surfaces on PB have not adequately been addressed.

PURPOSE

The main aim of this study was to investigate the effect of different conditions of footwear, surfaces, and standing positions on static and dynamic PB ability of young ballet dancers.

METHODS

A total of 36 male and female young professional ballet dancers (aged 14-19 years) completed static and dynamic balance testing, measured by head and lumbar accelerometers, while standing on one leg in the turnout position, under six different conditions: (1) "relaxed" posture; (2) "ballet" posture; (3) barefoot; (4) ballet shoes with textured insoles; (5) barefoot on a textured mat; and (6) barefoot on a spiky mat.

RESULTS

A condition effect was found for static and dynamic PB. Static PB was reduced when dancers stood in the ballet posture compared with standing in the relaxed posture and when standing on a textured mat and on a spiky mat (p < .05), and static PB in the relaxed posture was significantly better than PB in all the other five conditions tested. Dynamic PB was significantly better while standing in ballet shoes with textured insoles and when standing on a spiky mat compared with all other conditions (p < .05).

CONCLUSIONS

The practical implications derived from this study are that both male and female dancers should try to be relaxed in their postural muscles when practicing a ballet aligned position, including dance practice on different types of floors and on different types of textured/spiky materials may result in skill transfer to practice on normal floor surfaces, and both static and dynamic PB exercises should be assessed and generalized into practical dance routines.

Effects of indoor slippers on plantar pressure and lower limb EMG activity in older women

Open-toe mule slippers are popular footwear worn at home especially by older women. However, their biomechanical effects are still poorly understood. The objective of this study is to therefore evaluate the physical properties of two typical types of open-toe mule slippers and the changes in plantar pressure and lower limb muscle activity of older women when wearing these slippers. Five walking trials have been carried out by ten healthy women. The results indicate that compared to barefoot, wearing slippers results in significant increases in the contact area of the mid-foot regions which lead to plantar pressure redistribution from metatarsal heads 2-3 and the lateral heel to the midfoot regions. However, there is no significant difference in the selected muscle activity across all conditions. The findings enhance our understanding of slipper features associated with changes in biomechanical measures thereby providing the basis of slipper designs for better foot protection and comfort.

Effects of insoles contact on static balance

[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.

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

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.