The effect of compression and combined compression-tactile stimulation on lower limb somatosensory acuity

Background

Lower limb somatosensation and proprioception are important for maintaining balance. Research has shown that compression garments or exposure to textured surfaces, can enhance somatosensation however, little is known about the effect of combined compression and texture on somatosensory acuity in the lower limb. This study aimed to assess the effects of combined compression socks with a plantar textured sole, on lower limb somatosensory acuity.

Methods

Thirty participants completed a somatosensory acuity task (active movement extent discrimination apparatus; AMEDA) under three conditions: barefoot (control condition), standard knee-high compression sock (compression sock), and knee-high compression sock with internal rubber nodules situated on the sole (textured-compression sock). Somatosensory acuity was assessed between the different sock conditions for the (i) entire group, (ii) high performers, and (iii) low performers. It was hypothesized that low performers would see gains wearing either sock, but the greatest improvement would be in the textured-compression sock condition.

Results

AMEDA scores were not significantly different between conditions when the entire group was analyzed (p = 0.078). The low performers showed an improvement in somatosensory acuity when wearing the compression sock (p = 0.037) and the textured compression sock (p = 0.024), when compared to barefoot, but there was no difference between the two sock conditions (p > 0.05). The high performers did not show any improvement (p > 0.05 for all).

Conclusion

These findings demonstrate that additional sensory feedback may be beneficial to individuals with lower baseline somatosensory acuity but is unlikely to provide benefit for those with higher somatosensory acuity.

Influence of Footwear on Posture and Comfort in Elite Rugby Players

Influence of footwear on posture in athletes is poorly documented despite its potential impact on biomechanics and injury risk. The aim of this study was to investigate effects of different footwear geometries on comfort and posture on a cohort of 48 elite rugby players. Spine posture was characterized by photogrammetry, while center of pressure was measured by means of a force platform. Three different footwear outsoles architectures (one rugby shoe with flat outsole, one rugby shoe with a 10 mm heel rise and foot arch support, and a running shoe with a 10mm heel rise and foot arch support) were compared to non-shod in randomized order. Then comfort felt at the level of foot and spine was also estimated by subjective questionnaires. Compared to the flat rugby model, both other models induced significantly (p<0.05) greater comfort at the level of foot and spine, a slight shift toward of center of pressure and a spinal posture closer to that observed when non-shod. The footwear geometry influences comfort and posture at the level of the foot as well as spine and should be considered in a dual purpose of injury prevention and performance.

Using the Active Movement Extent Discrimination Apparatus to Test Individual Proprioception Acuity: Implications for Test Design

The Active Movement Extent Discrimination Apparatus (AMEDA) has been used for measuring proprioception at various joints in the body for more than two decades. The utility of this instrument for discriminating groups has been reported in terms of an area under the curve (AUC) derived from an absolute identification test. This metric has supported statistically significant group differences, but it is not clear whether the AMEDA's testing protocol is suitable for measuring individual proprioception acuity changes. This study aimed to test the reliability, variance and absolute AUC scores obtained with the AMEDA with reference to other studies that have tested absolute identification acuity in other domains and the theoretical underpinnings of the testing protocol. We re-analyzed raw data from a 2013 study involving 65 people, most of whom were tested three times over two separate sessions on the ankle AMEDA by now assessing the accuracy of individual responses and calculating the sensitivity index, d', in addition to the AUC. To assess reliability, we calculated the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for those who completed all three tests. Fewer than 50% of presented stimuli were accurately identified and relatively poor discrimination was achieved between adjacent stimuli (in only one case was the median d' value greater than 1). The ICC of AUC scores across the three tests was poor (0.47). The SEM was 0.04, while 90% of participants' AUC scores fell between 0.59 and 0.76. The variation in performance at the individual level was substantial, producing a large SEM relative to the population spread of scores. We considered potential theoretical factors that may be affecting these results and concluded that an alternative approach will be needed in order for the apparatus to be used to explore individual proprioceptive performance.

Ipsilateral vs Contralateral Presentation of Familiarization Trials in a Lower-Limb Proprioception Test

We examined the effect of pretest familiarization with ipsilateral or contralateral limbs on the performance in a proprioception test conducted afterwards. Sixty adults were randomly assigned to six different familiarization-session patterns. Ankle proprioception was tested using active movement extent discrimination assessment. The results reflected a beneficial effect of familiarization session on performance in the subsequent proprioception test (ES = 0.777). However, no significant difference was found between proprioceptive acuity scores when familiarization and test happened with either ipsilateral or contralateral limbs (ES= 0.361), or between the tested left and right foot no matter which side was familiarized (ES = 0.343). These results suggest that proprioceptive information from the familiarization session facilitates the subsequent proprioception test and is equally available to both hemispheres without loss of quality.

Proprioceptive abilities improve in expert skiers and snowboarders from early-season to mid-season

OBJECTIVES

To determine whether the proprioceptive ability of advanced and expert snowsport participants increased with time on-snow, and whether gender, age, snowsport discipline and/or previous ankle injury were factors in proprioceptive ability at the start of the winter snow season (T1, n=80) compared to mid- season (T2, n=39).

DESIGN

Observational study METHOD: Participants completed a questionnaire at T1, and proprioception was measured at T1 and T2 by the Active Movement Extent Discrimination Apparatus (AMEDA), which tests lower limb proprioception.

RESULTS

At T1 there was no significant difference between the proprioception scores of the two cohorts of advanced and expert snowsport participants, between females and males, younger and older age groups, nor between alpine skiers and snowboarders. At T2, after a minimum of 5 weeks on-snow, the whole group had improved their proprioception by 0.04 (p<.0001) as measured by the AMEDA. Groups undertaking different snowsport disciplines achieved different gains across the season, with minimal change of 0.02 in skiers (p=.056), while snowboarders and mixed ski/snowboard participants gained 0.05 (p=.034) and 0.06 (p=.005) (η² 0.63 and 0.47 respectively). Males, females, instructors and elite youth participants all improved their proprioception by mid-season (η² 0.29-0.46).

CONCLUSIONS

Amongst an established group of snowsports participants, lower limb proprioception is a consistent skill that is equally well developed in all cohorts. Several weeks of regular snowsport exposure improves this proprioceptive acuity amongst snowboarders, and those who mix snowboarding with skiing. Exposure to a prolonged period of snowsport improves proprioception, with benefits to neuromuscular control mechanisms.

Comparison of the effect of foot orthoses on Star Excursion Balance Test performance in patients with chronic ankle instability

BACKGROUND:

Chronic ankle instability as a prevalent consequence of ankle sprain causes various impairments such as balance and postural control deficits. Foot orthoses are one of the common interventions for rehabilitation of patients with chronic ankle instability.

OBJECTIVES:

To investigate the effect of custom-molded foot orthoses with textured surfaces on dynamic balance of chronic ankle instability patients and to compare their effects with other types of foot orthoses.

STUDY DESIGN:

This is a repeated measure design.

METHODS:

A total of 30 participants were recruited based on the guideline introduced by the International Ankle Consortium. The effect of prefabricated, custom-molded, and custom-molded with textured surface foot orthoses was evaluated on dynamic balance by the Star Excursion Balance Test. Normalized reach distances in anteromedial, medial, and posteromedial directions of the test were computed to be used for statistical analysis.

RESULTS:

The foot orthoses increased reach distances compared to the no-orthosis conditions in all three directions. The custom-molded with textured surface foot orthosis has significant differences compared with prefabricated foot orthosis ( p = 0.001) in all measured directions and with custom-molded foot orthosis ( p < 0.01) in medial and posteromedial directions.

CONCLUSION:

Foot orthoses improve reach distances in patients with chronic ankle instability. Custom-molded with textured surface foot orthosis has a more pronounced effect compared with other foot orthoses.

CLINICAL RELEVANCE

The custom-molded foot orthosis with textured surface could be an effective device to improve dynamic balance in chronic ankle instability (CAI) patients. It may be considered as an efficient intervention to reduce ankle sprain recurrence in these individuals, although further research should be conducted.

Snowsport experience, expertise, lower limb injury and somatosensory ability

OBJECTIVES

Previous research demonstrates that a history of ankle injuries increases the risk of overall future injuries, and that somatosensory scores are correlated to sport performance. This research explores the relationship between lower limb somatosensory scores in snowsport participants and ankle injury history; and the relationship between lower limb somatosensory scores and Instructor qualification.

DESIGN AND METHODS

Experienced snowsport participants who were recruited through a western Canadian snowsport school completed a questionnaire that included their ankle injury history, the Identification of Functional Ankle Instability (idFAI), the Cumberland Ankle Instability Tool (CAIT), and their current instructor qualification level, as a proxy for sport performance. Lower limb somatosensory was assessed using the active movement extent discrimination assessment (AMEDA) method.

RESULTS

Of the 75 participants, 55% reported at least one previous ankle injury. An independent sample t-test did not show any significant difference in somatosensory scores of those with an ankle injury history (x¯=.66, SD=.05) or not (x¯=.66, SD=.05). Nor was there any difference between those with a functionally unstable ankle (i.e. CAIT<24 and idFAI>11) and all others [x¯=.66, SD=.04 cf. x¯=.66, SD=.05; t(67)=.54, p=.78]. An ANOVA exploring the relationship between Instructor Qualification and somatosensory scores was significant at p<.05 [F(4, 68)=4.0, p=.006].

CONCLUSIONS

The results did not reveal any significant difference in perceived functional instability and somatosensory scores, which contrasts with previous research. The sport performance finding is consistent with previous work examining the relationship between somatosensory scores and sport performances. Further research is needed to explore if the dynamic snowsport working environment impacts ankle instability and somatosensory scores.

A balance and proprioception intervention programme to enhance combat performance in military personnel

BACKGROUND

Optimal functioning of the lower extremities under repeated movements on unstable surfaces is essential for military effectiveness. Intervention training to promote proprioceptive ability should be considered in order to limit the risk for musculoskeletal injuries. The aim of this study was to assess the effect of a proprioceptive intervention programme on static and dynamic postural balance among Israel Defense Forces combat soldiers.

METHODS

Twenty-seven male soldiers, aged 18-20 years, from a physical fitness instructor's course, were randomly divided into two groups matched by age and army unit. The intervention group (INT) underwent 4 weeks of proprioceptive exercises for 10 min daily; the control group underwent 4 weeks of upper body stretching exercises for 10 min daily. All participants were tested pre and postintervention for both static and dynamic postural balance.

RESULTS

Significant interaction (condition*pre-post-test*group) was found for static postural balance, indicating that for the INT group, in condition 3 (on an unstable surface-BOSU), the post-test result was significantly better compared with the pretest result (p<0.05). Following intervention, the INT group showed significant correlations between static postural stability in condition 2 (eyes closed) and the dynamic postural stability (length of time walked on the beam following fatigue) (r ranged from 0.647 to 0.822; p<0.05).

CONCLUSIONS

The proprioceptive intervention programme for combat soldiers improved static postural balance on unstable surfaces, and improved the correlation between static postural balance in the eyes closed condition and dynamic postural balance following fatigue. Further longitudinal studies are needed to verify the relationship between proprioception programmes, additional weight bearing and the reduction of subsequent injuries in combat soldiers.

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.

Compression and texture in socks enhance football kicking performance

The purpose of this study was to observe effects of wearing textured insoles and clinical compression socks on organisation of lower limb interceptive actions in developing athletes of different skill levels in association football. Six advanced learners and six completely novice football players (15.4±0.9years) performed 20 instep kicks with maximum velocity, in four randomly organised insoles and socks conditions, (a) Smooth Socks with Smooth Insoles (SSSI); (b) Smooth Socks with Textured Insoles (SSTI); (c) Compression Socks with Smooth Insoles (CSSI) and (d), Compression Socks with Textured Insoles (CSTI). Reflective markers were placed on key anatomical locations and the ball to facilitate three-dimensional (3D) movement recording and analysis. Data on 3D kinematic variables and initial ball velocity were analysed using one-way mixed model ANOVAs. Results revealed that wearing textured and compression materials enhanced performance in key variables, such as the maximum velocity of the instep kick and increased initial ball velocity, among advanced learners compared to the use of non-textured and compression materials. Adding texture to football boot insoles appeared to interact with compression materials to improve kicking performance, captured by these important measures. This improvement in kicking performance is likely to have occurred through enhanced somatosensory system feedback utilised for foot placement and movement organisation of the lower limbs. Data suggested that advanced learners were better at harnessing the augmented feedback information from compression and texture to regulate emerging movement patterns compared to novices.

The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury

Balance control improvement is one of the most important goals in sports and exercise. Better balance is strongly positively associated with enhanced athletic performance and negatively associated with lower limb sports injuries. Proprioception plays an essential role in balance control, and ankle proprioception is arguably the most important. This paper reviews ankle proprioception and explores synergies with balance control, specifically in a sporting context. Central processing of ankle proprioceptive information, along with other sensory information, enables integration for balance control. When assessing ankle proprioception, the most generalizable findings arise from methods that are ecologically valid, allow proprioceptive signals to be integrated with general vision in the central nervous system, and reflect the signal-in-noise nature of central processing. Ankle proprioceptive intervention concepts driven by such a central processing theory are further proposed and discussed for the improvement of balance control in sport.

The effect of textured ballet shoe insoles on ankle proprioception in dancers

BACKGROUND

Impaired ankle inversion movement discrimination (AIMD) can lead to ankle sprain injuries. The aim of this study was to explore whether wearing textured insoles improved AIMD compared with barefoot, ballet shoes and smooth insoles, among dancers.

METHODS

Forty-four adolescent male and female dancers, aged 13-19, from The Australian Ballet School were tested for AIMD while barefoot, wearing ballet shoes, smooth insoles, and textured insoles.

RESULTS

No interaction was found between the four different footwear conditions, the two genders, or the two levels of dancers in AIMD (p > .05). An interaction was found between the four different footwear conditions and the three tertiles when tested in ballet shoes (p = .006). Although significant differences were found between the upper tertiles and the lower tertiles when tested with ballet shoes, barefoot and with smooth insoles (p < .001; p < .001; p = .047, respectively), when testing with textured insoles dancers in the lower tertile obtained similar scores to those obtained by dancers in the upper tertile (p = .911).

CONCLUSION

Textured insoles improved the discrimination scores of dancers with low AIMD, suggesting that textured insoles may trigger the cutaneous receptors in the plantar surface, increasing the awareness of ankle positioning, which in turn might decrease the chance of ankle injury.

Chronic ankle instability affects learning rate during repeated proprioception testing

OBJECTIVES

1. To determine whether individuals with chronic ankle instability (CAI) have lower proprioception sensitivity scores from a test on the Active Movement Extent Discrimination Apparatus (AMEDA). 2. To determine whether individuals with CAI can improve proprioception sensitivity scores with repeated active movement testing using the AMEDA. 3. To assess the test-retest reliability of the AMEDA.

DESIGN

A cohort study comparing those with CAI or healthy ankles.

SETTING

University clinical laboratory.

PARTICIPANTS

61 healthy university students, 36 with CAI, 25 with stable ankles.

MAIN OUTCOME MEASURES

A 2-way ANOVA was conducted to compare performance of CAI and stable ankle groups, over 3 test repetitions on the AMEDA. The reliability intra-class correlation coefficient (ICC) was obtained for test repetitions.

RESULTS

The scores improved in both groups when the AMEDA test was repeated (p = <0.001). The rates of improvement in proprioception test scores differed, with the CAI group showing a slower learning rate than the stable ankle group (p = 0.047). The ICC for the whole group across the three trials was 0.80 (95% CI = 0.69 to 0.87, p = <0.001).

CONCLUSIONS

CAI participants improve their proprioception scores more slowly upon repeated AMEDA testing, suggesting differences in learning strategies.

The role of textured material in supporting perceptual-motor functions

Simple deformation of the skin surface with textured materials can improve human perceptual-motor performance. The implications of these findings are inexpensive, adaptable and easily integrated clothing, equipment and tools for improving perceptual-motor functionality. However, some clarification is needed because mixed results have been reported in the literature, highlighting positive, absent and/or negative effects of added texture on measures of perceptual-motor performance. Therefore the aim of this study was to evaluate the efficacy of textured materials for enhancing perceptual-motor functionality. The systematic review uncovered two variables suitable for sub-group analysis within and between studies: participant age (groupings were 18–51 years and 64.7–79.4 years) and experimental task (upright balance and walking). Evaluation of studies that observed texture effects during upright balance tasks, uncovered two additional candidate sub-groups for future work: vision (eyes open and eyes closed) and stability (stable and unstable). Meta-analysis (random effects) revealed that young participants improve performance by a small to moderate amount in upright balance tasks with added texture (SMD = 0.28, 95%CI = 0.46–0.09, Z = 2.99, P = 0.001; Tau² = 0.02; Chi² = 9.87, df = 6, P = 0.13; I² = 39.22). Significant heterogeneity was found in, the overall effect of texture: Tau² = 0.13; Chi² = 130.71, df = 26, P<0.0001; I² = 85.98%, pooled samples in upright balance tasks: Tau² = 0.09; Chi² = 101.57, df = 13, P<0.001; I² = 72.67%, and in elderly in upright balance tasks: Tau² = 0.16; Chi² = 39.42, df = 5, P<0.001; I² = 83.05%. No effect was shown for walking tasks: Tau² = 0.00; Chi² = 3.45, df = 4, P = 0.27, I² = 22.99%. Data provides unequivocal support for utilizing textured materials in young healthy populations for improving perceptual-motor performance. Future research is needed in young healthy populations under conditions where visual and proprioceptive information is challenged, as in high-speed movements, or where use of equipment mediates the performer-environment interaction or where dysfunctional information sources ‘compete’ for attention. In elderly and ailing populations data suggests further research is required to better understand contexts where texture can facilitate improved perceptual-motor performance.

Impact of soft and hard insole density on postural stability in older adults

A significant predictor of falls in the elderly population is attributed to postural instability. Thus, it is important to identify and implement practical clinical interventions to enhance postural stability in older adults. Shoe insoles have been identified as a mechanism to enhance postural control, and our study aimed to evaluate the impact of 2 shoe insoles on static standing balance in healthy, older adults compared with standing posture while barefoot. We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition. Indeed, excursion distances and sway areas were reduced, and sway velocity was decreased when wearing insoles. The hard insole was also effective when visual feedback was removed, suggesting that the more rigid an insole, the greater potential reduction in fall risk. Thus, shoe insoles may be a cost-effective, clinical intervention that is easy to implement to reduce the risk of falling in the elderly population.

The influence of shoe sole's varying thickness on lower limb muscle activity

BACKGROUND

The lateral ligament injury of the ankle is acknowledged to be the most common ankle injury sustained in sport. Increased peroneus longus muscle contraction in the shod population has already been documented. This study aimed to quantify the effect of shoe sole's varying thickness on peroneus longus muscle activity.

METHODS

Electromyographic recordings of the peroneus longus muscle activity following unanticipated inversion of the foot from 0° to 20° in a two-footplate tilting platform were collected from 38 healthy participants. The four test conditions were: barefoot, standard shoe, and shoes with 2.5 cm and 5 cm sole adaptation respectively.

RESULTS

Compared to the barefoot condition, there is an increase in the magnitude of muscle contraction on wearing shoes, which further increases with thickening shoe soles. The peroneus longus was responding earlier in the shod conditions when compared to the barefoot, although the results were variable within the three shod conditions.

CONCLUSION

Footwear with increasing shoe sole thickness evokes a correspondingly stronger protective eversion response from the peroneus longus to counter the increasing moment at the ankle-subtalar joint complex following sudden foot inversion. Hence, fashion footwear with thicker sole is likely to increase the risk of lateral ligament injury of the ankle when such protective response is overwhelmed. Similarly, the clinicians need to be cautious regarding the amount of shoe raise that they could provide for patients with limb length discrepancy without any detrimental untoward side effects.

The effects of enhanced plantar sensory feedback and foot orthoses on midfoot kinematics and lower leg neuromuscular activation

Excessive foot pronation has been associated with injuries of the lower extremity. No research has investigated the effect of enhancing plantar sensory feedback on foot pronation. The aim of this study was to determine whether a shoe with enhanced plantar sensory feedback reduces midfoot pronation. Midfoot kinematics and electromyography of the peroneus longus, tibialis anterior and medial gastrocnemius of 21 males (age: 21.0±4.0 years, height: 176.8±5.0 cm, mass: 73.3±6.5 kg) were recorded whilst walking in a neutral shoe, a neutral shoe with a prefabricated foot orthotic and a neutral shoe with nodules located on the plantar-medial insole (experimental shoe). Friedman's ANOVA and Wilcoxon tests were used to evaluate differences between shoe conditions. Mean midfoot-tibia angles during ground contact were significantly more supinated when wearing the experimental shoe (+7.14°, p=0.023) or orthotic (+3.83°, p=0.006) compared to the neutral shoe. During the loading phase, midfoot angles were significantly more supinated when wearing the experimental shoe compared to the orthotic (+5.53°, p=0.008) or neutral shoe (+6.20°, p=0.008). In the midstance phase, midfoot supination was significantly higher in the orthotic compared to the neutral shoe (+2.79°, p=0.006). Finally, supination was increased during the propulsive phase when wearing the experimental shoe compared to the orthotic (+7.43°, p=0.010) or neutral shoe (+10.83°, p=0.009). No significant (p<0.05) differences in muscle activation were observed. These results suggest that increasing plantar sensory feedback to the medial aspect of the foot reduces midfoot pronation during an acute bout of walking. Further work is needed to explore whether these effects remain over longer time periods.

The effect of varying footwear configurations on the peroneus longus muscle function following inversion

BACKGROUND

The ankle is one of the most commonly injured joints with inversion injury affecting its lateral ligament complex being the commonest of all. Shoes are one of the known risk factors for such an injury.

OBJECTIVE

This study seeks to examine the impact of varying shoe configurations on the protective function of the peroneus longus muscle during unanticipated foot inversion.

METHODS

The peak amplitude, latency and post-peak average amplitude of the ipsilateral peroneus longus muscle were recorded by surface electromyography following unanticipated inversion of the feet of 35 subjects in a two-footplate tilting platform from 0° to 20°. The test conditions were barefoot, standard training shoe, shoe with a sole flare, and an above the ankle laced boot.

RESULTS

Analysis revealed significant differences in peak muscle contraction between shod and unshod conditions. The standard shoe and the flared sole design showed greater statistically significant differences from the unshod condition, than the boot. The muscle was responding earlier in the shod conditions compared to the barefoot. The post-peak average amplitude with the standard shoe and the flared sole shoe were significantly different from the barefoot condition.

CONCLUSION

Albeit no marked differences could be demonstrated between the tested shoes, the inherent construct of the laced boot probably attempts to protect the ankle-subtalar joint complex evidenced by evoking a less strong peroneus longus muscle's protective response.

Effect of textured foot orthotics on static and dynamic postural stability in middle-aged females

Foot orthotics (FO) may be prescribed for a range of lower limb and foot conditions. Prior studies report use of FO in enhancing postural stability in healthy younger adults, and do not control for footwear type. Currently, interest in the effects of FO on postural stability in older adults has increased. Limited reports exist of the effects on postural stability of FO made of combinations of materials, thicknesses and surface textures. In this study 40 healthy females (51.1+/-5.8 years) recruited into a within subject test-retest randomised clinical trial were provided with identical footwear and randomised into four FO conditions (control, grid, dimple and plain, n=10 for each condition). Participants wore the footwear for 4 weeks, a minimum of 6h/day. A Kistler force plate was used to determine postural stability variables (anterior-posterior displacements and medial-lateral displacements) for each participant in a static position, with eyes open and eyes closed. Base of support was evaluated using the GAITRite system. Each outcome measure was measured at baseline and 4 weeks. Postural stability variables demonstrated no significant differences between the four FO conditions. No significant differences were observed with base of support between the four conditions. We have demonstrated no detrimental effects on postural stability in older females after 4 weeks. This is regardless of orthotic texture and is independent of footwear. Biomechanical or sensory effects of FO on postural stability are still to be determined. These may be dependent on the geometry and texture of the orthotic.

The Effect of a 5-Week Wobble-Board Exercise Intervention on Ability to Discriminate Different Degrees of Ankle Inversion, Barefoot and Wearing Shoes: A Study in Healthy Elderly

OBJECTIVES

There is some evidence of an improvement in falls risk in the elderly after completing a wobble-board training program. This study examined the effects of wobble-board training on ability to discriminate between different extents of ankle inversion movements in a group of older subjects, tested wearing shoes and barefoot.

DESIGN

A randomized, controlled, crossover pilot study.

SETTING

Canberra region, Australia.

PARTICIPANTS

Twenty community-dwelling subjects aged 65 to 85 participated in this study; all were in good health with no known disorder of the musculoskeletal system.

MEASUREMENTS

The accuracy with which subjects could identify a set of ankle inversion movements of different extents was measured, with testing conducted in an upright, weightbearing stance.

INTERVENTION

The effects of a 5-week training program using a wobble board modified for data logging or a period of normal activity only were assessed. Subjects underwent an ankle movement discrimination test pre- and posttraining, with shoes on and off.

RESULTS

Greater improvement in ankle movement discrimination capability was made in subjects who underwent wobble-board training than in subjects who did not train (F(1,18)=11.2, P=.003). Active movements at the ankle were also significantly better discriminated throughout when subjects were wearing shoes than when barefoot (F(1,18)=40.6, P=.001).

CONCLUSION

Training with a wobble board provides a simple in-home intervention that improves ability to differentiate between extent of movements into ankle inversion in subjects aged 65 and older. Research on trip and fall frequency after wobble-board use is needed before such training could be widely used.