The effect of 6 weeks of custom-molded foot orthosis intervention on postural stability in participants with >or=7 degrees of forefoot varus

The Impact of a Foot-Toe Orthosis on Dynamic Balance: An Exploratory Randomized Control Trial

CONTEXT

The influence of custom and over-the-counter foot orthoses on dynamic balance has been investigated in the past. However, there has not been an exploration of the use of a foot-toe orthosis for improving balance. The ability of clinicians to influence balance could have important implications for injury prevention and rehabilitation.

OBJECTIVE

To determine the impact of a foot-toe orthosis on dynamic balance in healthy, young adults.

DESIGN

Randomized control trial.

SETTING

Athletic training laboratory.

PARTICIPANTS

In total, 64 healthy, recreationally active participants aged 18-29 years were randomly allocated to one of the following groups: the foot-toe orthosis and laboratory-issued shoe group, the laboratory-issued shoe only (SO) group, or the control group.

INTERVENTIONS

Subjects in the intervention group wore the foot-toe orthosis and laboratory-issued shoe with activities of daily living for 4 weeks. Subjects in the SO intervention group wore the laboratory-issued shoe with activities of daily living for 4 weeks. Participants in the control group did not receive any intervention.

MAIN OUTCOME MEASURES

The instrumented version of the Star Excursion Balance Test, known as the Lower Quarter Y-Balance Test, was used to quantify the dynamic balance at baseline and follow-up. Reaches were normalized for leg length.

RESULTS

There were statistically significant differences in postintervention scores on the Lower Quarter Y-Balance Test for both the dominant (P = .03, effect size = 0.84; 95% confidence interval, 0.25 to 1.43) and nondominant (P = .002, effect size = 0.74; 95% confidence interval, 0.15 to 1.32) legs when comparing dynamic balance scores of the foot-toe orthosis and laboratory-issued shoe group with the SO and control groups. No significant differences were observed when comparing dynamic balance between the SO and control groups.

CONCLUSIONS

A 4-week intervention with a foot-toe orthosis and laboratory-issued shoe resulted in improved dynamic balance in a healthy young adult population. These findings suggest a novel intervention for increasing balance.

Effect of 4 Weeks of Foot Orthosis Intervention on Ambulatory Capacities and Posture in Normal-Weight and Obese Patients

BACKGROUND

Several works have shown the benefits of foot orthosis intervention on postural stability in healthy individuals and patients with foot malalignment. However, the effects of foot orthoses on the daily ambulatory activities explored by the Six-Minute Walk Test (6MWT) were never examined. We hypothesized that foot orthoses could increase the gait distance and attenuate the post-6MWT posture alterations already reported in healthy individuals.

METHODS

In ten normal-weight (NW) and ten obese patients with foot malalignment and/or abnormal foot arch, we examined the benefits of 4 weeks of custom-molded orthosis intervention (D30) on 6MWT gait distance, fatigue sensation scores, ankle plantarflexion force, and post-6MWT sway of the center of pressure (COP) measured by a pedobarographic platform. Data were compared with those measured in two control-matched groups of ten NW and ten obese individuals, explored at study inclusion and at D30.

RESULTS

At study inclusion, the post-6MWT changes in COP surface and the medial and lateral COP deviations were significantly higher in obese participants who needed to wear the foot orthoses compared with obese control subjects. The foot orthosis intervention significantly improved the ambulatory performances of NW and obese individuals during the 6MWT, attenuated the bodily fatigue sensation after the 6MWT, and reduced the post-6MWT COP deviations, with the benefits of insoles being significantly accentuated in obese participants.

CONCLUSIONS

Four weeks of foot orthosis intervention significantly increases gait distance and is an effective means to reduce postural sway after walking.

INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder.

A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text].

There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole.

Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.

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.

Comparing the immediate effects of UCBL and modified foot orthoses on postural sway in people with flexible flatfoot

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.

Evaluation of standing stability in individuals with flatfeet

OBJECTIVE

Flatfoot is one of the most common foot disorders, which not only influences the performance of the foot but also affects the alignments of the ankle, knee, and hip joints. The performance of the flat-arched individuals differs from that of normal individuals during walking. However, there is not enough information in the literature regarding their standing stability. Moreover, the influence of use of foot insole on standing stability has not been evaluated. Therefore, the aim of this study was to evaluate standing stability in individuals with flatfoot with and without insole.

METHODS

Two groups of normal and flat-arched individuals were recruited into this study. A Kistler force plate was used to measure the center of pressure (CoP), which is recognized as a good approximation of sway of center of gravity in a horizontal plane. Stability was determined by calculating the CoP excursions, path length, and velocity in the mediolateral and anteroposterior directions. The difference between stability in normal individuals and those with flatfoot was examined using the independent t test. The paired t test was used to determine the difference between stability in each group with and without insole. Significant P value was set at α ≤.05.

RESULTS

There was a significant difference between stability of flat-arched and normal individuals based on CoP velocity and total velocity. In addition, there was no direct correlation between the severity of flatfoot and instability during quiet standing. However, the mean values of CoP total velocity during standing with and without insole were significantly different (P < .001).

CONCLUSION

This study suggests that individuals with flatfoot are more unstable when compared with normal individuals during quiet standing. It seems that the foot insole improves the alignment of foot structure and reduces the forces applied on the ligament, thus, improving standing stability. Therefore, stability assessment in patients with flatfoot may be important, and the insole is a useful modality that can be used to improve stability in this patient group.

LEVELS OF EVIDENCE

Therapeutic, Level II: Prospective, comparative trial.

Foot orthoses for adults with flexible pes planus: a systematic review

BACKGROUND

Foot orthoses are widely used in the management of flexible pes planus, yet the evidence to support this intervention has not been clearly defined. This systematic review aimed to critically appraise the evidence for the use of foot orthoses for flexible pes planus in adults.

METHODS

Electronic databases (Medline, CINAHL, Cochrane, Web of science, SportDiscus, Embase) were systematically searched in June 2013 for randomised controlled, controlled clinical and repeated measure trials where participants had identified flexible pes planus using a validated and reliable measure of pes planus and the intervention was a rigid or semi-rigid orthoses with the comparison being a no-orthoses (shoes alone or flat non-posted insert) condition. Outcomes of interest were foot pain, rearfoot kinematics, foot kinetics and physical function.

RESULTS

Of the 2,211 articles identified by the searches, 13 studies met the inclusion criteria; two were randomised controlled trials, one was a controlled trial and 10 were repeated measure studies. Across the included studies, 59 relevant outcome measures were reported with 17 calculated as statistically significant large or medium effects observed with use of foot orthoses compared to the no orthoses condition (SMD range 1.13 to -4.11).

CONCLUSIONS

No high level evidence supported the use of foot orthoses for flexible pes planus. There is good to moderate level evidence that foot orthoses improve physical function (medial-lateral sway in standing (level II) and energy cost during walking (level III)). There is low level evidence (level IV) that foot orthoses improve pain, reduce rearfoot eversion, alter loading and impact forces; and reduce rearfoot inversion and eversion moments in flexible pes planus. Well-designed randomised controlled trials that include appropriate sample sizes, clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult flexible pes planus.

Changes in balancing ability of athletes with chronic ankle instability after foot orthotics application and rehabilitation exercises

Objective

To compare the effect of foot orthotics and rehabilitation exercises by assessing balancing ability and joint proprioception in athletes who have chronic ankle instability.

Methods

Forty-one athletes who visited hospitals due to chronic ankle instability were randomly assigned to two groups. One group had ankle rehabilitation exercises while the other group had the same rehabilitation exercises as well as foot orthotics. Joint position sense of the ankle joint was examined by using an isokinetic exercise machine. Balancing abilities categorized into static, dynamic and functional balance abilities were evaluated by using computerized posturography. We tested the subjects before and after the four-week rehabilitation program.

Results

After the four-week treatment, for joint reposition sense evaluation, external 75% angle evaluation was done, revealing that the group with the application of foot orthotics improved by -1.07±1.64 on average, showing no significant difference between the two groups (p>0.05). Static, dynamic and functional balancing abilities using balance masters were evaluated, revealing that the two groups improved in some items, but showing no significant difference between them (p>0.05).

Conclusion

This study found that athletes with chronic ankle instability who had foot orthotics applied for four weeks improved their proprioceptive and balancing abilities, but did not show additional treatment effects compared with rehabilitation exercise treatment.

Effects of foot orthoses on balance in older adults

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.

Does footwear type impact the number of steps required to reach gait steady state?: an innovative look at the impact of foot orthoses on gait initiation

Many studies have attempted to better elucidate the effect of foot orthoses on gait dynamics. To our knowledge, most previous studies exclude the first few steps of gait and begin analysis at steady state walking. These unanalyzed steps of gait may contain important information about the dynamic and complex processes required to achieve equilibrium for a given gait velocity. The purpose of this study was to quantify gait initiation and determine how many steps were required to reach steady state walking under three footwear conditions: barefoot, habitual shoes, and habitual shoes with a prefabricated foot orthoses. Fifteen healthy subjects walked 50m at habitual speed in each condition. Wearing habitual shoes with the prefabricated orthoses enabled subjects to reach steady state walking in fewer steps (3.5 steps+/-2.0) compared to the barefoot condition (5.2 steps+/-3.0; p=0.02) as well as compared to the habitual shoes condition (4.7 steps+/-1.6; p=0.05). Interestingly, the subjects' dynamic medial-lateral balance was significantly improved (22%, p<0.05) by using foot orthoses compared to other footwear conditions. These findings suggest that foot orthoses may help individuals reach steady state more quickly and with a better dynamic balance in the medial-lateral direction, independent of foot type. The findings of this pilot study may open new avenues for objectively assessing the impact of prescription footwear on dynamic balance and spatio-temporal parameters of gait. Further work to better assess the impact of foot orthoses on gait initiation in patients suffering from gait and instability pathologies may be warranted.