Effect of magnetic insoles on postural sway measures in men and women during a static balance test

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.

Effect of Insoles with a Toe-Grip Bar on Toe Function and Standing Balance in Healthy Young Women: A Randomized Controlled Trial

Objective

The aim of this randomized controlled study was to investigate the effects of insoles with a toe-grip bar on toe function and standing balance in healthy young women.

Methods

Thirty female subjects were randomly assigned to an intervention group or a control group. The intervention group wore shoes with insoles with a toe-grip bar. The control group wore shoes with general insoles. Both groups wore the shoes for 4 weeks, 5 times per week, 9 hours per day. Toe-grip strength, toe flexibility, static balance (total trajectory length and envelope area of the center of pressure), and dynamic balance (functional reach test) were measured before and after the intervention.

Results

Significant interactions were observed for toe-grip strength and toe flexibility (F = 12.53, p < 0.01; F = 5.84, p < 0.05, resp.), with significant improvement in the intervention group compared with that in the control group. Post hoc comparisons revealed that both groups showed significant improvement in toe-grip strength (p < 0.01 and p < 0.05, resp.), with higher benefits observed for the intervention group (p < 0.01). Conversely, no significant interaction was observed in the total trajectory length, envelope area, and functional reach test.

Conclusions

This study suggests that insoles with a toe-grip bar contribute to improvements in toe-grip strength and toe flexibility in healthy young women.

A systematic review of the effect of foot orthoses and shoe characteristics on balance in healthy older subjects

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.

Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly

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.

Influence of magnetic knee wraps on joint proprioception in individuals with osteoarthritis: a randomized controlled pilot trial

Objective: To determine the effects of magnetic knee wraps (MKWs) on joint position sense (JPS) in individuals with mild-to-moderate knee osteoarthritis.

Design: Randomized, double-blind, placebo-controlled pilot trial.

Setting: Rehabilitation clinic of a tertiary hospital.

Subjects: Fifty volunteers with mild-to-moderate knee osteoarthritis participated and 33 (66%) completed the trial; only one (2%) withdrew due to study-related adverse effects.

Interventions: Knee wraps with a static magnetic field (35 mT) were compared with control knee wraps for 12 weeks.

Main measures: The main outcome measure was JPS at first, fourth, and twelfth week while applying of the knee wrap, quantified as the ability to replicate target knee joint angles. The secondary outcome was the Comprehensive Osteoarthritis Test (COAT) total score.

Results: In the intention-to-treat analysis with an alpha-level of 0.05, 12-week application of the MKWs did not significantly reduce the mean absolute error (MAE) of JPS ( n = 18; P = 0.627); contrarily, the MAE was found to decrease significantly after wearing the sham MKWs ( n = 20; P = 0.01). The COAT total score gradually improved in both groups ( P < 0.05). When comparing the improvement of MAE and COAT total score at each follow-up between two groups, no significant differences were found; the maximal difference in the improvement of MAE between two groups was noted at week 12 (mean difference: 1.2°; 95% confidence interval −0.4 to 2.9; P = 0.144). In the per-protocol analysis, the study group showed better improvement in the COAT total score at week 12 ( P = 0.033).

Conclusion: The 35-mT MKWs could not significantly influence knee JPS in individuals with mild-to-moderate knee osteoarthritis.

The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial

BACKGROUND

Aged-related loss of afferent feedback of the feet plays an important role in gait performance. Although strength, balance and gait training can significantly improve the muscle power and functional abilities of older individuals, it remains unclear whether training effects can be enhanced by augmenting afferent feedback from the feet adding shoe insoles complementary to conventional training.

OBJECTIVE

The current study investigated the effect of physical exercise combined with wearing MedReflex shoe insoles on the gait performance and muscle power in older adults.

METHODS

Twenty-eight independent living, older adults aged 65-91 years were randomly assigned to either an insole group (IG; n=14) or a training group (TG; n=14). Further 14 subjects matched to the IG and TG were recruited as a control group (CG; n=14) (no exercise). The IG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas, the IG wore the insoles during everyday life and during training sessions. Assessments included the Falls Efficacy Scale - International (FES-I), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training.

RESULTS

There were significant time x group interactions in walking speed, step length and in several muscle power measurements. The positive effects of gait parameters ranged between 1% and 12% and between 1% and 8% and the trend to improvements of muscle power ranged between 15-79% and 20-79% for the IG and TG, respectively. The IG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0% and-5% for gait parameters and between-4% and-14% for muscle power. No significant change in FES-I score occurred in neither groups.

CONCLUSIONS

The results of this study provide evidence of significant improvements in gait performance and muscle power after a conventional training program in independent living, older adults. However, there is no additional effect of long-term adaptation of gait caused by wearing insoles concurrent to physical training.

Optimization of static magnetic field parameters improves analgesic effect in mice

The present study deals with the analgesic effect induced by static magnetic fields (SMF) in mice exposed to the field with their whole body. It discusses how the effect depends on the distribution of the magnetic field, that is, on the specification and arrangement of the applied individual permanent magnets. A critical analysis of different magnet arrangements is given. As a result the authors propose a magnet arrangement recipe that achieves an analgesic effect of over 80% in the writhing test. This is a widely accepted screening method for animal pain and predictor of human experimental results. As a non-drug, non-invasive, non-contact, non-pain, non-addictive method for analgesia with immediate and long-lasting effect based on the stimulus of the endogenous opioid network, the SMF treatment may attract the attention of medical doctors, nurses, magnet therapists, veterinarians, physiotherapists, masseurs, and fitness trainers among others.

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.

Static magnetic field therapy: a critical review of treatment parameters

Static magnetic field (SMF) therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to:(i) summarize SMF research conducted in humans; (ii) critically evaluate reporting quality of SMF dosages and treatment parameters and (iii) propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61%) of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial.

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

The objective of the study was to determine whether insoles with a low Shore A value (15 degrees) as prescribed for patients with a diabetic neuropathy have a negative effect on posture stability because these insoles may reduce somatosensory input under the feet. It was conducted in the Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands The study was observational and conducted on 30 diabetic patients (aged 37 - 82 years) with a neuropathy. Posture stability (body sway) was assessed in a shoe without insole, on a flat insole with a low Shore A value (15 degrees) and on a flat insole with a higher Shore A value (30 degrees). These assessments were done under four different conditions: (1) eyes open, no dual-task, (2) eyes closed, no dual-task, (3) eyes open, dual-task (mental arithmetic) and (4) eyes closed, dual-task. Additionally 10 healthy controls (aged 27 - 51 years) were assessed similarly. A significantly higher root-mean-square (rms) value of the anterior-posterior velocity, V(y), was found in patients compared with controls (3.4 cm/s vs. 1.2 cm/s, p < 0.05). Also a significant difference in rms value of the anterior-posterior velocity, V(y), was found between eyes open and eyes closed (1.9 cm/s vs. 2.7 cm/s, p < 0.05). No significant effects were found for insoles or dual tasks for the total group. In diabetic patients no significant effect was found of insoles on posture stability. The effect of closed eyes on posture stability was significantly larger for diabetic patients compared to controls. It was found that prescribing insoles with a low Shore A value (15 degrees), compared to insoles with a higher Shore A value (30 degrees) has no significant negative effect on posture stability in patients with a diabetic neuropathy.

A systematic review of the effects of shoes and other ankle or foot appliances on balance in older people and people with peripheral nervous system disorders

The objective of this paper is to identify and review all publications on effects ankle and/or foot appliances (AFA) on balance in older people (>or=60 years) and patients with peripheral nervous system disorders (PNSD). These two groups account for the majority of the population with deteriorated balance due to peripheral somatosensory feedback problems. To provide a context for understanding and interpreting the studies that have been published to date, we will briefly summarize current theories on the role of somatosensory mechanisms in control of balance and how balance can be affected by AFA. A systematic literature review is presented in which publications were searched in Medline, Embase and Recal. In total 146 papers were identified and 18 were selected based on title and abstract for qualitative assessment by two independent reviewers. Based on assessment of the total articles, seven of the 18 papers fulfilled predetermined qualitative criteria and were selected for detailed review. No definitive conclusions can be drawn concerning the effects of AFA on balance in older people or in patients with PNSD because of the small number of studies and the weak level of evidence. The available literature seems to indicate that a training program may be helpful in ensuring the effectiveness of an appliance. Insoles with tubing or vibrating elements may improve balance, whereas thick or soft soles may deteriorate balance. The effects of these different types of insoles or soles are consistent with theories about somatosensory mechanisms that play a role in control of balance. More and better quality research is needed to support the prevalent use of appliances in these populations.

Comparative effect of positive and negative static magnetic fields on heart rate and blood pressure in healthy adults

OBJECTIVE

To compare changes in heart rate (HR) and blood pressure (BP) associated with short-term exposure to static magnetic fields (SMFs) of positive versus negative polarity.

DESIGN

A double-blind, randomized controlled trial using a time series design.

SETTING

Physical therapy laboratory in a university setting.

SUBJECTS

Seventy-five adults with a mean age of 30.6 years were assigned to one of three treatment groups. No subjects had any symptoms of cardiovascular disease or cardiac irregularity.

INTERVENTIONS

Fifteen-minute exposure to an SMF by lying on a mattress pad containing magnets of positive polarity, negative polarity, or none (placebo).

MAIN OUTCOME MEASURES

HR and BP were monitored prior to exposure, at 1-minute, 5-minute, 10-minute and 15-minute intervals following exposure, and again 5 minutes after exposure.

RESULTS

Subjects in all groups demonstrated slight decreases in HR and BP, but none of these changes were associated with the intervention (p = 0.170).

CONCLUSIONS

Short-term exposure to an SMF of either positive or negative polarity does not appear to cause any clinically meaningful changes in HR or BP among asymptomatic subjects. This finding supports the safe use of unipolar SMFs that contain low-intensity magnets (< 1000 gauss) relative to the cardiovascular system.

Single-use acupuncture needles: scanning electron-microscopy of needle-tips

Unselected, disposable acupuncture needles from various manufacturers and retail suppliers were taken from a pool of donated and bought samples. Three needles of each type were prepared for electron-microscopy. The needle tips were inspected at two magnifications (x39.37 and x612.5): 52 electron-micrographs were taken of 31 individual needles from 11 different types. No needle-tip looked perfect and significant faults were seen in most; some appeared seriously deformed. The faults noted were: scratch marks along or across the needle, metallic scuff, lumps and irregularities in the needle surface, needle-tip stubbed or malformed, and needle point off-centre. An additional test made was to wipe a number of needles firmly on white paper tissue. Some left grey lines, and these were regarded as evidence of metallic or oily residue from the needle surface which could have been deposited in the patient. These unexpected findings, in a variety of popularly used needles from well-respected suppliers, suggest that most manufacturers need to reassess their quality control procedures.