Impact of alternative footwear on human balance

The effect of a combined compression-tactile stimulating sock on postural stability

Previous research has demonstrated that postural stability may be improved by increasing stimulation to the somatosensory system. Wearing lower limb compression garments or textured in-soles have been found to be effective short-term methods for improving postural stability, hypothesized to be due to enhanced tactile feedback. The aim of this study was to assess whether a combined compression-tactile sock increases postural stability in healthy adults, compared to barefoot. Participants completed a sensory organization test (SOT) to assess postural stability under two conditions: (a) barefoot, and (b) wearing a compression sock with a textured inner lining (small rubber nodules on the skin side of the sole). SOT composite scores and three sensory scores - somatosensory, vestibular, visual - were assessed between the two conditions to identify whether wearing the socks was associated with enhanced postural stability. Comparisons between the two conditions were analyzed via a paired t-test for the (i) entire group, and an ANOVA when the group was split into (ii) "high performers" and "low performers", according to their baseline performance on the SOT. Fifty-four participants (28 females, 26 males, mean age 40 ± 14 years) completed the study. SOT scores were not different between the compression-tactile sock and barefoot conditions when analyzed as an entire group (p > 0.0125), or when the group was split into performance groups (p > 0.0125). These findings demonstrate that, for healthy adults, mixed compression and tactile stimulation socks do not appear to be associated with improved postural stability, when measured using the sensory organization test. Although prior research indicates that wearing a compression-tactile sock improves somatosensory acuity compared to being barefoot, these benefits do not seem to carry over to postural stability. It may be that in healthy adults, the additional sensory feedback becomes redundant, or the SOT is not challenging enough for this study population.

Sensory Organization Test Conditions Influence Postural Strategy Rather than Footwear or Workload

BACKGROUND

Postural strategies such as ankle, hip, or combined ankle-hip strategies are used to maintain optimal postural stability, which can be influenced by the footwear type and physiological workload.

PURPOSE

This paper reports previously unreported postural strategy scores during the six conditions of the sensory organization test (SOT).

METHODS

Fourteen healthy males (age: 23.6 ± 1.2 years; height: 181 ± 5.3 cm; mass: 89.2 ± 14.6 kg) were tested for postural strategy adopted during SOT in three types of occupational footwear (steel-toed work boot, tactical work boot, low-top work shoe) every 30 min during a 4-h simulated occupational workload. Postural strategy scores were analyzed using repeated measures analysis of variance at 0.05 alpha level.

RESULTS

Significant differences among postural strategy scores were only evident between SOT conditions, and but not between footwear type or the workload.

CONCLUSIONS

Findings indicate that occupational footwear and occupational workload did not cause a significant change in reliance on postural strategies. The significant changes in postural strategy scores were due to the availability of accurate and/or conflicting sensory feedback during SOT conditions. In SOT conditions where all three types of sensory feedback was available, the ankle strategy was predominantly adopted, while more reliance on hip strategy occurred in conditions with absent or conflicting sensory feedback.

Lower Extremity Muscle Activation in Alternative Footwear during Stance Phase of Slip Events

Muscle activity from the slipping leg have been previously used to analyze slip induced falls. However, the impact of casual alternative footwear on slipping leg muscle activity when exposed to slippery environments is still unknown. The purpose of the study was to analyze the impact of alternative footwear (crocs (CC) and flip-flops (FF)) compared to slip-resistant footwear (LT) on lower extremity muscle activity when exposed to dry gait (NG), unexpected (US), alert (AS), and expected slips (ES). Eighteen healthy males (age: 22.3 ± 2.2 years; height: 177.7 ± 6.9 cm; weight: 79.3 ± 7.6 kg) completed the study in a repeated measures design in three footwear sessions separated by 48 h. Electromyography (EMG) muscle activity from four muscles of the lead/slipping leg was measured during the stance phase of the gait-slip trials. A 3 (footwear) × 4 (gait-slip trials) repeated measures analysis of variance was used to analyze EMG dependent variables mean, peak, and percent of maximal voluntary contraction. Greater lower extremity muscle activation during the stance phase was seen in US and AS conditions compared to NG and ES. In addition, footwear differences were seen for the alternative footwear (CC and FF) during US and AS, while the low top slip resistant shoe had no differences across all gait trials, suggesting it as the most efficient footwear of choice, especially when maneuvering slippery flooring conditions, either with or without the knowledge of an impending slip.

Influences of heel height on human postural stability and functional mobility between inexperienced and experienced high heel shoe wearers

Background

High heel shoes (HHS) can affect human postural control because elevated heel height (HH) may result in plantar flexed foot and limit ankle joint range of motion during walking. Effects of HH and HHS wearing experience on postural stability during self-initiated and externally triggered perturbations are less examined in the literature. Hence, the objective of the present study is to investigate the influences of HH on human postural stability during dynamic perturbations, perceived stability, and functional mobility between inexperienced and experienced HHS wearers.

Methods

A total of 41 female participants were recruited (21 inexperienced HHS wearers and 20 experienced HHS wearers). Sensory organization test (SOT), motor control test (MCT), and limits of stability (LOS) were conducted to measure participant’s postural stability by using computerized dynamic posturography. Functional reach test and timed up and go test were performed to measure functional mobility. The participants’ self-perceived stability was assessed by visual analog scale. Four pairs of shoes with different HH (i.e., 0.8, 3.9, 7.0, and 10.1 cm) were applied to participants randomly. Repeated measures analysis of variance was conducted to detect the effects of HH and HHS wearing experience on each variable.

Results

During self-initiated perturbations, equilibrium score remarkably decreased when wearing 10.1 cm compared with flat shoes and 3.9 cm HHS. The contribution of vision to postural stability was larger in 10.1 cm HHS than in flat shoes. The use of ankle strategy worsened when HH increased to 7 cm. Similarly, the directional control of the center of gravity (COG) decreased for 7 cm HHS in LOS. Experienced wearers showed significantly higher percentage of ankle strategy and COG directional control than novices. Under externally triggered perturbations, postural stability was substantially decreased when HH reached 3.9 cm in MCT. No significant difference was found in experienced wearers compared with novices in MCT. Experienced wearers exhibited considerably better functional mobility and perceived stability with increased HH.

Conclusions

The use of HHS may worsen dynamic postural control and functional mobility when HH increases to 3.9 cm. Although experienced HHS wearers exhibit higher proportion of ankle strategy and COG directional control, the experience may not influence overall human postural control. Sensory organization ability, ankle strategy and COG directional control might provide useful information in developing a safety system and prevent HHS wearers from falling.

Muscle Activity during Postural Stability Tasks: Role of Military Footwear and Load Carriage

Decrements to postural control manifest as an increase in muscle activity, indicating continuous attempts to maintain body equilibrium and postural stability. Extrinsic factors such as footwear, and intrinsic factors such as muscle fatigue, can affect postural stability. The purpose of this study was to analyze the impact of two types of military footwear and a military-type load-carrying task on lower extremity muscle activity during various postural stability tasks. Sixteen males’ (age: 26.63 ± 3.93 years; mass: 87 ± 12.4 kg; height: 178.04 ± 6.2 cm) muscle activity from knee flexors, extensors, ankle dorsiflexors, and plantar flexors were measured using electromyography in standard (STD) and minimalist (MIN) military footwear, before (PRE) and after (POST) a simulated workload during sensory organization and motor control tests on the Neurocom EquitestTM. Mean muscle activity was analyzed using 2 (footwear) × 2 (time) repeated measures ANOVA with an alpha level of 0.05. Results revealed a requirement of significantly greater muscle activity in POST and STD. MIN demonstrated lesser balance decrements POST workload, which could be attributed to its design characteristics. Results will help in suggesting footwear design characteristics to minimize muscular exertion while eliciting better postural control, and to prevent postural instability due to overexertion in military personnel.

Military-Type Workload and Footwear Alter Lower Extremity Muscle Activity During Unilateral Static Balance: Implications for Tactical Athletic Footwear Design

Maintaining upright standing balance is critical for military personal. The impact of military footwear and occupation-related fatigue on muscle activity during balance performance has been previously documented. However, the current literature has not provided a muscle activation profile of the lower extremity during challenging conditions such as unilateral balance trials. Twenty-two recreationally active male participants (age: 22.2 ± 2.7 years; height: 177 ± 6.8 cm; mass: 79.8 ± 9.7 kg) donned two styles of military footwear (minimalist and standard) and performed a military style workload. Unilateral static balance was accessed before (PRE) and after (POST) the workload as surface electromyography was recorded on the right lower extremity. This study found that the minimalist footwear increased muscle activation prior to the workload compared to the standard footwear (co-contraction index mean difference: 0.149), whereas the standard footwear increased muscle activity after the workload (co-contraction index mean difference: 0.097). These findings suggest that footwear design characteristics affect lower extremity muscle activity differently depending on the workload condition. These findings intend to aid in the design of military footwear to maximize balance performance in a military population.

Virtual-Reality-Induced Visual Perturbations Impact Postural Control System Behavior

Background: Virtual reality (VR) is becoming a widespread tool in rehabilitation, especially for postural stability. However, the impact of using VR in a “moving wall paradigm” (visual perturbation), specifically without and with anticipation of the perturbation, is unknown. Methods: Nineteen healthy subjects performed three trials of static balance testing on a force plate under three different conditions: baseline (no perturbation), unexpected VR perturbation, and expected VR perturbation. The statistical analysis consisted of a 1 × 3 repeated-measures ANOVA to test for differences in the center of pressure (COP) displacement, 95% ellipsoid area, and COP sway velocity. Results: The expected perturbation rendered significantly lower (p < 0.05) COP displacements and 95% ellipsoid area compared to the unexpected condition. A significantly higher (p < 0.05) sway velocity was also observed in the expected condition compared to the unexpected condition. Conclusions: Postural stability was lowered during unexpected visual perturbations compared to both during baseline and during expected visual perturbations, suggesting that conflicting visual feedback induced postural instability due to compensatory postural responses. However, during expected visual perturbations, significantly lowered postural sway displacement and area were achieved by increasing the sway velocity, suggesting the occurrence of postural behavior due to anticipatory postural responses. Finally, the study also concluded that VR could be used to induce different postural responses by providing visual perturbations to the postural control system, which can subsequently be used as an effective and low-cost tool for postural stability training and rehabilitation.

Does Minimalist Footwear Design Aid in Postural Stability and Fall Prevention in Ergonomics?

The purpose of the article is to identify if novel footwear design could aid in postural stability and fall prevention in workplace. Footwear design has been reported to aid the task of maintaining postural stability or balancing in an erect stance while minimizing risk of falls. Minimalistic footwear that has design features such as low mass, lower heel height, and thin midsole can positively influence postural stability. Minimalistic military footwear has been shown to lower incidences of falls with efficient muscular effort. Occupational footwear that abides by safety standards with minimalistic features can help maintain postural stability and reduce falls.

Effects of 7-Day Ketone Ingestion and a Physiological Workload on Postural Stability, Cognitive, and Muscular Exertion Measures in Professional Firefighters

Background: Postural stability and cognitive performance are challenged in firefighters. The purpose of this investigation was to examine the impact of 7-day ketone supplementation on postural stability, cognitive performance, and muscular activation before and after a physiological workload. Methods: Nine professional firefighters completed two experimental sessions (pre- and post-workload) in a counterbalanced, double-blind design. Participants ingested either a ketone salt (KS) or placebo (PLA) daily for seven days, and had an eighth ingestion 30 min prior to testing. Each experimental testing consisted of maximal voluntary contractions (MVIC) for four muscles (knee flexors—BF, extensor—VM, ankle dorsiflexors—TA, and plantar flexors—MG) using electromyography and postural stability testing (eyes open (EO), eyes closed (EC), and eyes open-dual-task using a FitLight™ system (EOT)), before (pre-workload) and after (post-workload) a simulated physiological workload. The workload consisted of 35 min steady state exercise at 60% of peak oxygen consumption wearing firefighter personal protective equipment (PPE). Results: Significant differences were limited to time effects (pre-workload vs. post-workload), with no differences between groups (KS vs. PLA). Significantly lower muscle activity in VM, TA, and MG during MVIC, greater postural sway and muscle activity in BF during EC and EOT, and slower response time during EOT were evident post-workload. Conclusions: A 7-day ketone supplementation does not impact postural stability, muscle activity, and cognitive tasks, but a fatiguing workload causes significant performance reduction.

The Influence of an Acute Bout of Whole Body Vibration on Human Postural Control Responses

The use of vibrating platforms has become increasingly available, and popular at sports and rehabilitation institutes. Given the discrepancies in the literature regarding whole body vibration (WBV) and human reflexive responses, the purpose of this study was to examine the acute effects of WBV on postural response latencies, as well as associated electromyography measures of the lower extremities during balance perturbations. Reflexive responses during backward and forward balance perturbations were examined before, after, and 10 min after a bout of WBV. The findings suggest that following an acute bout of whole body vibration, muscle activity of the lower extremities is decreased during a reflexive response to an unexpected perturbation, and may be associated with faster reaction time.