Effects of prefabricated foot orthoses and soft insoles on postural stability in professional soccer players

Can a rigid antipronation foot orthosis change the effects of prolonged standing on postural control in men with patellofemoral pain?

BACKGROUND

Pronated foot posture is known as a contributing factor for patellofemoral pain (PFP) development. Patients with patellofemoral pain often experience poor postural control. Implementation of optimal management strategies for enhancing their postural performance is important.

OBJECTIVES

The aim of this study was to determine whether a rigid antipronation foot orthosis changes prolonged standing effects on postural control in men with PFP.

STUDY DESIGN

Case-control study.

METHODS

Twenty-eight men with PFP and pronated foot and 28 healthy men were enrolled in this study. Center-of-pressure parameters were measured during short trials (60 seconds) of single-leg standing before and immediately after prolonged standing (20 minutes) using force platform. In patients with PFP, postural control was examined on 2 separate days with and without rigid antipronation foot orthosis.

RESULTS

Findings showed that the pre-post differences of sway area (t(48) = -2.22, p = 0.03), mediolateral (ML) displacement (t (48) = -2.51, p = 0.01), and mean velocity (t(48) = -2.01, p = 0.04) were significantly greater in patients with PFP without foot orthosis compared with those in the healthy group. Significant intervention main effect ( p = 0.04) and time-by-intervention interaction ( p = 0.006) for sway area were shown. Significant intervention main effects were noted for ML displacement ( p = 0.007) and mean velocity ( p = 0.003). For these variables, significant time-by-intervention interactions were found. Further analysis showed greater values of ML displacement and mean velocity parameters before the prolonged standing in patients with PFP without foot orthosis compared with patients with PFP with orthosis.

CONCLUSIONS

Rigid antipronation foot orthosis can improve the postural performance after prolonged standing in young adult men with PFP.

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.

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.

Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet

Objective: To evaluate the effect of rigid foot orthoses on balance parameters in participants with clinically diagnosed excessively pronated feet.

Design: Randomized clinical trial.

Setting: University biomechanics laboratory.

Participants: Thirty female and 20 male healthy participants (mean 23.89 ± 2.2 years old) with excessively pronated feet, according to a validated foot classification system were randomly assigned to either a control or intervention group.

Interventions: Balance testing was performed using the Balance Performance Monitor with an over-the-counter rigid foot orthoses.

Main outcome measures: Standing balance in the form of mean balance (measures the participants ability to stand with an even load), medial–lateral sway and anterior–posterior sway. All participants were measured while standing bipedally.

Results: There was no significant mean difference in balance scores between the control and intervention group at baseline. After four weeks the results demonstrated no significant differences between mean) balance ( p > 0.05) and anterior–posterior sway ( p > 0.05). However, there was a reduction with the intervention group in medial–lateral sway ( p > 0.02).

Conclusion: The use of foot orthoses in the current study may have improved postural control by stabilizing the rear foot and thus maintaining balance. By the same argument, the benefits of limiting excessive foot pronation may contribute to effective control of internal rotation of the tibia and thereby reduce counter-rotatory motion at the knee and lower leg and maintain balance.

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.

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.

Can Taekwondo footwear affect postural stability in young adults?

BACKGROUND

This study aims to investigate the effect of taekwondo footwear on unilateral stance stability and use of postural control strategies and to determine whether taekwondo footwear influences the somatosensory inputs for postural stability and postural strategies in young adults.

METHODS

A quasi-randomized crossover trial was conducted on 33 healthy young adults at a university research laboratory. Independent variables, including shoe conditions (shoes on and shoes off) and visual conditions (eyes open and eyes closed), were taken into account. The center of gravity (COG) sway velocity in unilateral stance and the strategy scores in the sensory organization test were measured. No intervention was given to the participants.

RESULTS

There was no significant interaction between the two factors (the shoe and visual conditions) for COG sway velocities (P = .447) and strategy scores (P = .320). The shoe condition was not significant in either COG sway velocity (P = .484) or strategy score (P = .126). The visual condition was significant for COG sway velocity (P < .001) but not for strategy score (P = .573). The mean ± SD COG sway velocity with eyes open was 0.7° ± 0.2°/sec and with eyes closed was 1.7° ± 0.6°/sec (P < .001).

CONCLUSIONS

Taekwondo footwear is unlikely to affect somatosensory inputs and balance performance in young adults.

Standing balance on the ground -the influence of flatfeet and insoles

[Purpose] The aim of this study was to determine whether insoles change standing balance on the ground in normal and flat-footed subjects. [Subjects] Twenty subjects with flatfeet and 20 subjects with normal feet were included in this study. [Methods] Body sway was evaluated based on the center of pressure while subjects stood on the ground. Body sway was measured during upright standing with the feet 10 cm apart for 30 seconds. The total locus length and the area of body sway were then measured using a zebris system. Measurements were made under three sets of conditions: using BMZ insoles, which supported the cuboid; using Superfeet insoles, which supported the medial longitudinal arch; and with no insoles. [Results] The 3 insole conditions were compared. On level ground, the total locus length for the Superfeet insole was significantly less than those for the BMZ insole and no insole. [Conclusion] On level ground, Superfeet feet insoles were effective in stabilizing standing balance in both flat-footed and normal-footed subjects.

Association of lower limb injury with boot cleat design and playing surface in elite soccer

Reducing external injury risk factors associated with the boot-surface interaction is important in reducing the incidence and severity of foot and ankle injury. A review of prospective football (soccer) injury epidemiology studies determined that the incidence of noncontact ankle sprain injury is relatively high. Research on the impact of cleat shape and configuration and boot design on the boot-surface interaction is providing new understanding of the impact on player biomechanics and injury risk but is not keeping pace with commercial advances in boot design and innovation in natural and synthetic turf surface technology.

Changes of Postural Steadiness Following Use of Prefabricated Orthotic Insoles

Orthoses are designed to assist a malaligned foot in adapting to the environment and reduce the frequency of injury. Literature is divided on the benefits of orthotics insoles for postural stability. The current study was conducted to determine the effect of prefabricated orthotic arch supports on postural stabilization. Twelve healthy young adults participated in this study and were tested with and without prefabricated orthotics. Different variables were computed from movement of center of pressure (COP) during orthotic use as suggested in the literature. The mean position of COP was significantly shifted forward and toward the dominant side. Neither the COP movement nor the velocity changes following the use of orthotics revealed significant differences. Mediolateral range of COP movement and the 95% confidence circle area of sway was significantly reduced (P = .022 and 0.048 respectively), but changes in 95% confidence circle and ellipse areas of fractal dimension were not significant (P = .053 and P = .057 respectively). In conclusion, orthotic insoles significantly improved postural sway initially by reducing mediolateral range of postural sway and 95% confidence circle area of sway at the cost of increased fractal dimension area variables and power.

Effects of prefabricated ankle orthoses on postural stability in basketball players with chronic ankle instability

Purpose

Ankle sprain is one of the most common injuries among athletes and instability and injury to this joint is responsible for long time loss of physical and recreational activity. Also, it can impose high costs to sport teams. Prevention of this injury is an important concern of practice and rehabilitation. One way of reducing the possibility of ankle joint injury is using an ankle orthosis. The present study aimed at inspecting the effects of two ankle orthoses on dynamic and semi-dynamic postural stability in athletes with chronic ankle instability (CAI).

Methods

Twenty basketball players with CAI and fifteen non-injured athletes volunteered to participate in this study. Biodex Balance System was used to assess the participants’ postural stability in bilateral position at level 8 and level 2. Repeated measures analysis of variance (ANOVA) was performed in order to examine the effects of ankle orthoses. Statistical significance level was determined at P< 0.05.

Results

Statistical analyses revealed the significant effect of ankle supports on dynamic and semi-dynamic postural stability in the two groups and results indicated there wasn't significant difference between groups.

Conclusions

According to our results the orthoses improved both dynamic and semi-dynamic postural stability. Therefore, orthoses can prevent injury and its reoccurrence.

Orthotic intervention and postural stability in participants with functional ankle instability after an accommodation period

CONTEXT

Most protocols established to treat patients with functional ankle instability (FAI) have focused on taping the ankle. Orthotic intervention is a different treatment protocol that may have a positive effect on these patients, especially after an accommodation period.

OBJECTIVE

To determine whether the use of a prefabricated orthotic affects postural stability in patients with FAI and a control group.

DESIGN

Randomized controlled clinical trial.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty patients with unilateral FAI.

INTERVENTION(S)

Postural stability was measured on both limbs using a force plate on 3 occasions. Participants were instructed to balance on 1 limb with their eyes closed for 20 seconds. In session 1, postural stability was measured with the patient wearing his or her own athletic shoes. The control group repeated this procedure in sessions 2 and 3. When those in the orthotic group returned for session 2, they received prefabricated, full-length Quick Comfort Insoles for both feet, immediately placed the orthotics in their shoes, and were tested for postural stability. Patients in the orthotic group were instructed to wear the inserts daily and return 2 weeks later for session 3 and repeat postural stability testing.

MAIN OUTCOME MEASURE(S)

Center of pressure.

RESULTS

In the orthotic group, postural stability improved between sessions 1 and 2 and sessions 1 and 3. In session 3, postural stability was different for the orthotic and control groups. We also identified a difference between the limbs such that the FAI ankle displayed worse postural stability than did the healthy ankle.

CONCLUSIONS

Prefabricated orthotics improved postural stability in participants with FAI. Similar to the findings of previous researchers, we found that postural stability was worse in FAI ankles than in healthy ankles.

The effect of different skin-ankle brace application pressures with and without shoes on single-limb balance, electromyographic activation onset and peroneal reaction time of lower limb muscles

BACKGROUND

Several studies have been carried out in order to investigate the effect of ankle bracing on ankle joint function and performance. However, no study so far has examined the role of skin-brace interface pressure in neuromuscular control. The aim of this study was to investigate the effect of different skin-ankle brace interface pressures, with and without shoes, on quiet single-limb balance and the electromyographic (EMG) activation sequence of four lower limb muscles.

METHODS

Twelve male physical education students who volunteered to take part in the study were measured with and without shoes under three ankle brace conditions: (i) without brace, (ii) with brace and 30 kilopascals (kPa) application pressure and (iii) with brace and 60 kPa application pressure. Single-limb balance (anteroposterior and mediolateral parameter) was assessed on the dominant lower limb, with open and closed eyes, on a force platform, simultaneously with the EMG recording of four lower lower limb muscles' (gastrocnemius, peroneus longus, rectus femoris and biceps femoris) activation onset. Peroneus longus reaction time was also measured by provoking a sudden subtalar inversion stress test using a trap-door.

RESULTS

The results showed that the application of athletic footwear resulted in a significant difference between the condition with shoes and without shoes, with a significantly increased anteroposterior sway and sway velocity, in all three ankle brace application conditions with shoes (F=50.9, d.f.=1, p<0.001 and F=58.4, d.f.=1, p<0.001), but had no effect in the mediolateral stability, or the total stability parameter. Shoes had no significant effect on the EMG activation sequence of the four lower limb muscles. Lastly, ankle brace application with 30 and 60 kPa application pressures, with and without athletic footwear, led to a significant delay in the peroneus longus reaction time (F=9.71, d.f.=2, p<0.001).

CONCLUSIONS

These findings suggest that different ankle brace application pressures may have an effect on single-limb balance, and peroneal reaction time. The application of athletic footwear, further adversely affects these parameters significantly. Further research is needed in this area with more dynamic and functional measurements, before the safe use of ankle bracing can be widely recommended.

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.

Effect of orthoses on postural stability in asymptomatic subjects with rearfoot malalignment during a 6-week acclimation period

OBJECTIVE

To determine the effect of custom-fitted orthoses on postural sway over a 6-week acclimation period.

DESIGN

Repeated-measures analysis of variance on postural sway measures with factors being group (control, malaligned), time (initial, 2 wk, 4 wk, 6 wk postintervention), and condition (with orthoses, without orthoses). For single-limb stance, side (right, left) was analyzed to determine bilateral differences.

SETTING

Biodynamics laboratory.

PARTICIPANTS

Twenty-one subjects, 11 asymptomatic with rearfoot malalignment and 10 asymptomatic with normal rearfoot alignment.

INTERVENTIONS

Orthoses were prescribed and worn for 6 weeks. Balance testing was performed on 4 different dates with each subject tested in both orthotic conditions. Postural control was measured with three 10-second eyes-closed trials for single-limb stance, one 20-second eyes-closed bilateral stance with the platform moving, and one 20-second eyes-open bilateral stance with the platform and surroundings moving.

MAIN OUTCOME MEASURES

Sway velocity (in deg/s) for single-limb stance and equilibrium score for bilateral stance.

RESULTS

Postural sway measures were significantly decreased during single-limb testing with orthoses versus without orthoses, regardless of group. The orthotic intervention significantly improved bilateral stance equilibrium score in the malaligned group at weeks 2, 4, and 6 when compared with measures at the initial week. Equilibrium score of the malaligned group with orthoses at initial week was significantly lower (worse) than the control group with orthoses at initial week; however, these results were not repeated during measurements taken at weeks 2, 4, or 6.

CONCLUSIONS

The application of orthoses decreased sway velocity for single-limb stance, improving postural stability regardless of group when visual feedback was removed. During bilateral stance, postural stability was initially worse for the malaligned group with and without orthoses when compared with the control group; however, improvements were seen by week 2 and continued throughout the remainder of testing. Clinically, the application of orthoses appears to improve postural control in people with rearfoot malalignment, particularly when vision is removed.

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

OBJECTIVE

Postural stability (PS) was assessed in a group of participants with >or=7 degrees of forefoot varus (FV) after 6 weeks of custom-molded functional foot orthosis (FO) intervention to investigate the effect of FO intervention in a population that may have decreased PS due to their foot structure.

DESIGN

A force platform was used to assess right and left single-limb stance position and eyes open and eyes closed condition PS.

SETTING

PS was assessed in a biomechanics research laboratory.

PARTICIPANTS

Twelve participants with >or=7 degrees of FV (MFV) and 5 participants with <7 degrees of FV (LFV) participated in the study.

INTERVENTIONS

PS of the MFV group was assessed initially when FOs were received and after 6 weeks of FO intervention. The LFV group PS was assessed during initial and 6-week testing sessions.

MAIN OUTCOME MEASURES

The root mean square of the center of pressure velocity was used to quantify single-limb stance PS during no FO and FO conditions.

RESULTS

LFV group PS did not change significantly (P=0.829) over the 6-week time period. Significant improvement was, however, reported in the MFV group anteroposterior (P=0.003) and mediolateral (P=0.032) PS at the 6-week assessment versus the initial assessment during both the noFO and FO conditions.

CONCLUSIONS

Six weeks of FO intervention may significantly improve PS in participants with >or=7 degrees of FV both when wearing FOs and when not wearing FOs.

Influence of Foot Type and Orthotics on Static and Dynamic Postural Control

Context:

The effects of custom-molded foot orthotics on neuromuscular processes are not clearly understood.

Objective:

To examine these effects on postural control in subjects with different foot types.

Design:

Between-groups, repeated-measures design.

Setting:

Athletic training laboratory.

Subjects:

30 healthy subjects assigned to groups by foot type: planus (n = 11), rectus (n = 12), or cavus (n = 7).

Interventions:

Custom-fit semirigid orthotics.

Main Outcome Measures:

Static postural control was measured on a force plate. Dynamic postural control was measured using the Star Excursion Balance Test. Both measurements were assessed with and without orthotics at baseline and 2 weeks later.

Results:

For static postural control, a significant condition-by-group interaction was found. Subjects with cavus feet had a decreased center-of-pressure velocity while wearing orthotics. For dynamic postural control, a significant condition-by-direction-by-group interaction was found. Subjects with cavus feet had increased reach distances in 3 of 8 directions while wearing orthotics.

Conclusions:

Custom orthotics were associated with some improvements in static and dynamic postural control in subjects with cavus feet.