February 2012

Enhancing balance

In the moment: Footcare

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Foot orthoses may help prevent falls

Recent research suggests older patients at risk for falls from poor balance may benefit from custom foot orthoses. Report­ed improvements indicate clini­cians could potentially help prevent falls by testing patients’ balance and considering inter­ventions to improve it. 

By Emily Delzell and Jordana Bieze Foster

“Based on my clinical experience, patients who complain of poor balance and who are at risk for falls might be helped by an insert, especially if they have an excessively supinated or pronated foot structure,” said Michael T. Gross, PT, PhD, University of North Carolina at Chapel Hill professor of physical therapy and lead author of the study, which tested the effects of custom foot orthoses on static and dynamic balance.

“Clinicians should consider asking older patients about their balance and having them perform a simple one leg balance test. There is strong relationship between the inability to stand on one foot for more than five seconds and an increased risk of falling,” he said.

Gross and colleagues in UNC’s Division of Physical Therapy recruited 13 adults (six women) older than 65 years who had reported at least one unexplained fall in the previous year. Participants had to demonstrate poor balance on the single leg stance test, one of the study’s four balance measures. Investigators also used a tandem stance test, tandem gait test, and alternating step test, testing volunteers in three sessions approximately two weeks apart.

After establishing baseline balance in the first session, Gross created custom inserts for each participant based on a structural alignment exam. Only two participants had neutral feet and received orthoses with no corrective features. All other orthoses were designed to correct participants’ specific structural issues.

During the second session patients received the orthoses and were retested on all balance measures immediately before and after orthosis application. All measures except for tandem gait improved significantly immediately after application. Gross pointed out, however, that participants took more than three times the steps during the tandem gait test right after orthosis application compared with baseline scores. Investigators asked participants to wear the orthoses as much as possible during the two weeks between application and follow-up testing.

At follow-up, participants maintained balance improvements equivalent to those seen right after application of the orthoses.

“Our sample size was small and results are preliminary, but they’re promising,” Gross said. “It’s important to note that we examined and addressed individual foot issues. Adding simple arch support may not be enough to confer the same benefits.”

A second study e-published in January looked at the effects of a noncustom insole on postural sway. Adding a textured surface underneath feet might increase somatosensory function, which declines with age, and decrease postural sway, potentially improving postural stability, said Feng Qiu, MD, PhD, lead author of the study conducted at Queensland University of Technology in Brisbane, Australia.

Investigators performed standing balance tests in seven older adults (mean age, 72 ± 4 years) and 10 younger controls (mean age, 27 ± 3 years). Tests were done on a force plate with participants’ eyes open and closed and while they were barefoot, wearing a hard textured insole, and wearing a soft textured insole.

Older adults demonstrated greater postural sway, which decreased significantly and progressively as volunteers moved from the barefoot to hard to soft textured insole conditions. The effect was most significant in the eyes-closed condition. Qiu noted that noncustom insoles are an inexpensive intervention that may provide improved balance.

Gross said decreasing postural sway alone may not reduce fall risk and also noted that Australian participants weren’t tested under real-world conditions.

“When you’re simply standing, your center of mass doesn’t wander much,” he said. “And most people tend to do things with their eyes open.” –ED


Gross MT, Mercer VS, Lin FC. Effects of foot orthoses on balance in older adults. J Orthop Sports Phys Ther 2012 Jan 25. [Epub ahead of print.]

Qiu F, Cole MH, Davids KW, et al. Enhanced somatosensory information decreases postural sway in older people. Gait Posture. 2012 Jan 12. [Epub ahead of print.]

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