Impact of Soft and Hard Insole Density on Postural Stability in Older Adults

doi:10.1016/j.gerinurse.2012.01.007

Geriatric Nursing

Volume 33, Issue 4, July–August 2012, Pages 264-271

https://doi.org/10.1016/j.gerinurse.2012.01.007 Get rights and content

A significant predictor of falls in the elderly population is attributed to postural instability. Thus, it is important to identify and implement practical clinical interventions to enhance postural stability in older adults. Shoe insoles have been identified as a mechanism to enhance postural control, and our study aimed to evaluate the impact of 2 shoe insoles on static standing balance in healthy, older adults compared with standing posture while barefoot. We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition. Indeed, excursion distances and sway areas were reduced, and sway velocity was decreased when wearing insoles. The hard insole was also effective when visual feedback was removed, suggesting that the more rigid an insole, the greater potential reduction in fall risk. Thus, shoe insoles may be a cost-effective, clinical intervention that is easy to implement to reduce the risk of falling in the elderly population.

Section snippets

Subjects

Twenty-two people participated in the study. Subjects were randomly selected from a group of 128 people already participating in nutritional research studies in various nursing centers throughout Madrid, Spain. Forty-six residents were included in the sample criteria, were asked to participate, and gave consent. From this population, we performed a simple random for 26 subjects (56% of total).²⁴ Only 22 participants decided to participate in the study.

The sample consisted of 16 healthy women

Results

Kolmogorov-Smirnov tests indicated that all data were normally distributed.

When evaluating postural sway by visual field conditions, there were significant differences as subjects were barefoot for DSA (P = .022), SV (P = .020), and SA (P = .026; Table 2). In each instance, values were greater during the eyes-closed condition compared with eyes open. When subjects wore the gel insole, there were significant differences across visual fields for AE (P = .044), DSA (P = .017), and SA (P = .021;

Discussion

The maintenance of postural stability is dependent on a range of somatosensory inputs. Tactile sensitivity within the foot has a strong influence on maintenance of postural stability, as evidenced when this sensory input is lost in diabetic neuropathy.30, 31 Furthermore, vision has a definitive role in postural control.31, 32 Elderly persons are often unable to take advantage of the reinsertion of proprioception when vision is not available. Reintegration of proprioception under a no-vision

Conclusion

There were significant improvements in postural sway when subjects stood on both soft and hard insoles compared with standing barefoot, with more pronounced improvements when a hard insole was used. Providing increased sensory inputs with hard insoles may be an inexpensive and effective way to reduce fall risk in older adults.

MARTA ELENA LOSA IGLESIAS, PhD, is a Professor in the Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain.

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Immediate effect of insoles on balance in older adults
2021, Foot
Citation Excerpt :
A total of 626 studies were excluded after the full text articles were retrieved and reviewed. Thus, seven studies were finally included in this meta-analysis [9,11,22,24,26–28]. The detailed process of study selection is shown in Supplementary Figure 1.
In recent years, fall prevention in older adults has received considerable attention in healthcare. Among many interventions, insoles are considered cost-effective and easily adopted tools to improve balance in older people. Numerous studies have verified the immediate effects of insoles on balance in older adults. However, there is still lack of consensus regarding the immediate benefits of using insoles on balance improvement.
Given this, a meta-analysis was conducted to provide more conclusive evidence about the immediate effect of insoles on balance in older adults and answer the question: “Do insoles influence balance in older people?”
PubMed, NDSL, Medline, Google Scholar, and Web of Science were searched from March to August 2018. The key terms were “insole”, “elderly”, “gait”, “balance”, “shoe”, “foot”, and “postural”. Finally, seven primary studies were selected for this meta-analysis. The balance related outcomes were coded to compute effect sizes and the overall effect size of the standardized mean differences was analyzed. Moderating variables included kinematic variables of balance, static and dynamic balance, and type of insole.
The overall effect size of insoles was medium (d = 0.618), which suggests that insoles are beneficial for older adults for improving balance. More specifically, this study revealed that textured and vibration insoles were the most effective types of insoles.
This finding supports the idea that augmented tactile and mechanical sensory input from insoles can enhance the postural control mechanisms in older adults with age-related deterioration of sensory mechanisms. The use of insoles may lead to a reduction in the rate of falls which are related to decreased quality of life in older adults.
Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study
2021, Geriatric Nursing
Citation Excerpt :
The hardness of the sole influences awareness of foot position, which is related to stability and balance.9 However, these studies have not assessed all features of properly fitting footwear and focused only on a particular aspect.1,7,8 Moreover, the subjects used a different footwear than their habitual footwear in these studies.
The aim of the study was to assess the characteristics of footwear altogether and to compare the effect of appropriate-fitting and ill-fitting footwear on functional performance, balance, and fear of falling (FoF) in older adults. Individuals who wore appropriate-fitting (n = 61) or ill-fitting footwear (n = 92) were enrolled in the study. Footwear was evaluated using the Footwear Assessment Scale (FAS). The participants were assessed using the Berg Balance Scale (BBS) for balance, the Timed Up and Go test for functional performance and the Activities-specific Balance Confidence scale for FoF. Tests were conducted twice for each individual with or without footwear. Differences between the groups were analyzed using the MANOVA for scores of balance, performance and fear of falling and Chi-squared test for homogeneity. The Paired t-test was used to compare test scores with or without footwear. It was concluded that appropriate-fitting footwear improves balance, reduces fear of falling and may affect functional performance positively.
ClinicalTrials.gov No: NCT04151654
Relationship Between Postural Stability and Paraspinal Muscle Adaptation in Lame Horses Undergoing Rehabilitation
2020, Journal of Equine Veterinary Science
Citation Excerpt :
Use of foam pads has been used in human posturography to exaggerate balance deficits by altering the reliability of somatosensory input [14,16–18]. Human studies using force platforms have also shown increased postural sway when participants stood on a soft versus firm surface [19,20]. Improved postural stability has been shown to have multiple benefits in humans including protection of the spinal column [1,2] and enhancing the ability to respond to destabilizing forces [3,4].
Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses after a rehabilitation strengthening exercise program; however, correlation with functional postural stability has not been shown. The objective of the present study is to evaluate the relationship of the thoracolumbar m. multifidus CSA and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the equine rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data were also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.
Immediate Effects of Intermittent Bilateral Ankle Plantar Flexors Static Stretching on Balance and Plantar Pressures
2020, Journal of Manipulative and Physiological Therapeutics
The purpose of this study was to analyze the immediate effects of an intermittent plantar flexion static-stretching protocol on balance and plantar pressures.
The study included a sample size of 24 healthy participants (21 female and 3 male). Participants were 32.20 ± 8.08 years, 166.20 ± 8.43 cm, and 62.77 ± 9.52 kg. All participants performed an intermittent plantar flexion static-stretching protocol. Five sets (60 seconds intermittent stretch; 15 seconds for the rest time) of a passive plantar flexor stretching (70% to 90% of the point of discomfort) were performed. Static footprint analysis and a stabilometry analysis were performed before and after stretching. A P value < .05 with a CI of 95% was considered statistically significant for all tests.
Intermittent ankle plantar static stretching resulted in a significantly greater forefoot surface contact area and lower rear foot medium and maximum plantar pressures. In addition, static stretching caused a lower displacement of the center of pressure for both eyes open and eyes closed conditions.
An intermittent plantar flexor static-stretching protocol improved balance and reduced rear foot plantar pressures (maximum and medium pressures).
Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear
2019, Maturitas
Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility.
A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults.
Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.
Immediate effects of wearing knee length socks differing in compression level on postural regulation in community-dwelling, healthy, elderly men and women
2018, Gait and Posture
Citation Excerpt :
Recent investigations have suggested some beneficial effects of wearing a knee compressive sleeve in reducing postural sway in the anteroposterior (AP) direction [15] and donning a compression stocking reduced the CoP trajectory amplitude [16]. In an elderly sample, Losa Iglesia (2012) [17] reported that wearing socks reduced sway areas compared to when the same participants regulated posture in a barefoot condition. These initial findings suggest that more research is needed to address the role of wearing compression socks in stimulating somatosensory system feedback that emerges from pressure on cutaneous and joint receptors in the lower legs in the elderly population.
Stimulation of lower limbs’ cutaneous receptors and mechanoreceptors through compression garments could potentially increase somatosensory system efficiency and aid postural regulation in elderly individuals.
This study examined immediate effects of wearing knee length socks (KLS) of various compression levels on somatosensory function in community-dwelling healthy elderly men and women during a double-limb standing, balancing task.
A total of forty-six elderly participants (Male = 23), aged between 65 and 84 years old, randomly selected from the Singapore community-dwelling, healthy population. Three treatment interventions (wearing clinical compression socks; wearing non-clinical compression socks; wearing commercial socks) and one control condition (barefoot), in a counterbalanced order, were administered to participants while they performed a 30-s Romberg test, with four levels of performance difficulty: (1) standing on a stable surface with vision (SO); (2) a stable surface without vision (SC); (3) a foam surface with vision (FO); and (4), a foam surface without vision (FC).
Results showed that immediate effects of applying KLS of various compression levels significantly reduced sway area, trace length, velocity, and anterior-posterior (AP) sway as compared to barefoot condition (control) during the FO task condition.
This finding indicates the positive immediate effects of garments on somatosensory system function and postural regulation in the elderly men and women, especially when standing on the unstable surface. Wearing compression KLS could be included as a viable intervention on top of other forms of balance training to reduce risk of falling in elderly people.

View all citing articles on Scopus

MARTA ELENA LOSA IGLESIAS, PhD, is a Professor in the Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain.

RICARDO BECERRO DE BENGOA VALLEJO, DPM, PhD, is a Professor at the Escuela Universitaria Enfermería, Fisioterapia y Podología, Facultad de Medicina, Universidad Complutense de Madrid, Spain.

DOMINGO PALACIOS PEÑA, PhD, is a Professor in the Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain.

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Feature ArticleImpact of Soft and Hard Insole Density on Postural Stability in Older Adults

Section snippets

Subjects

Results

Discussion

Conclusion

Physiotherapy

Lancet

Gait Posture

J Electromyogr Kinesiol

Arch Phys Med Rehabil

Gait Posture

Clinical biomechanics (Bristol, Avon)

Arch Phys Med Rehabil

J Electromyogr Kinesiol

Gait Posture

Clin Geriatr Medicine

J Clin Epidemiol

Phys Ther Sport

Clin Biomech

Gait Posture

Gait Posture

Clin Biomech

Gait Posture

Feature Article
Impact of Soft and Hard Insole Density on Postural Stability in Older Adults