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STUDY DESIGN: Controlled laboratory study using a single-cohort design. OBJECTIVES: To determine if balance in older adults could be significantly improved with foot-orthotic intervention.
BACKGROUND: Poor balance has been associated with risk for falls. Limited evidence exists indicating that foot orthoses influence balance.
METHODS: Thirteen individuals older than 65 years, who reported at least 1 unexplained fall during the past year and demonstrated poor balance, participated in the study. Subjects were tested for 1-leg stance, tandem stance, tandem gait, and alternating step tests during the first (SCREEN) and second (PRE) sessions prior to foot-orthotic intervention. Tests were repeated during the second testing session immediately after custom foot-orthotic intervention (POST) and 2 weeks following foot-orthotic use (FU). SCREEN and PRE measures were compared for stability using absolute difference computations and the Friedman rank test. PRE, POST, and FU data were analyzed using the Friedman rank test (α = .05), with Bonferroni correction for multiple post hoc comparisons.
RESULTS: Each balance measure was statistically equivalent between the SCREEN and PRE measurements. One-leg stance times for PRE were significantly less than POST (P = .002) and FU (P = .013) measurements. Tandem stance times for PRE were significantly less than POST (P = .013) and FU (P = .013) measurements. Steps taken for the tandem gait test during the PRE measurements were significantly fewer than steps taken for the FU test (P = .007). Steps taken during the alternating step test for the PRE test were significantly fewer than steps taken during the POST (P = .002) and FU (P =.001) tests. POST and FU measurements were not significantly different for any of the 4 outcome measures.
CONCLUSIONS: The results provide preliminary evidence that foot orthoses can effect improvement in balance measures for older adults.
Re: Effects of Foot Orthoses on Balance in Older Adults
Effectiveness of a multifaceted podiatry intervention to
prevent falls in community dwelling older people with
disabling foot pain: randomised controlled trial
Objective To determine the effectiveness of a
multifaceted podiatry intervention in preventing falls in
community dwelling older people with disabling foot
Design Parallel group randomised controlled trial.
Setting University health sciences clinic in Melbourne,
Participants 305 community dwelling men and women
(mean age 74 (SD 6) years) with disabling foot pain and an
increased risk of falling. 153 were allocated to a
multifaceted podiatry intervention and 152 to routine
podiatry care, with 12 months’ follow-up.
Interventions Multifaceted podiatry intervention
consisting of foot orthoses, advice on footwear, subsidy
for footwear ($A100 voucher; £65; €74), a home based
programme of foot and ankle exercises, a falls prevention
education booklet, and routine podiatry care for
12 months. The control group received routine podiatry
care for 12 months.
Main outcome measures Proportion of fallers and
multiple fallers, falling rate, and injuries resulting from
falls during follow-up.
Results Overall, 264 falls occurred during the study. 296
participants returned all 12 calendars: 147 (96%) in the
intervention group and 149 (98%) in the control group.
Adherence was good, with 52% of the participants
completing 75% or more of the requested three exercise
sessions weekly, and 55% of those issued orthoses
reporting wearing them most of the time. Participants in
the intervention group (n=153) experienced 36% fewer
falls than participants in the control group (incidence rate
ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01).
The proportion of fallers and multiple fallers did not differ
significantly between the groups (relative risk 0.85, 0.66
to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One
fracture occurred in the intervention group and seven in
the control group (0.14, 0.02 to 1.15, P=0.07). Significant
improvements in the intervention group compared with
the control group were found for the domains of strength
(ankle eversion), range of motion (ankle dorsiflexion and
inversion/eversion), and balance (postural sway on the
floor when barefoot and maximum balance range wearing
Conclusions A multifaceted podiatry intervention reduced
the rate of falls in community dwelling older people with
disabling foot pain. The components of the intervention
are inexpensive and relatively simple to implement,
suggesting that the programme could be incorporated
into routine podiatry practice or multidisciplinary falls
Trial registration Australian New Zealand Clinical Trials