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From the Journals of Gerontology:

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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63:595-602 (2008)

Efficacy and Effectiveness of a Balance-Enhancing Insole

Stephen D. Perry, Alison Radtke, William E. McIlroy, Geoff R. Fernie and Brian E. Maki

Background. Age-related loss of foot-sole cutaneous sensation is very common and is associated with impaired balance control. This study investigated the effect of a balance-enhancing insole (designed to facilitate foot-sole sensation) on lateral gait stability and evaluated its effectiveness in daily life.

Methods. Forty community-dwelling older adults (age 65–75) with moderate loss of foot-sole sensation (unrelated to neuropathy) were fitted with the same model of walking shoes. Half of the participants were assigned, at random, to wear the shoes with a facilitatory insole for 12 weeks; the other participants wore a conventional insole. A gait perturbation protocol, simulating uneven terrain, was performed at baseline and after wearing the assigned insoles for 12 weeks. Participants were tested with both types of insoles during each gait-testing session and sent in weekly postcards with information pertaining to insole comfort, hours of wear, and falls.

Results. The facilitatory insole improved lateral stability during gait, and this benefit did not habituate after 12 weeks of wearing the insole in daily life. Nine participants who wore conventional insoles experienced one or more falls, whereas only five of the facilitatory group fell. Although there were initial reports of mild discomfort in 10 cases, all but one participant tolerated the facilitatory insole, and most indicated that they would like to continue wearing the insole on a long-term basis.

Conclusions. A relatively simple change in insole design can help to counter effects of age-related (non-neuropathic) decline in foot-sole sensitivity, and is a viable intervention to enhance balance control.

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A far bigger study needs to be done before this device can be considered effective in reducing falls, but it's an interesting result.

Attached Images

solesensor.jpg (73.4 KB, 200 views)

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Cheers,

Hylton

Hylton B. Menz, PhD
Associate Professor and Reader
NHMRC Australian Clinical Research Fellow
Director, Musculoskeletal Research Centre
La Trobe University

Hello Hylton!

I deduce from the attached picture the distinguishing feature of the insole is the circumferential 'lip' as opposed to any specific difference in the property of the material ? The attached article suggest the use of plastic tubing ...

Attached Files

IH_46_1_40.pdf (1,006.2 KB, 28 views)

Hi Dieter,

The original device tested in the J Gerontol 1999 paper (link) was a simple tube adhered to the sole of the foot. The patented device incorporates this into the insole, but to my knowledge the material is consistent throughout the device. I'm waiting on a pair arriving in the mail, so I can provide more details when I actually get my hands on one.

__________________
Cheers,

Hylton

Hylton B. Menz, PhD
Associate Professor and Reader
NHMRC Australian Clinical Research Fellow
Director, Musculoskeletal Research Centre
La Trobe University

Hilton,

Is this already a commercially available product ? If yes, where is it sold?

Thanks

PS I know of a grandma who could be a useful guinea pig

It is good to see shoe insoles/inserts having a role to play in postural stability. If you read the literature there are many designs that have been reported to enhance postural stability. Vibrating insoles is literally the ‘buzz’ concept relating to at risk groups such as diabetics or those with stroke. However, other researchers have looked at textured insoles, custom-made foot orthoses and orthoses with either forefoot or rearfoot wedges. Previous studies have related to younger folk so it is good to see studies relating to older adults with a history of falls.

I am interested in evidence of age related neuropathy as I have always referred to it, but I note from the artical it is referred to ( unrelated neuropathy). I have talked to Dr A Vinik and received 2 titles of papers but my previous searches came up bare. In my practise I test every new patient with the biothesiometer and monofilaments and have the physcian rule out DM, B12 defiency and abnormal thyroid levels. This "neuropathy" is affecting approx 2/3 of my seniors and highest in the advanced decades. Balance is clearly the main symptoms in the mobile pt and in nursing home work I was finding "neuropathic" wounds although I no longer have a nursing home practice to monitor this aspect.

Following an earlier study regarding shod verses slippers I nag everybody with any neuropathy to banish their slippers. It would be interesting to see how the study controlled for footwear with these insoles.

From Applied Nursing Research:

Arch support use for improving balance and reducing pain in older adults

Debbie Mulford, Helen M. Taggart, Anita Nivens, Camille Payrie

Abstract

Purpose
The purpose of this study was to examine the effects of arch supports on balance, functional mobility, and pain in the back and lower extremity joints among older adults.

Design
A single-factor within-subjects design was used.

Method
A convenience sample of older adults formed a single group for fitting with arch supports. Balance, functional mobility, and self-reported pain in the back and lower extremities were measured without the arch supports, immediately after the insertion of the supports in the subjects' shoes, and after 6 weeks of arch support use.

Findings
Sixty-seven older adults completed the study. The measures used indicated statistically significant improvements in scores for the Berg Balance Scale [Berg, K., Williams-Dauphinee, S., & Williams, J. I., (1995). The Balance Scale: Reliability assessment for elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27, 27–31] and functional mobility [Timed Up and Go test; Podsiadlo, D., & Richardson, S. (1991). The Timed “Up and Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148] as well as reduced back, foot, knee, and hip pain (p < .05). There was no statistically significant change in ankle pain (p > .05).

Implications
Knowledge of interventions that enhance health and well-being is essential for nurses. Arch supports may provide improved balance and functional mobility while reducing back and lower extremity joint pains. Further research is needed to support evidence-based practice.

__________________
Cheers,

Hylton

Hylton B. Menz, PhD
Associate Professor and Reader
NHMRC Australian Clinical Research Fellow
Director, Musculoskeletal Research Centre
La Trobe University

Hi Hylton and Co,

We are currently organizing a pilot study in this field (falls prevention) along with Physiotherapists and Occupational Therapists. As I have not been a coordinator of a study before, I would appreciate your help with the following question.

In applying for ethics clearance, is there a stringent set format to follow? Or is it a case of illustrating the obvious (background, aim, methodology, etc)?

Thanking you in advance,

Con Psaromatis

Hi Everyone

There seems to be a growing body of evidence relating to shoe inserts and postural stability. The biggest issue relates to the type of shoe insert and the type of participants that need the shoe insert. Should further studies also include modifications to footwear?

These balance-enhancing insoles to prevent falls in older people look interesting. I would like to see more evidence base before trying these out as a recommendation in nursing home or community-dwelling older people.
Following completion of a thesis in this subject, I have organised a pilot study of sturdy footwear vs slippers in ambulant nursing home residents related to falls, with some statistically positive results in falls reduction.
Compliance, however is a problem. Slippers appear to be the 'footwear of choice' for the majority of nursing home residents. Convincing residents and relatives otherwise is often a hurdle to overcome. These simple inserts, if they work, might be a compromise.

From my client base it is not the elderly client that needs to be convinced to wear shoe as apposed to slippers, it is the staff that dress/assist that complain that the footwear must be easy to slip on.
So the daughter comes in and says ..."oh no, Mum cant have laces or velcro the staff complain"

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David Sutton
C.Ped.CM
My location
www.bilbyshoes.com

Co-operation from managers and polocy-makers, introducing care plans and conducting small seminars in-house, advocating soft velcro shoes, is slowly getting the message across to staff:
1. Increased ease of foot entry and adjustability (particularly oedematous & arthritic feet)
2. Increased stability
3. Increased fixation.

Information boards in reception areas for relatives (who usually hold the purse strings!) and individual consultation is taking a little longer.

Suggestions welcome!