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In press with Gait and Posture:

A systematic review of the effects of shoes and other ankle or foot appliances on balance in older people and people with peripheral nervous system disorders

Juha M. Hijmans, Jan H.B. Geertzen, Pieter U. Dijkstra and Klaas Postema

The objective of this paper is to identify and review all publications on effects ankle and/or foot appliances (AFA) on balance in older people (≥60 years) and patients with peripheral nervous system disorders (PNSD). These two groups account for the majority of the population with deteriorated balance due to peripheral somatosensory feedback problems. To provide a context for understanding and interpreting the studies that have been published to date, we will briefly summarize current theories on the role of somatosensory mechanisms in control of balance and how balance can be affected by AFA. A systematic literature review is presented in which publications were searched in Medline, Embase and Recal. In total 146 papers were identified and 18 were selected based on title and abstract for qualitative assessment by two independent reviewers. Based on assessment of the total articles, seven of the 18 papers fulfilled predetermined qualitative criteria and were selected for detailed review. No definitive conclusions can be drawn concerning the effects of AFA on balance in older people or in patients with PNSD because of the small number of studies and the weak level of evidence. The available literature seems to indicate that a training program may be helpful in ensuring the effectiveness of an appliance. Insoles with tubing or vibrating elements may improve balance, whereas thick or soft soles may deteriorate balance. The effects of these different types of insoles or soles are consistent with theories about somatosensory mechanisms that play a role in control of balance. More and better quality research is needed to support the prevalent use of appliances in these populations.