Session 4 – Friday
Footwear, orthoses, and insoles, and their effects on balance in older adults: a scoping review (20min)
Background: Footwear, orthoses, and insoles can influence balance in older adults, yet it remains unclear which features are considered optimal. The aim of this scoping review was to identify and synthesise the evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four databases were searched. Key terms such as “shoe*”, “orthoses”, “balance” and “older people” were searched. Studies meeting the following criteria were included: (i) participant age ≥ 60 years, free of neurological, musculoskeletal, and cardiovascular diseases, (ii) an intervention of either footwear, orthoses or insoles, and (iii) one objective outcome measure of balance was reported.
Summary: Fifty-six studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n=44; randomised parallel group, n=6; cohort study n=6). Duration of studies varied; 41 studies evaluated immediate-effects, 14 evaluated effects from 3-days to 12-weeks, and 1 study having a duration of 6-months. Seventeen interventions were evaluated; textured insoles (n=12), heel elevation (n=8), non-specific footwear and changes in sole thickness or hardness (n=7 each), sole geometry or rocker-soles, contoured or custom insoles and high-collar height (n=6 each), insole thickness or hardness and vibrating insoles (n=5 each), outsole tread (n=4), minimalist footwear and slippers (n=3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n=2 each), and eversion insoles, heel cups, and unstable footwear (n=1 each). Twenty-three different outcomes were assessed. The most common was postural sway (n=20), followed by temporo-spatial gait parameters (n=17). Features such as secure fixation, textured insoles, firm-to-hard midsoles and a higher-ankle collar, positively impacted balance. Conversely, elevated heel-height and use of socks and slippers impaired balance.
Key messages: Considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.
Ameer Nor Azhar
Ameer Nor Azhar
Podiatrist & PhD Candidate ||
La Trobe University
Ameer Nor Azhar
Podiatrist and PhD Candidate
Ameer Nor Azhar graduated from La Trobe University with a Bachelor of Applied Science/Master of Podiatric Practice in 2021. Since then, he has worked in private practice in Melbourne, Victoria.
Ameer returned to La Trobe University in a research assistant capacity in 2022, during this time, an opportunity to complete a PhD in footwear and balance arose. Ameer also works as a casual academic, teaching a variety of classes to podiatry students.
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Immediate and long-term impact of customized insole fabricated from different materials on gait parameters in participants with flat feet during running: Pilot study. (20min)
Introduction: Flat foot deformity is a common deformity that can negatively impact running performance and gait parameters. Customized insoles fabricated from different materials are frequently prescribed to correct flat foot deformity. However, immediate and long-term effects of customized insoles are rarely accessed, especially during running activity.
Objective: The objective of this study was to investigate the immediate and long-term effects of customized insoles fabricated from foam and natural rubber on gait parameters in participants with flat feet during running.
Materials and methods: Six participants (4 females and 2 males) with flat feet were recruited following specific inclusion and exclusion criteria. The participants were divided into two groups and each group was randomly assigned either customized foam insoles (CFI) or combination of natural rubber and foam insoles (CNI). The running gait parameters including speed, cadence, stride length, running cycle duration and symmetry index were collected immediately after donning insole and following three months use as long-term. Using the IMU sensor system the data was collected from trials including a) without insole, b) customized foam insole or c) combination of natural rubber and foam insole.
Result: The immediate use of CFI and CNI resulted in reduction of running speed by 3.61% and 0.21% compared to without insoles, respectively. Long-term use further reduced speed by 16.04% (CFI) and 12.00% (CNI). Cadence increased with CFI (20.21% immediate, 20.34% long-term) and CNI (47.75% immediate, 35.46% long-term). Stride length reduced with both CFI (3.46% immediate and 18.63% long-term) and CNI (8.69% immediate and 18.18% long-term). The symmetry index improved with CFI (immediate 1.75% and long-term 6.71%) and reduced 4.12% with CNI after immediate use and increased 0.06% with long-term use compared to without insole.
Conclusion: Customized insoles influence running gait parameters in individuals with flat feet. CFI generally provides improvements in cadence and symmetry index, however, CNI showed mixed results. The findings suggest that the material of the insole plays a vital role in its effectiveness and highlights the need for personalized insole prescriptions based on specific gait characteristics and long-term usage patterns
Nathanit Jirapongpathai
Nathanit Jirapongpathai
Lecturer, Researcher & Clinician ||
Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nathanit Jirapongpathai CPO, M.Sc. (Pedorthic) is working as a lecturer, researcher and clinician. She has done her bachelor and master's from Sirindhorn School of Prosthetics and is currently working as a lecturer and Certified Prosthetist and Orthotist at Sirindhorn School of Prosthetics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. She is involved with research related to various foot complications and foot biomechanics.
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A randomized controlled trial of digital foot scanning by different healthcare personnel in the CAD-CAM manufacture insoles system for people with foot-related conditions: A Pilot study. (20min)
Background: The increasing popularity of Computer-Aided Design and Manufacturing (CAD-CAM) insoles highlights their advantages, particularly in the rapid production for mass customization of foot orthoses. In regions with limited resources and insufficient orthotists, CAD-CAM foot orthoses utilizing a centralized fabrication system can potentially enhance the accessibility of this treatment. However, limiting the number of orthotists could be a challenge in the process. This study aims to evaluate the digital foot scanning process from the perspectives of different healthcare personnel.
Methods: A double-blind randomized controlled trial was conducted with 16 participants who had foot-related conditions requiring insoles. Participants were equally divided into two groups, undergoing digital foot scanning by either a physiotherapist or an orthotist. CAD-CAM insoles were then designed based on the foot scans then the insoles would be adjusted as prescribed by the physiatrist. The rate of insoles delivered without requiring adjustments was calculated. Assessments using the Foot Function Index questionnaire (FFI-Thai version) were performed at baseline, 1 month, and 3 months post-intervention.
Results: The rate of insoles delivered without adjustment was 88% in the orthotist group and 63% in the physiotherapist group, with satisfaction scores of 8.5 and 8.88 respectively (P=0.362). Follow-up at 1 and 3 months indicated improvements in the FFI subscales for pain (P=0.202) and disability (P=0.067), as well as the total score (P=0.111), although no significant differences were noted between the groups.
Conclusions: The study identified a difference in the success rates between the two groups. However, for a broader implementation of CAD-CAM central fabrication insoles in healthcare systems, further research with a larger sample size is necessary to better understand the system’s limitations.
Hathaichanok Arunsaengsin
Hathaichanok Arunsaengsin
Prosthetist and Orthotist ||
Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Hathaichanok Arunsaengsin is a Prosthetist and Orthotist at Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. With five years of experience in prosthetics and orthotics, she has dedicated the past three years to specializing in pedorthics. Her professional focus is on podiatry and orthotic management, areas in which she is deeply passionate.
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