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Footwear Interventions

A Review of Their Sensorimotor and Mechanical Effects on Balance Performance and Gait in Older Adults

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  • 1 School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
  • | 2 Health and Rehabilitation Research Institute and School of Podiatry, Auckland University of Technology, Auckland, New Zealand.
  • | 3 Health and Social Care Institute, Teesside University, Middlesbrough, England.
  • | 4 Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY.
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Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation. (J Am Podiatr Med Assoc 103(6): 516–533, 2013)

Corresponding author: Anna L. Hatton, PhD, School of Health and Rehabilitation Sciences, Therapies Building (84A), The University of Queensland, Brisbane, Queensland 4072, Australia. (E-mail: a.hatton1@uq.edu.au)