The Effects of Insoles and Footwears on Balance in Older People A Review of Literatures

Document Type : Review Articles


1 PhD, Department of Orthotics and Prosthetics, Musculoskeletal Research center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 MSc, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran



AbstractOlder people enconter a reduced balance performance as they have lower sensory and motor abilities. Balance problem pomote the risk of falling and subsequent disabling injuries and even death among older people.These problems can impose an extensive chargers on healthcare systems. Insole and footwear are an interface between plantar surface and the ground and can regulate the sensory inputs from the foot. In the light of the given background, the role of footwear and insole can be given more attention to prevent falling problem in older people. This study was to review the effects of different types of shoes and insoles and their roles on balance in older people.A systematic search was carried out within electronic data-bases.Key words included all different synonyms of aging, balance, shoe, insoles and their combinations.There are three possible ways in which can affect balance using shoe and insole: First, by increasing sensory feedbacks as (e.g.vibrating insoles or textured insoles). Second, by making changes in plantar pressure (e.g. Arch support insoles). Third, by applying changes in alignment of ankle joint (e.g. different heel height in shoe). The finding of this review implied that reduction of sensory inputs from the foot in older people can cause a higher risk of balance instability and falling.  Based on the research evidnces, using appropriate footwear and insole can effectively control the risk of balance instability and its complications in elder people. Key words: insole, footwear, older people, balance

  1. Winter DA. Human balance and posture control during standing and walking. Gait Posture. 1995; 3(4):193-214.
  2. Horak FB, Nashner LM, Diener HC. Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res 1990; 82(1): 167-77.
  3. Manchester D, Woollacott M, Zederbauer-Hylton N, Marin O. Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontol 1989; 44(4): M118-27.
  4. Borah D, Singh U, Wadhwa S, Bhattacharjee M. Postural stability: Effect of age. IJPMR 2007; 18(1): 7-10.
  5. Qiu F, Cole M, Davids K, Hennig E, Silburn P, Netscher H, et al. Enhanced somatosensory information decreases postural sway in older people. Gait Posture 2012; 35(4): 630-5.
  6. Fitzpatrick R, Rogers DK, McCloskey D. Stable human standing with lower-limb muscle afferents providing the only sensory input. J Physiol 1994; 480(Pt 2): 395-403.
  7. Barak Y, Wagenaar RC, Holt KG. Gait characteristics of elderly people with a history of falls: a dynamic approach. Phys Ther 2006; 86(11): 1501-10.
  8. Newstead AH, Walden GJ, Gitter AJ. Gait variables differentiating fallers from nonfallers. J Geriatr Phys Ther 2007; 30(3): 93-101.
  9. Lafond D, Corriveau H, Prince F. Postural control mechanisms during quiet standing in patients with diabetic sensory neuropathy. Diabetes Care 2004; 27(1): 173-8.
  10. Berry SD, Miller RR. Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep 2008; 6(4): 149-54.
  11. Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995.
  12. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Eng J Med 1988; 319(26): 1701-7.
  13. Maki BE, Holliday PJ, Topper AK. Fear of falling and postural performance in the elderly. J Gerontol 1991; 46(4): M123-31.
  14. Yasuda T, Nakagawa T, Inoue H, Iwamoto M, Inokuchi A. The role of the labyrinth, proprioception and plantar mechanosensors in the maintenance of an upright posture. Eur Arch Otorhinolaryngol 1999; 256(Suppl 1): S27-32.
  15. Hijmans JM, Geertzen JH, Dijkstra PU, Postema K. 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. Gait Posture 2007;25(2): 316-23.
  16. Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, et al. Footwear style and risk of falls in older adults. J Am Geriatr Soc 2004; 52(9): 1495-501.
  17. Losa Iglesias ME, Becerro de Bengoa Vallejo R, Palacios Peña D. Impact of soft and hard insole density on postural stability in older adults. Geriatr Nurs 2012; 33(4): 264-71.
  18. Priplata AA, Niemi JB, Harry JD, Lipsitz LA, Collins JJ. Vibrating insoles and balance control in elderly people. Lancet 2003; 362(9390): 1123-4.
  19. Nelson C. Do Noisy Insoles Improve Balance?. Back Letter 2003; 18(12): 134.
  20. Hinman MR. Effect of magnetic insoles on balance in older adults. J Am Geriatr 20. Soc 2004; 52(1): 166.
  21. Nigg BM, Wakeling JM. Impact forces and muscle tuning: a new paradigm. Exerc Sport Sci Rev 2001; 29(1): 37-41.
  22. Kavounoudias A, Roll R, Roll JP. Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation. J Physiol 2001; 532(Pt 3): 869-78.
  23. Janin M, Dupui P. The effects of unilateral medial arch support stimulation on plantar pressure and center of pressure adjustment in young gymnasts. Neurosci Lett 2009; 461(3): 245-8.
  24. Gross MT, Mercer VS, Lin F-C. Effects of foot orthoses on balance in older adults. J Orthop Sports Phys Ther 2012; 42(7): 649-57.
  25. Mulford D, Taggart HM, Nivens A, Payrie C. Arch support use for improving balance and reducing pain in older adults. Appl Nurs Res 2008; 21(3): 153-8.
  26. Maki BE, Perry SD, Norrie RG, McIlroy WE. Effect of facilitation of sensation from plantar foot-surface boundaries on postural stabilization in young and older adults. J Gerontol A Biol Sci Med Sci 1999; 54(6): M281- 7.
  27. Palluel E, Nougier V, Olivier I. Do spike insoles enhance postural stability and plantar-surface cutaneous sensitivity in the elderly?. Age 2008; 30(1): 53-61.
  28. Palluel E, Olivier I, Nougier V. The lasting effects of spike insoles on postural control in the elderly. Behav Neurosci 2009; 123(5): 1141-7.
  29. Perry SD, Radtke A, McIlroy WE, Fernie GR, Maki BE. Efficacy and effectiveness of a balance-enhancing insole. J Gerontol A Biolog Sci Med Sci 2008; 63(6): 595-602.
  30. Wilson ML, Rome K, Hodgson D, Ball P. Effect of textured foot orthotics on static and dynamic postural stability in middle-aged females. Gait Posture 2008; 27(1): 36-42.
  31. Hatton AL, Dixon J, Rome K, Martin D. Standing on textured surfaces: effects on standing balance in healthy older adults. Age Ageing 2011; 40(3): 363-8.
  32. Galica AM, Kang HG, Priplata AA, D’Andrea SE, Starobinets OV, Sorond FA, et al. Subsensory vibrations to the feet reduce gait variability in elderly fallers. Gait Posture 2009; 30(3): 383-7.
  33. Hijmans JM, Geertzen JH, Schokker B, Postema K. Development of vibrating insoles. Int J Rehabil Res 2007; 30(4): 343-5.
  34. Roll R, Kavounoudias A, Roll JP. Cutaneous afferents from human plantar sole contribute to body posture awareness. Neuroreport 2002; 13(15): 1957-61.
  35. Moss F, Ward LM, Sannita WG. Stochastic resonance and sensory information processing: a tutorial and review of application. Clin Neurophysiol 2004; 115(2): 267-81.
  36. Spink MJ, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, Lord SR, et al. Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. BMC Geriatr 2011; 11(1): 51.
  37. Landsman A, DeFronzo D, Anderson J, Roukis T. Scientific assessment of over-the-counter foot orthoses to determine their effects on pain, balance, and foot deformities. J Am Podiatr Med Assoc 2009; 99(3): 206-15.
  38. Brenton-Rule A, Bassett S, Walsh A, Rome K. The evaluation of walking footwear on postural stability in healthy older adults: An exploratory study. Clin Biomech 2011; 26(8): 885-7.
  39. Arnadottir SA, Mercer VS. Effects of footwear on measurements of balance and gait in women between the ages of 65 and 93 years. Phys Ther 2000; 80(1): 17-27.
  40. Tencer AF, Koepsell TD, Wolf ME, Frankenfeld CL, Buchner DM, Kukuii WA, et al. Biomechanical properties of shoes and risk of falls in older adults. J Am Geriatr soc 2004; 52(11): 1840-6.
  41. Robbins S, Waked E, McClaran J. Proprioception and stability: foot position awareness as a function of age and footware. Age Ageing 1995; 24(1): 67-72.
  42. Ramstrand N, Thuesen AH, Nielsen DB, Rusaw D. Effects of an unstable shoe construction on balance in women aged over 50 years. Clin Biomech 2010; 25(5): 455-60.
  43. Hömme AK, Hennig EM, Müller C, Ninck C. The influence of two unstable shoe modifications on lower extremity kinetics during walking and postural balance in elderly men. Footwear Sci 2012; 4(2): 83-91.
  44. Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev 2008; 45(8): 1167-81.
  45. Robbins S, Gouw GJ, McClaran J. Shoe sole thickness and hardness influence balance in older men. J Am Geriatrics Soc 1992; 40(11): 1089-94.