Efficacy and effectiveness of a balance-enhancing insole. Impact of soft and hard insole density on postural stability in older adults. Intervention Study to Improve Quality of Life and Health Problems of Community-Living Elderly Women in Japan by Shoe Fitting and Custom-Made Insoles Effect of cushioned insoles on impact forces during running. A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait A shoe insole delivering subsensory vibratory noise improves balance and gait in healthy elderly people. A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participant-blinded randomised controlled trial Viscoelastic shoe insoles: their use in aerobic dancing. Baseline-dependent effect of noise-enhanced insoles on gait variability in healthy elderly walkers. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Efficacy of an insole shoe wedge and augmented pressure sensor for gait training in individuals with stroke: a randomized controlled trial Randomized controlled trial for clinical effects of varying types of insoles combined with specialized shoes in patients with rheumatoid arthritis of the foot. The effect of heel pads on the treatment of Achilles tendinitis: A double blind trial Effects of walking surfaces and footwear on temporo-spatial gait parameters in young and older people. Effectiveness of Total Contact Insoles in Patients with Plantar Fasciitis Effect of viscoelastic insoles on pain. A 2-year follow-up of a study to compare the efficacy of lateral wedged insoles with subtalar strapping and in-shoe lateral wedged insoles in patients with varus deformity osteoarthritis of the knee.
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 ( design ed 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 r and om , 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 A significant predictor of falls in the elderly population is attributed to postural instability . Thus , it is important to identify and implement practical clinical interventions to enhance postural stability in older adults .  Shoe insoles have been identified as a mechanism to enhance postural control , and our study aim ed to evaluate the impact of 2 shoe insoles on static st and ing balance in healthy , older adults compared with st and ing posture while barefoot . We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition . Indeed , excursion distances and sway areas were reduced , and sway velocity was decreased when wearing insoles . The hard insole was also effective when visual feedback was removed , suggesting that the more rigid an insole , the greater potential reduction in fall risk . Thus , shoe insoles may be a cost-effective , clinical intervention that is easy to implement to reduce the risk of falling in the elderly population Background : To maintain and improve foot environment that forms the basis of everyday life of the elderly is an important issue not only from the viewpoint to provide support for functional capacity , but also to maintain the quality of life ( QOL ) of the elderly . Objective : To determine the effects of shoe-fitting guidance and wearing shoes with custom-made insoles ( CMI ) on improving the health-related QOL of community-living elderly women . Methods : Seventy-nine healthy women who lived in an urban community aged 65–92 years were allocated r and omly to a control group ( n = 40 ; mean age ± SD 75.0 ± 5.1 years ) or an intervention group ( n = 39 ; mean age ± SD 75.5 ± 6.0 years ) . The intervention group was given detail guidance on shoe fitting and asked to wear shoes with CMI for 1 month . The control group had a 30-min lecture on better ways of choosing shoes .  The QOL was assessed using the Medical Outcomes Study Short Form 36 ( SF-36 ) . Results : No significant differences in baseline measurements were observed between the two groups in all 10 scores of the SF-36 ( 8 domains and 2 summary scores ) . After intervention , the two groups differed significantly in three domains : mental health , bodily pain , and general health ( p < 0.05 ) . In comparing the mean baseline and postintervention SF-36 scores , the control group showed no significant differences in all 10 scores . On the other h and , the intervention group improved in five domains and two summary scores , i.e. , vitality and mental component summary ( p < 0.05 ) , role physical , general health perceptions , role emotional and physical component summary ( p < 0.01 ) , and mental health ( p = 0.0003 ) . The intervention was markedly effective not only in the physical but also in the mental aspect . Conclusion : Wearing shoes with CMI adjusted to individual feet significantly improves the health-related QOL , including both physical and mental aspects in community-living elderly women BACKGROUND The use of cushioned or shock-absorbing insoles has been suggested as a mechanism to reduce the impact forces associated with running , thereby protecting against overuse injuries . The purpose of this study was to determine whether the use of cushioned insoles reduced impact forces during running in healthy subjects . METHODS Sixteen recreational runners ( 9 females and 7 males ) ran at a self-selected pace for five trials with and without the use of cushioned insoles . During each trial , ground reaction forces , tibial accelerations , lower-extremity kinematics , and subject-perceived comfort were recorded . All variables were tested with the level of statistical significance set at alpha = .05 . RESULTS The use of cushioned insoles result ed in significant reductions in mean vertical ground reaction force peak impact ( 6.8 % ) and ground reaction force loading rate ( 8.3 % ) , as well as peak tibial acceleration ( 15.8 % ) . Spectral analysis of the tibial acceleration data in the frequency range associated with impact accelerations ( 12 - 25 Hz ) revealed no change in the predominant frequency or the power of the predominant frequency . The knee flexion angle at initial contact and perceived comfort were similar for the two conditions . CONCLUSIONS This study demonstrates the effectiveness of one type of cushioned insole in reducing peak impact force and tibial acceleration at initial foot-ground contact during running . The impact reduction observed was independent of knee kinematic adjustments or changes in perceived comfort . Further study is required to determine whether the reduction in loading that accompanied the use of the cushioned insoles can affect the incidence of running-related injuries Background : Shear stresses have been implicated in the formation of diabetes-related foot ulcers . The aim of this study was to evaluate the effect of a novel shear-reducing insole on the thermal response to walking , balance , and gait . Method : Twenty-seven diabetes peripheral neuropathy patients were enrolled and asked to take 200 steps in both intervention and st and ard insoles . Thermal foot images of the feet were taken at baseline ( 1 ) following a 5-minute temperature acclimatization and ( 2 ) after walking . Testing order was r and omized , and a 5-minute washout period was used between testing each insole condition . Sudomotor function was also assessed . Gait and balance were measured under single and dual task conditions using a vali date d body worn sensor system . Results : The mean age was 65.1 years , height was 67.3 inches , weight was 218 pounds , and body mass index was 33.9 , 48 % were female , and 82 % had type 2 diabetes . After walking in both insole conditions , foot temperatures increased significantly in st and ard insoles . The intervention insole significantly reduced forefoot and midfoot temperature increases ( 64.1 % , P = .008 ; 48 % , P = .046 ) compared to st and ard insoles . There were significant negative correlations with sudomotor function and baseline temperatures ( r = .53-.57 ) . The intervention demonstrated 10.4 % less gait initiation double support time compared to st and ard insoles ( P = .05 ) . There were no differences in static balance measures . Conclusions : We found significantly lower forefoot and midfoot temperature increases following walking with shear-reducing insoles compared to st and ard insoles . We also found improvements in gait . These findings merit future study for the prevention of foot ulcer OBJECTIVES To test whether subsensory vibratory noise applied to the sole of the foot using a novel piezoelectric vibratory insole can significantly improve sensation , enhance balance , and reduce gait variability in elderly people , as well as to determine the optimal level of vibratory noise and whether the therapeutic effect would endure and the user 's sensory threshold would remain constant during the course of a day . DESIGN A r and omized , single-blind , crossover study of 3 subsensory noise stimulation levels on 3 days . SETTING Balance and gait laboratory . PARTICIPANTS Healthy community-dwelling elderly volunteers ( N=12 ; age , 65 - 90y ) who could feel the maximum insole vibration . INTERVENTIONS A urethane foam insole with the piezoelectric actuators delivering subsensory vibratory noise stimulation to the soles of the feet . MAIN OUTCOME MEASURES Balance , gait , and timed Up and Go ( TUG ) test . RESULTS The vibratory insoles significantly improved performance on the TUG test , reduced the area of postural sway , and reduced the temporal variability of walking at both 70 % and 85 % of the sensory threshold and during the course of a day . Vibratory sensation thresholds remained relatively stable within and across study days . CONCLUSIONS This study provides proof of concept that the application of the principle of stochastic resonance to the foot sole sensory system using a new low-voltage piezoelectric technology can improve measures of balance and gait that are associated with falls . Effective vibratory noise amplitudes range from 70 % to 85 % of the sensory threshold and can be set once daily Background Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced . Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk . The type of insole best suited to achieve this is unknown . This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet . Method A participant-blinded r and omised controlled trial recruited 119 neuropathic participants with diabetes who were r and omly allocated to custom-made functional or prefabricated insoles . Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system . Primary outcomes were : peak pressure , forefoot pressure time integral , total contact area , forefoot rate of load , duration of load as a percentage of stance . Secondary outcomes were patient perceived foot health ( Bristol Foot Score ) , quality of life ( Audit of Diabetes Dependent Quality of Life ) . We also assessed cost of supply and fitting . Analysis was by intention-to-treat . Results There were no differences between insoles in peak pressure , or three of the other four kinetic measures . The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue ( 27 % vs. 22 % ) , remained more effective at six month follow-up ( 30 % vs. 24 % , p=0.001 ) , but was more expensive ( UK £ 656 vs. £ 554 , p<0.001 ) . Full compliance ( minimum wear 7 hours a day 7 days per week ) was reported by 40 % of participants and 76 % of participants reported a minimum wear of 5 hours a day 5 days per week . There was no difference in patient perception between insoles . Conclusion The custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure . We recommend that where clinical ly appropriate , the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy . Trial registration Clinical trials.gov ( NCT00999635 ) . Note : this trial was registered on completion To determine whether use of viscoelastic insoles would significantly decrease the frequency of musculoskeletal overuse injury in aerobic dancers , 139 high-level aerobic dancers were divided r and omly into two groups . The control group received placebo foam insoles and test subjects were fitted with viscoelastic insoles .  Subjects used these insoles during dance class for 15 weeks . Injury rates were low in both groups and no statistical difference was found . Pain syndromes were fewer in the group using viscoelastic insoles , but the difference was not statistically significant . About a third of dancers fitted with viscoelastic insoles and a tenth of placebo insert wearers found that the insoles made their shoes too tight to be comfortable . No conclusion can be drawn on whether shock-absorbing insoles decrease injuries from aerobic dancing , but use of viscoelastic insoles may improve comfort and provide pain relief for some high-level aerobic dancers if proper fit is achieved The purpose of this study was to determine whether providing subsensory stochastic-resonance mechanical vibration to the foot soles of elderly walkers could decrease gait variability . In a r and omized double-blind controlled trial , 29 subjects engaged in treadmill walking while wearing s and als customized with three actuators capable of producing stochastic-resonance mechanical vibration  embedded in each sole . For each subject , we determined a subsensory level of vibration stimulation . After a 5-min acclimation period of walking with the footwear , subjects were asked to walk on the treadmill for six trials , each 30s long . Trials were pair-wise r and om : in three trials , actuators provided subsensory vibration ; in the other trials , they did not . Subjects wore reflective markers to track body motion . Stochastic-resonance mechanical stimulation exhibited baseline-dependent effects on spatial stride-to-stride variability in gait , slightly increasing variability in subjects with least baseline variability and providing greater reductions in variability for subjects with greater baseline variability ( p<.001 ) . Thus , applying stochastic-resonance mechanical vibrations on the plantar surface of the foot reduces gait variability for subjects with more variable gait . Stochastic-resonance mechanical vibrations may provide an effective intervention for preventing falls in healthy elderly walkers A prospect i ve controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities .  The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Isl and , South Carolina .  Polymer and st and ard mesh insoles were systematic ally distributed in boots that were issued to members of odd and even numbered platoons . The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training . To control for the confounding effects of running in running shoes , which occurred for about one and one-half hours per week for the first five weeks , we also examined the association of age of shoes and cost of shoes with injury incidence . A slight trend of increasing stress injuries by increasing age of shoes was observed . However , this trend did not account for the similarity of rates in the two insole groups . In addition , we observed a strong trend of decreasing stress injury rate by history of increasing physical activity , as well as a higher stress injury rate in White compared to Black recruits . The results of the trial were not altered after controlling for these factors . This prospect i ve study confirms previous clinical reports of the association of stress fractures with physical activity history . The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits . The findings are relevant to civilian population Objective : To determine whether external feedback to promote symmetrical weight distribution during st and ing and walking would improve gait performance and balance in people with stroke . Design : R and omized , controlled , assessor-blinded trial . Setting : Rehabilitation unit and physical therapy department . Subjects : Thirty-five individuals with stroke ( mean ( SD ) age = 53.0 ( 9.3 ) years ) were r and omly assigned to an experimental ( n = 17 ) or control group ( n = 18 ) . Time post stroke was less than six months for most subjects ( n = 27 , 77 % ) . Interventions : Subjects participated in 15 rehabilitation sessions including 30 minutes of gait retraining per session . During gait retraining , the experimental group used an insole shoe wedge and sensors set-up ( I-ShoWS ) while the control group received a conventional programme . The I-ShoWS set-up consisted of a wedge insole and a footswitch for the non-paretic leg and a pressure sensor on the paretic leg . Outcome measures : Gait speed , step length and single support time asymmetry ratio , balance and amount of load on paretic leg during stance were evaluated twice : one day before and after training . Results : The experimental group demonstrated significant increase in st and ing and gait symmetry compared with the control group ( P < 0.05 ) . They demonstrated 3 times greater improvement in gait speed than the control group ( P = 0.02 ) . Balance improvement was significantly greater for the experimental than for the control group ( P < 0.05 ) . Conclusion : Gait retraining using the I-ShoWS set-up was more effective in restoration of gait speed , st and ing and walking symmetry and balance than a conventional treatment programme . These results indicate the benefit of implementing feedback during gait retraining OBJECTIVE To determine the effects of specialized shoes with insoles in patients with rheumatoid arthritis and the differences in terms of type of insole and anatomical location of foot pathology . DESIGN Single-blinded r and omized controlled trial . SETTING Out patients of physical medicine and rehabilitation clinic at university hospital . SUBJECTS Forty-two patients with rheumatoid foot lesions were r and omly assigned to two different orthotic intervention groups . The anatomical locations of the foot lesions were recorded ( hindfoot or forefoot ) . INTERVENTION Participants were provided with an extra deep forefoot-rockered shoe and either a custom-made semi-rigid insole or a ready-made simple soft insole . They wore the provided footwear for at least 3 hours a day over six months . MAIN OUTCOME MEASURES Primary outcome measures were foot pain visual analogue scale ( VAS ) scores and Foot Function Index ( FFI ) . Secondary outcome measures were erythrocyte sedimentation rate and C-reactive protein levels in blood , amounts of medications and active joint counts . These were checked at baseline and post intervention . RESULTS Eight patients dropped out at follow-up after six months of treatment . At six-month follow-ups , VAS scores and total Foot Function Index scores had decreased significantly in both groups versus baseline but intergroup comparison showed no significant differences in view of type of insoles and anatomical locations of foot pathology . CONCLUSIONS We were unable to identify differences between the types of insoles in terms of their clinical effects or between anatomical locations of foot lesions in the two groups , but both groups improved . Therapeutic shoes plus soft insoles might be effective enough in terms of foot pain and foot function for specific patients with rheumatoid foot problems regardless of the location of foot pathology Thirty-three subjects entered a blind-observer , r and om , prospect i ve study of three forms of conservative treat ment of sports-induced Achilles tendinitis , results being assessed by clinical and biomechanical parameters . Two patient groups received heel pads , ultrasound , and exercises , while the third received only ultrasound and exercises . All three groups showed some improve ment at both 10 day and 2 month assessment , but the cl aim ed benefit of viscoelastic pads widely used by athletes was not substantiated . The more striking bene fit from  ultrasound and exercises  alone occurred in patients with a shorter history ; a comparison of duration of injury in all three groups suggested this was an important factor influencing outcome . The study has highlighted the need for biomechanical outcome measures as well as for more objective clinical outcome measures in the assessment of physical ther apy This study aim ed to investigate the effects of walking surfaces and shoe features on gait variables associated with balance control and the risk of slips and trips in 10 young and 26 older adults . A systematic approach was adopted in which the features of a st and ard , Oxford-type shoe were individually modified . Subjects walked along a level ( control ) , irregular , and wet walkway in eight r and omised shoe conditions ( st and ard , elevated heel , soft sole , hard sole , high-collar , flared sole , bevelled heel and tread sole ) . Walking velocity , step length , step width , cadence , double-support time , heel horizontal velocity and shoe-floor angle at heel contact , and toe clearance at mid-swing were measured . Older people exhibited a more conservative walking pattern , especially on the irregular and wet surfaces . Compared to the st and ard shoes , the elevated heel shoes elicited increased double-support time , heel horizontal velocity at heel strike and toe clearance . On the wet surface , the soft sole shoes led to shorter steps and a flatter foot l and ing , gait adaptations which are associated with perceptions of shoe/surface slipperiness . Increasing collar height led to greater double-support time and step width . The results indicate that shoes with elevated heels or soft soles impair walking stability in older people , especially on wet floors , and that high-collar shoes of medium sole hardness provide optimal stability on level dry , irregular and wet floors Objective . To assess the effectiveness of total contact insoles ( TCI ) in patients with plantar fasciitis ( PF ) . Methods . A double-blind r and omized controlled trial was carried out with intention-to-treat analysis . Seventy-four patients were r and omly allocated to use a TCI made of ethylene vinyl acetate ( study group , n = 37 ) or a flat insole ( control group , n = 37 ) . The following assessment tools were used : visual analog scale for pain while walking and at rest , Medical Outcomes Study Short Form-36 ( SF-36 ) for quality of life , Foot Function Index and Foot Health Status Question naire for foot function , 6-min walk test ( 6MWT ) , and baropodometer FootWalk Pro for plantar pressure analysis . The groups were evaluated by a blinded assessor at baseline and after 45 , 90 , and 180 days . Results . The groups were homogeneous for the majority of variables at baseline . The over-time comparisons show a statistical difference between the groups for pain while walking ( p = 0.008 ) and the 6MWT ( p = 0.010 ) . Both groups showed significant improvements in pain at rest , foot function , and some quality of life variables ( physical functioning , bodily pain , vitality , and social functioning ) , with no significant statistical differences between them . The baropodometer recorded no changes from the use of the insoles . Conclusion . A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF The purpose of this study was to assess the effect of viscoelastic shoe inserts on  pain in nursing students . Students ( N = 100 ) were r and omly assigned to control and viscoelastic groups . The viscoelastic group used viscoelastic insoles in their work shoes for five weeks . A pain question naire was used to measure location and intensity of post-work pain . The question naire was administered as a pre-test and after five weeks . Post-test comparisons between groups indicated significant differences which were not present at pre-test . The viscoelastic group reported a significant peripheral shift in pain location from back to lower extremity ; the viscoelastic group also showed significant changes in duration of post-work pain and frequency of pain during the workday . The clinical efficacy of viscoelastic shoe inserts for modifying weight bearing-induced back pain is supported . Further clinical research into the therapeutic and prophylactic value of shock-attenuating shoe inserts for healthy as well as patient population s is advocated OBJECTIVE This study was conducted in order to assess the effect of wearing a lateral wedged insole with a subtalar strap for 2 years in patients with osteoarthritis varus deformity of the knee ( knee OA ) . DESIGN The setting was an outpatient clinic . The efficacies of the strapped insole and a traditional shoe insert wedged insole ( the inserted insole ) , as a positive control , were compared at the baseline and after 2 years of treatment . R and omization was performed according to birth date . The 61 female out patients with knee OA who completed a prior 6-month study were asked to wear their respective insoles continuously as treatment during the course of the 2-year study . The femorotibial angle ( FTA ) was assessed by st and ing radiographs obtained while the subjects were barefoot and the Lequesne index of the knee OA at 2 years was compared with those at baseline in each insole group . RESULTS There were 61 patients in the original study , but 13 patients ( 21.3 % ) did not want to wear the insole continuously and five ( 8.2 % ) withdrew for other reasons . The 42 patients who completed the 2-year study were evaluated . At the 2-year assessment , participants wearing the subtalar strapped insole ( n=21 ) demonstrated significantly decreased FTA ( P=0.015 ) , and significantly improved Lequesne index ( P=0.031 ) in comparison with their baseline assessment s. These significant differences were not found in the group with the traditional shoe inserted wedged insole ( n=21 ) . CONCLUSION Only those participants using the subtalar strapped insole demonstrated significant change in the FTA in comparison with the baseline assessment s. If the insole with a subtalar strap maintains FTA for more than 2 years , it may restrict the progression of degenerative articular cartilage lesions of knee OA
A moderate level of evidence was found in support of using cushioned material s in reducing discomfort/fatigue among st and ing workers .
A limited level of evidence exists in favour of using insoles over anti-fatigue mats .
This systematic review up date s the current state of evidence on the effectiveness of softer flooring and cushioned shoe insoles on reducing  musculoskeletal discomfort amongst workers who are required to st and for prolonged periods to work and the impact of factors such as age and gender on the outcomes .