Can Only One Orthotic Device Improve Postural Control?

Recently, podiatric physicians may have seen advertising suggesting that only one particular ankle brace has been “clinically proven to reduce postural sway and improve postural stability.” As an owner of an ankle brace company and having published several peer-reviewed papers on the subject of postural control, I am compelled to address the validity of this claim and review the medical literature for studies relevant to orthoses and postural control.^1-3

Postural control is the ability of a human to maintain his or her center of mass over the supportive foot.1 We can think of postural control as a mechanism to maintain balance. Balance is the ability of a person to remain upright during stance and gait. Postural control is a strategy to maintain balance. Postural control and dynamic balance are both risk factors for ankle sprains in athletes and traumatic falls in elderly patients.^1,4

We can measure postural control in the clinical setting by measuring “sway” or deviation of the center of mass during quiet stance. There are various techniques to measure sway. Stabilometry, which measures center of pressure deviations on a force platform, is the most common assessment of postural sway in research studies.³ We can commonly measure sway during tandem (two leg) stance or single leg stance. Many studies combine assessment of postural sway during static stance with dynamic balance assessment during specific movement tasks. Postural control appears to be most relevant to the assessment of ankle sprain risk while dynamic balance testing appears to be more relevant to fall risk assessment.^1,4

Contrary to recent advertising, many different forms of foot orthoses and ankle braces can improve postural control in various patient groups. It is interesting to note that the majority of the orthoses tested were simple prefabricated devices that are available to the general public at a fraction of the cost of custom ankle braces.

There are no less than 12 peer-reviewed studies published in the medical literature that demonstrate the effectiveness of simple foot orthoses to improve postural control in humans.^5-16 Half of these studies utilized prefabricated foot inserts and demonstrated improvements in balance and postural control.

Ankle-foot orthoses (AFOs) of various designs have demonstrated improvements in postural control and dynamic balance in several studies. Three studies of prefabricated ankle braces have shown improvements in postural control and dynamic balance.^17-19 Custom AFO devices have demonstrated improvements in dynamic balance only in stroke patients.²⁰ In a systematic review of the literature, Tyson and Kent found no less than 12 published articles in the medical literature that measured improvements in postural control when stroke patients wore custom AFO devices of various designs.²¹

In summary, I have cited 25 peer-reviewed studies published in the scientific literature that collectively demonstrate that many different types of orthoses can improve postural control. Therefore, I would question why anyone would proclaim that only one single device has ever produced these same results in laboratory testing. To add the additional claim that the testing procedure proved that a device was “clinically proven” has been the topic of a previous DPM Blog.²²

Editor’s note: Dr. Richie is the founder and owner of Richie Technologies, Inc.

References

1. Richie DH. Functional instability of the ankle and role of neuromuscular control. Comprehensive review. J Foot Ankle Surg. 2003; 42(5):79-86.
2. Richie DH. Chronic ankle instability: can orthotics help? Podiatry Today. 2006; 19(10):48-57.
3. Richie DH. Effects of foot orthoses in the treatment of chronic ankle instability. J Am Podiatr Med Assoc. 2007; 97(1):19-30.
4. Muir SW, Berg K, Chesworth B, et al. Balance impairment as a risk factor for falls in community- dwelling older adults who are high functioning: a prospective study. Phys Ther. 2010;90(3):338–347.
5. Hamlyn C, Docherty CL, Klossner J. Orthotic intervention and postural stability in participants with functional ankle instability after an accommodation period. J Athl Train. 2012;47(2):130–135. 

6. Sesma AR, Mattacola CG, Uhl TL, Nitz AJ, McKeon PO. Effect of foot orthotics on single- and double-limb dynamic balance tasks in patients with chronic ankle instability. Foot Ankle Spec. 2008;1(6):330–337.
7. Guskiewicz KM, Perrin DH. Effect of orthotics on postural sway following inversion ankle sprain. J Orthop Sports Phys Ther. 1996;23(5):326–331. 

8. Corbin DM, Hart JM, McKeon PO, Ingersoll CD, Hertel J. The effect of textured insoles on postural control in double and single leg stance. J Sport Rehabil. 2007;16(4):363–372. 

9. Orteza LC, Vogelbach WD, Denegar CR. The effect of molded and un- molded orthotics on balance and pain while jogging following inversion ankle sprain. J Athl Train. 1992;27(1):80–84. 

10. Ochsendorf DT, Mattacola CG, Arnold BL. Effect of orthotics on postural sway after fatigue of the plantarflexors and dorsiflexors. J Athl Train. 2000;35(1):26–30. 

11. Mattacola CG, Dwyer MK, Miller AK, Uhl TL, McCrory JL, Malone TR. Effect of orthoses on postural stability in asymptomatic subjects with rearfoot malalignment during a 6-week acclimation period. Arch Phys Med Rehabil. 2007;88(5):653–660. 

12. Corbin DM, Hart JM, McKeon PO, Ingersoll CD, Hertel J. The effect of textured insoles on postural control in double and single limb stance. J Sport Rehabil. 2007;16(4):363–372.
13. Hertel J, Denegar CR, Buckley WE, Sharkey NA, Stokes WL. Effect of rearfoot orthotics on postural sway after lateral ankle sprain. Arch Phys Med Rehabil. 2001;82(7):1000–1003.
14. Percy ML, Menz HB. Effects of prefabricated foot orthoses and soft in- soles on postural stability in professional soccer players. J Am Podiatr Med Assoc. 2001;91(4):194–202.
15. Hertel J, Denegar CR, Buckley WE, Sharkey NA, Stokes WL. Effect of rear-foot orthotics on postural control in healthy subjects. J Sport Rehabil. 2001;10(1):36–47.
16. Rome K, Brown CL. Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehabil. 2004;18(6):624–630.
17. Hadadi M, Mousavi ME, Fardipour S, Vameghi R, Mazaheri M. Effect of soft and semirigid ankle orthoses on star excursion balance test in patients with functional ankle instability. J Sci Med Sport. 2014;17(4):430–433. 

18. Forbes H, Thrussell S, Haycock N, Lonkamp M, White M. The effect of prophylactic ankle support during simulated soccer activity. J Sport Rehabil. 2013;22(3):170–176.
19. Whitney SL, Wrisley DM. The influence of footwear on timed balance scores of the modifed clinical test of sensory interaction and balance. Arch Phys Med Rehabil. 2004;85(3):439–443.
20. Chiung-Lin C, Ya-Ling T, Shu-Zon L et al. Effects of an anterior ankle-foot orthosis on walking mobility in stroke patients: get up and go and 
stair walking. Arch Phys Med Rehabil. 2014; 95(11):2167-71.
21. Tyson SF, Kent RM. Effects of an ankle-foot orthosis on balance and walking after stroke: a systematic review and pooled meta-analysis. Arch Phys Med Rehabil. 2013; 94(7):1377-85
22. Richie D. What does ‘clinically proven’ actually mean? Podiatry Today DPM Blog. Available at https://www.podiatrytoday.com/blogged/what-does-%E2%80%98clinically-proven%E2%80%99-actually-mean . Published Dec. 17, 2015.