Orthotics is an umbrella term covering everything from blister plasters to full-leg braces. They can correct deformities, improve gait (walking style), give support, improve balance, facilitate movement… but they can’t do it all at once. The tricky thing is that combating one thing usually makes another thing worse. If you’re trying to deal with a deformity like fallen arches, then the heavy-duty orthotics needed often limit movement. Bracing a limb helps improve balance, but at the expense of causing a clunky gait.
For this reason, there is a debate raging amongst experts. Some like to load a patient with orthotics, to make their range of motion as close as possible to normal. Others believe that orthotics weaken the muscles without providing a dramatic improvement in motion , so prescribe only the barest minimum of orthotics
Is it possible to find a compromise between these two points of view?
There is one orthotic intervention which provides surprising benefits with no known drawbacks. And it’s so cheap and simple, it seems almost too good to be true.
Textured insoles in your shoes.
Seriously. To make walking easier and reduce the risk of falling for people who are less mobile, simply slip a strip of dimpled foam into their shoes.
It’s tempting to assume that textured insoles give a better grip, in the same way that rubber gloves make it easier to handle wet dishes. Surprisingly, though, that’s not the reason why they help.
You see, poor balance is often linked to reduced plantar sensation (lack of feeling in the soles of the feet). It’s one of the most common side effects of MS, for example. Elderly people with reduced plantar sensation are at a higher risk of falls, and in healthy young people, numbing parts of the foot with ice makes it much harder to balance.
Textured insoles make your feet more sensitive, so your brain can correct your position automatically before you start to wobble. As a general rule, the thicker and more cushioned your shoes are, the more likely you are to injure yourself. In medical terms, a squishy sole reduces sensory feedback – it takes longer for your brain to receive messages about the conditions under your feet. Textured insoles mean you are just as sensitive with shoes on as you would be barefoot. (Source)
There are dozens of conditions which leave patients with reduced plantar sensation. So far, most tests on textured insoles have looked at either MS or Parkinson’s, but they have the potential to help patients with diabetes, arthritis sufferers, people who’ve had a stroke… The evidence is still being gathered, but it looks promising. “Wearing textured insoles is like taking vitamin C tablets,” jokes one podiatrist. “We haven’t yet proven the benefits, but it’s cheap, it might help, and it certainly won’t do you any damage. I recommend them to all my patients.”
What about the effects on people who don’t suffer from any illness? A study on older people, who were healthy apart from a risk of falls, showed mixed results. In that case, textured insoles reduced walking speed and step length. Of course, you’re less likely to slip if you’re walking more slowly, but it’s quite a trade-off to make. (Source)
The researchers suggested that people may need some time to acclimatise to the insoles. For patients with MS, textured insoles improved their balance – but not immediately. The full benefits were only seen after wearing them every day for four weeks. Another study suggested that as little as 5 minutes of practice time is enough to feel the benefits of walking on a textured surface, and after just a few minutes of practice with textured insoles there is a noticeable deterioration in balance after you take them off.
And it’s not only the elderly and frail who can benefit. A study on teenage ballet dancers showed a dramatic improvement in ankle proprioception (control of the ankle joint) after five weeks wearing textured insoles in their dance shoes. Dancers wearing insoles even improved their scores in ballet assignments. If a simple shoe lining can benefit a 19-year-old professional athlete, then it can probably benefit anyone.
Right now, there’s a lot of positive evidence on the benefits of textured insoles, but more in-depth work needs to be done to bring it all together.
For example, there’s not much evidence that textured insoles improve balance in healthy adults, but that can probably be blamed on the design of the test.
The standard balance test isn’t very sensitive: participants simply stand still on a board which senses when they wobble, and that’s the sort of task which a fit person could do easily in any type of footwear. Looking at performance in sport or at high speed would give a better picture. There’s also no consensus on the best type of texture. Some studies have looked at cross-hatched patterns on insoles, some have looked at plastic ‘bobbles’, some have looked at bristles or swirled patterns. Scientists seem to test whatever insoles they find in their local supermarket, rather than looking closely at which pattern will be most beneficial.
- They even improve balance in healthy adults.
- Also improves balance for Parkinson’s disease – in this case, the improvements were noticed immediately, perhaps because the nobbles are more grippy. Any type of insole was better than being barefoot, but only textured insoles helped balance with eyes closed.
- Thought to work by providing more sensory feedback
- Could be beneficial for many conditions which affect foot sensitivity and/or muscle tone – diabetes, cerebral palsy, arthritis etc.
- Future: needs more research on healthy adults/children. Does not seem to affect the balance of young adults with no health problems, but effects may not be noticeable as young healthy adults rarely have trouble standing still with both feet, regardless of the texture of their shoes. Look at whether it helps balance/gait at high speeds (e.g. during sports) (Source)
- Also need to compare different types of textured insole – some studies used a fine cross-hatched pattern, some used plastic nobbles, some ridges.