title: Effects of the site and extent of plantar cutaneous stimulation on dynamic balance and muscle activity while walking.
abstract: BACKGROUND
  Previous studies have demonstrated that stimulating the cutaneous plantar sensory receptors of the foot through textured insoles improves human balance and walking. This study investigated the effect of medial and lateral zoned textured insoles using tibialis anterior/peroneus longus surface electromyographic activity and Centre-of-Pressure as indicators of postural stability while walking.
  
  
  METHODS
  15 asymptomatic subjects were tested using a within-subject randomised repeated measures design. The effect of lateral and medial zoned insoles of varying heights (control, 2, 4 and 6mm) on stability while walking under normal and impaired visual conditions was assessed.
  
  
  RESULTS
  Impaired vision resulted in an increase in foot CoP variability while walking (p<0.05). The laterally zoned insole was associated with a significant (repeated measures ANOVA p<0.05) increase in the rate of medial-lateral CoP change.
  
  
  CONCLUSIONS
  These findings suggest that the site of stimulation of the plantar foot cutaneous receptors may increase postural instability during walking. This should be considered in the design of insoles that aim to improve balance and reduce falls risk. The importance of vision in balance control has been highlighted and using impaired vision may serve as a way of trialling clinical products in the healthy population.
authors.affiliation: Podiatry Service Torbay and Southern Devon Health and Care NHS Trust, United Kingdom. Electronic address: richard.collings@nhs.net.
authors.forename: R
authors.initials: R
authors.lastname: Collings
authors.affiliation: School of Health Professions, Faculty of Health and Human Sciences Plymouth University, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Paton
authors.affiliation: Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Chockalingam
authors.affiliation: School of Health Professions, Faculty of Health and Human Sciences Plymouth University, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Gorst
authors.affiliation: School of Health Professions, Faculty of Health and Human Sciences Plymouth University, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Marsden
mesh_terms: D000328:Adult; D004576:Electromyography; D056228:Feedback, Sensory; D005260:Female; D061826:Foot Orthoses; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D010812:Physical Stimulation; D004856:Postural Balance / Q000502:physiology*; D016138:Walking / Q000502:physiology*; D055815:Young Adult
keywords: Gait; Postural stability; Textured insole; Vision