Footwear width and balance-recovery reactions: A new approach to improving lateral stability in older adults.
BACKGROUND
Age-related difficulty in controlling lateral stability is of crucial importance because lateral falls increase risk of debilitating hip-fracture injury. This study examined whether a small increase in footwear sole width can improve ability of older adults to regain lateral stability subsequent to balance perturbation.


METHODS
The study involved sixteen healthy, ambulatory, community-dwelling older adults (aged 65-78). Widened base-of-support (WBOS) footwear was simulated by affixing polystyrene-foam blocks (20mm wide) on the medial and lateral sides of rubber overshoes; unaltered overshoes were worn in normal (NBOS) trials. Balance perturbations were applied using a motion platform.


RESULTS
Gait, mobility and agility tests revealed no adverse effects of wearing the WBOS footwear. Lateral-perturbation tests showed that the WBOS footwear improved ability to stabilize the body without stepping (p=0.002). Depending on the perturbation magnitude, the frequency of stepping was reduced by up to 25% (64% of NBOS trials vs 39% of WBOS trials). In addition, the WBOS footwear appeared to improve ability to maintain lateral stability during forward-step reactions, as evidenced by reduced incidence of additional lateral steps (p=0.04) after stepping over an obstacle in response to a forward-fall perturbation.


CONCLUSIONS
A small increase in sole width can improve certain aspects of lateral stability in older adults, without compromising mobility and agility. This finding supports the viability of WBOS footwear as an intervention to improve balance. Further research is needed to test populations with more severe balance impairments, examine user compliance, and determine if WBOS footwear actually reduces falling risk in daily life.
Graduate School of Engineering, Tohoku University, Sendai, Miyagi, Japan; Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Takeshi
T
Yamaguchi
Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
Kenneth C
KC
Cheng
Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; VHA Home HealthCare, Toronto, ON, Canada.
Sandra M
SM
McKay
Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, Institute of Biomaterials and Biomedical Engineering, and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Brian E
BE
Maki
aging; balance perturbation; compensatory stepping; fall prevention; footwear