Jun 23, 2014

The Effects of a Foot-Toe Orthosis on Dynamic Balance Pt. 2

Greetings Everybody! I wanted to take a moment today to follow up with my original post regarding my recent research study with some of our final findings. While we have finished the study and I have completed my thesis...this information is far from completing its journey through the peer-reviewed process.

Nevertheless, here is a quick rundown/recap: We had 63 healthy and physically active college age students between the ages of 18 and 29 years that volunteered for this study. All participants were randomly allocated into one of three groups by an online random group allocation generator. We hoped to have more subjects in this study but I ran out of time to recruit more and I needed to cut my losses if I wanted to finish the study and graduate on time. One group received the foot-toe orthosis (Correct Toes - FTO ) and the control shoe (Lems Primal 2 - SO), one group received the control shoe only, and one group was a true control (CON) that received neither intervention. The following table displays our group demographics...ideally I wish we could have made the groups perfectly even and had more subjects overall.
Screenshot 2014-06-23 at 3.43.22 PM.png
Just to review, we used the Lower Quarter Y-Balance Test (YBT-LQ) as our measure of dynamic balance. I’m not going to go over all of the procedures and what not again because you can find all of that information in the above link from the original post. So why don’t we just get down to the fun part...The Findings.
Screenshot 2014-06-23 at 3.49.21 PM.pngThere is a lot of numbers in that table...and it isn’t very pretty. Nevertheless, it does tell us some important information. After adjusting for baseline scores (ANCOVA) there were significant differences between the post-intervention scores on the YBT-LQ. This means that there was a statistically significant difference (p=.001) between the groups at follow-up testing. Also, these YBT-LQ scores are the composite scores. That means they are the maximum reach directions for each reach direction(anterior, posteromedial, and posterolateral), and then normalized for apparent leg length.

Pairwise comparisons revealed that the FTO group was significantly different (p=.001) from the CON group. There was also a significant difference (p=.034) between the SO and CON groups. Additionally, the FTO group was significantly different (p=.007) than the SO group. The FTO group had a strong effect size of .70 while the SO group had a moderate effect size of .45. Phew, that paragraph sounded a lot like a journal article...So lets use a pretty graph to highlight this information even further and it is much easier on the eyes.

So what does this all mean? The purpose of our study was to see if the foot-toe orthosis had any effect on dynamic stability. Our results were the first to show that this type of orthosis could be used to increase dynamic balance with 4 weeks of use in a healthy, young-adult population. These results were similar to other interventions to increase dynamic balance/postural stability using mediums such as textured surfaces, insoles and traditional orthoses. However, due to the difference in metrics and intervention choice...direct comparison isn't really feasible.

There are several theories abound for why such interventions may be efficacious such as increase afferent input to the feet/toes and the potential for passively increasing the base of support. However, it was beyond the scope and aim of this study to determine why they work and unfortunately we didn’t enough measures to control well enough to check on some of these theories.

We do know that when wearing the foot-toe orthosis the base of support is certainly increased, yet pre and post data collection was done without the use of the foot-toe orthosis. This means the increased dynamic balance was not reliant upon the foot-toe orthosis. Additionally, the control shoe only group saw an increase in dynamic balance as well.

This could be attributed that the control shoe was technically advertised as a“minimalist” shoe by manufacturer and despite a lack of universal definition for a minimalist shoe...I would have to agree that this shoe was minimally cushioned, zero drop (ramp from heel to forefoot), offered no support to the foot beyond grip, and had a wider toe box than most traditional footwear. This design could potentially work to increase dynamic balance through increasing the base of support and allowing better afferent input.

In conclusion, our results suggest that the use of the foot-toe orthosis and the control shoe may increase dynamic balance in a healthy and college-aged population. The moderate to strong effect sizes associated with our results are promising; However, it is imperative that future research be conducted to investigate the effects in differing populations such as the elderly, the injured, and people with neuropathic conditions such as diabetes. It must also be investigated on whether these findings have any impact on injury risk and to determine what the long-term effects of use. This information could help researchers or clinicians investigate potential treatment or prophylactic approaches.


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