* Increased postural sway
* Conflicting sensory inputs
* Increased reflex latency
* Delayed muscle reaction times
* Strength deficit in lower extremity musculature
* Decreased joint range of motion
* Compensated positioning of lower extremity skeletal segments
Can Foot Orthoses Help Improve Postural Control?
Emphasizing an increased awareness of those who may be at risk for fall injuries, this author discusses key elements in facilitating one's balance and reviews key studies to assess the potential impact of foot orthoses in improving balance.
Balance is defined as “the act of maintaining an upright posture in standing or locomotion.” Until recently, human balance was not a function normally evaluated or treated by podiatric physicians. Yet it is now understood that many of the pathologies we treat are accompanied by significant balance disorders. If you have not noticed this already, try asking your next patient presenting with posterior tibial tendon dysfunction to do a modified Romberg test, namely standing on one foot with the eyes closed and his or her arms crossed over the chest.
Perform a similar test of any patient with diabetic neuropathy, any patient who has recently suffered an ankle sprain or any patient over the age of 70. These patients may be surprised to discover they cannot stand on one foot and keep their balance for only a few seconds, even with their eyes open.
Podiatric physicians have a responsibility to screen for and direct treatment for any patient whom they suspect of having a balance disorder. Within the multidisciplinary team approach, the podiatric physician has the knowledge and skill to implement a new, innovative approach to the treatment of balance disorders. This approach utilizes a modality that previously has not been thought of as useful in the treatment of balance disorders. What is this modality? Custom functional foot orthoses.
Understanding The Gravity Of Fall Injuries
When we “lose our balance,” we are in the process of sustaining a fall. Accidental falls have become a significant public health issue around the world, particularly among the aging population. The following statistics emphasize the importance of preventing fall injuries in the elderly population.
* One-third to one-half of the population age 65 or older will experience a fall each year.1-3
* Falls are the leading cause of injury in older adults.4-7
* Falls are the leading cause of accidental death in people over age 85.6,7
* The medical cost for treatment of fall-related injuries in the United States exceeds $20 billion annually, and is expected to climb to $32 billion by 2020.8,9
* Falls cause approximately 350,000 hip fractures per year at a treatment cost of $35,000 per patient.7,10
* Most of the falls resulting in hip fracture are related to balance disorders.10
* Fear of falling causes a compensation strategy which actually impairs postural control, causing a vicious cycle.9
* Researchers have shown that elderly patients with diabetes, especially women, have a higher risk of sustaining an injurious fall.11,12
An increased risk of falling is not a normal part of aging. Studies have shown that elderly patients with a history of falling are different than their similarly aged counterparts without a history of falling.13-17 Patients at increased risk of falling have consistently shown deficits in balance control.18-23
A Closer Look At Key Factors In Balance Control
Balance control utilizes two systems: the gaze stabilization system, which ensures that the head remains upright and oriented to the body; and the postural stabilization system, which keeps the body upright while an individual stands or ambulates. The two systems are interdependent in their function to maintain overall body balance.
Researchers have recognized that over 50 percent of falls in the elderly are the result of vestibular problems.13 The vestibulo-ocular reflex stabilizes gaze during both head and body movements, and can be affected by a myriad of pathologies. Podiatric physicians should be aware of this important component of balance control and should make a specialty referral when appropriate.