Less Than One Millimeter Under the Great Toe is Enough to Change Balance Ability in Elite Women Handball Players

Abstract

Team handball is a complex intermittent sport game, which requires several motor abilities and effective postural control. Objective evaluation of stabilometric variables may be interesting to assess and improve functional parameters by postural control management. The purpose of the study was to evaluate the effects of a small additional thickness placed under the great toe (TUGT) on the Centre of Pressure (CoP) parameters in elite women handball players. Fourteen elite women handball players voluntarily participated in this study. Two conditions were compared: TUGT 0 (control) and TUGT 0.8 mm; four variables were computed from the CoP displacements. A paired T‐test was performed for each variable. This study concludes that a low focal additional thickness placed under both great toes has an effect on the CoP measures used to assess postural control during an unperturbed stance. These results suggest that a low TUGT could contribute to a change in balance ability, and may be of clinical interest. This brings new perspectives in the management of athletes to prevent injury risk and optimize performance.

Effect of sensory stimulation applied under the great toe on postural ability in patients with fibromyalgia

“…Our results suggest that a very small additional thickness is sufficient to change CoP measures. These postural reactions are consistent with previous reports that used mechanical stimulation of the plantar sole (Viseux et al 2018(Viseux et al , 2019b to promote cutaneous sensory facilitation, and could assist in changing the balance ability in patients with FM.…”

“…Light-touch from the great toe allowed the activation of this cutaneous mechanoreceptors, and induced by low additional thickness, (i) provided significant no painfully somatosensory cues and (ii) induce attenuated postural sway. Compared to the no touch condition, an additional sensory stimulus stemming from lighttouch would lead to a stabilising effect on postural sway (Viseux et al 2018(Viseux et al , 2019b. Our results suggested that cutaneous mechanoreceptors of the great toe, especially the most superficial ones (Macefield et al 1990;Inglis et al 2002) were activated by the lowest additional thickness and seem to be consistent with sensory hypothesis and earliest reports using light-touch, which showed an improvement in postural performance (Jeka and Lackner 1994).…”

“…Thus, the CNS has to compensate this mismatched information from sensory receptors to correctly functioning receptors where, according to Pyykko et al (1990), the most important source of somatosensory information comes from plantar mechanoreceptors, being the most important site when balance is perturbed (Stal et al 2003). In this way, the addition of a small thickness under the toes facilitated the tactile cutaneous sensation and reduced the individual's postural sway (Viseux et al 2018(Viseux et al , 2019b. In fact, plantar cutaneous afferents play a role in stabilising the feet, providing an additional source of sensory input that enhances the detection of movement and controlling small amplitude body sway (Kavounoudias et al 1998(Kavounoudias et al , 1999.…”

“…Based on surface electromyography, they showed that the low mechanical stimulus induced increased activation of the plantar flexor musculature and suggested that their small depression of the lateral aspect of the plantar surface stimulated both type I and II cutaneous mechanoreceptors units. Recently, an interaction between CoP parameters and different additional thickness placed under all the toes (Viseux et al 2018) or under the great toe (Viseux et al 2019b) was described and allowed to determine an optimal thickness of 0.8 mm. A significant change of balance was obtained with the lowest additional thickness of 0.8 mm even through the contact forces induced by this small thickness were probably too small to mechanically stabilise the body.…”

Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies

“…Others have recently confirmed that mechanical facilitation of sensation of the plantar soles enhances postural stability. 93,94 A small raised edge placed underneath the boundary of the foot was shown to improve the reaction to unpredictable postural perturbations. 95 Changing the texture of a shoe-insert from smooth to clearly perceptible textured material can alter lower leg muscle activity during walking, suggesting that the sensory feedback from cutaneous receptors of the plantar surface of the foot improves dynamic balance control.…”