The Effect of Heel Lifts on Postural Stability in Individuals with Parkinson’s Disease

Hastings, J. W.; Brown, Connor; McNabb, McKenna; Repasky, Cassie

doi:10.31532/physmedrehabil.1.1.006

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…The best postural performances are energy efficient since they rely on the skeletal and ligamentous systems to minimize muscle work and thus fatigue (Hastings et al 2018). In addition, a good posture includes efficient strategies to mitigate external perturbations and allows for a fast recovery following a potential loss of balance.…”

Section: Introductionmentioning

confidence: 99%

An interventional exploratory study to assess the effect of footwear on postural stability and strategy during quiet standing

Hausselle

Haddox

Kasitz

et al. 2021

International Biomechanics

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A stable quiet stance is achieved by controlling the relative position of the center of pressure and the vertical projection of the center of mass. The best postural performances include efficient strategies to mitigate external perturbations. Footwear impacts postural stability and strategy by affecting cutaneous proprioception and ankle proprioception in the case of heeled shoes. The purpose of this study was to quantify the effects of four common footwear conditions, i.e. barefoot, sports, flats, and heels, on postural stability and strategy during quiet standing of healthy young women. Postural stability and strategy were assessed overall and in the antero-posterior and medio-lateral directions using five parameters: total sway, average center of pressure (COP) velocity, α value computed using detrended fluctuation analysis, hip over ankle ranges of motion, and power of the COP time series. Significant differences with barefoot were consistently found when wearing heels, namely a decrease in postural sway and average COP velocity. Results seemed counter-intuitive as they indicate an apparent increase in postural stability when wearing heels. A deeper analysis revealed a more complex scheme. A potential tightening of the motion when wearing heels, combined with an increase of the neutral plantarflexion angle, shifts the postural strategy towards a predominant hip strategy. Finally, proprioception did not play a key role. This study highlighted the complexity of the multifactorial interactions between footwear characteristics and postural strategies. Additional work is needed to develop footwear that will enhance postural stability of populations at risk, such as pregnant women or the elderly.

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Section: Introductionmentioning

confidence: 99%

An interventional exploratory study to assess the effect of footwear on postural stability and strategy during quiet standing

Hausselle

Haddox

Kasitz

et al. 2021

International Biomechanics

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“…A "stooped posture" places one's center of gravity outside of their base of support. Hastings et al (2018) addressed this malalignment with the use of a heel lift to accommodate plantarflexion (PF) contracture in closed kinematic chain; hypothesizing that a lack of dorsiflexion (DF) range of motion can exacerbate postural alignment up the kinetic chain resulting in a "stooped posture". 6 Using a heel lift as their intervention, they found significant improvements in head tilt angle, trunk angle, and a more anterior placement of the pelvis; effectively shifting one's center of gravity over their base of support.…”

Section: Introductionmentioning

confidence: 99%

“…Hastings et al (2018) addressed this malalignment with the use of a heel lift to accommodate plantarflexion (PF) contracture in closed kinematic chain; hypothesizing that a lack of dorsiflexion (DF) range of motion can exacerbate postural alignment up the kinetic chain resulting in a "stooped posture". 6 Using a heel lift as their intervention, they found significant improvements in head tilt angle, trunk angle, and a more anterior placement of the pelvis; effectively shifting one's center of gravity over their base of support. As a result, they found that their participants not only looked more balanced, but their participants reported a greater sense of perceived stability with the heel lifts in.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

Uno¹,

Jusko²,

Roderos³

et al. 2021

Phys Med Rehabil

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This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

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The Effect of Heel Lifts on Postural Stability in Individuals with Parkinson’s Disease

Cited by 2 publications

References 17 publications

An interventional exploratory study to assess the effect of footwear on postural stability and strategy during quiet standing

An interventional exploratory study to assess the effect of footwear on postural stability and strategy during quiet standing

The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

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