The Effect of Textured Insoles on Gait in People with Multiple Sclerosis: An Exploratory Study

Abstract

Purpose. This study aimed to investigate whether textured insoles can improve gait in people with multiple sclerosis (MS). Relevance. Previous studies have shown that footwear, including textured insoles, may improve postural stability in healthy young and older adults (Palluel et al., 2008;Hatton et al., 2009;Hatton et al., 2011), and there is some evidence to show that footwear interventions may be beneficial for people with MS (Ramdharry et al., 2006;Kelleher et al., 2010). Participants. Forty-six people with MS (34 women), mean age (SD) 49 years (7), who reported that they were able to walk 100 m with or without resting with the use of one stick or crutch, participated in the study. Methods. Ethical approval was granted by the Local Research Ethics Committee. Participants were randomized to one of two textured insole groups: texture A (Algeos UK Ltd, Liverpool, UK), which was used in our previous studies (Hatton et al., 2009;Hatton et al., 2011), or texture B, a commercial insole (Crocs ™ , Den Haag, The Netherlands). Participants conducted baseline walking tests at their preferred speed along an instrumented walkway (GAITRite) in a laboratory setting, and temporal-spatial gait parameters were extracted. Participants then wore the insoles for two weeks and returned for repeat testing. Analysis. Paired t-tests were used to evaluate changes between baseline and follow-up. Results. Stride length increased between baseline and follow-up in both legs in group A (left p = 0.01, right p = 0.02) and group B (left p = 0.02, right p = 0.02). Velocity and cadence did not change significantly in either group. Discussion. This finding that textured insoles can produce improvements in stride length requires further investigation. It is consistent with research on foot orthoses in MS showing an improvement in balance after four weeks of wear (Ramdharry et al., 2006).

The Role of Textured Material in Supporting Perceptual-Motor Functions

“…There were 23 eligible studies [1]–[19], [21]–[24], comprising 21 published peer reviewed research articles and two published conference proceedings [9], [13]. Of the excluded studies, notably one was a special issue [20] reporting additional findings on a previously published sample [22] and, therefore, not included in our analysis.…”

“…The rho estimates were then averaged together and used for subsequent calculation of all estimates for the unbiased effect size variances [52]. There were a small number of cases where mean and standard deviation data were deemed unsuitable because of difficulty in interpreting the appropriate direction of the effect [13], [19], [20], [22] or were unobtainable [9], [18], in which case they were excluded from consideration for meta-analysis to avoid contamination. Significance for testing the null (no effect) was set at the one-tailed P<0.05 in favour of texture and utilized the Z-test method [56].…”

“…The morphology of textured surfaces used in previous work has been defined by a huge parameter space including variables such as nodule height, shape, material, area and packing density. Research has evaluated the efficacy of added texture that passively deforms the plantar surface of the foot in a variety of populations (elderly [2], [3], [5]–[12] and those with ailment [9]–[11], [13]–[15]) and under a range of perceptual-motor task constraints, including upright balance [1]–[7], [12], [15]–[18], walking [8]–[11], [13], [14], [18]–[22] and joint position discrimination [23], [24].…”

“…This is especially the case in populations, such as those with ageing [43] or diseased nervous systems and those with a high falls risk [44], where individual and social benefits are palpable (for reviews see [40], [45]–[48]). Evidence suggests that textured material can ameliorate reduced perceptual-motor system functionality related to ageing [2], [3], [5]–[7], [9], [11], disease [10], [11], [13], [14], and previous injury [15], and that observed benefits are not lost over extended time scales due to habituation to stimuli [2], [3], [11], [13].…”

“…nodule density) can affect the scale of postural sway in upright balance [1], characteristics of textured materials (i.e. internodule distance, width, height, shape, uniformity, hardness, compound type) and related equipment (shoes, insoles, orthotics, socks etc) have varied widely across studies [1], [7], and in some cases have gone unreported [13], [23], [24] or uncontrolled [8], [9], [15], [17]. It is possible, therefore, that inconsistencies in outcomes across studies may be due to variations in treatments, age, health status and experimental task designs reported across studies [40], [45], [47], [48].…”