Guest Post: The Effects of Toe Orthosis on Dynamic Balance by Adam Kelly | Modern Manual Therapy Blog

Guest Post: The Effects of Toe Orthosis on Dynamic Balance by Adam Kelly

Welcome Readers! My name is Adam Kelly, ATC and I am going to be your guest blogger today! I am the author over at Eat.Run.Rehabilitate. Dr. E asked me to write this post up as he is busy with the arrival of another little one at home. I want to congratulate him on the newest addition to his family!

I am currently finishing up my final semester of graduate school and that means finishing up my research study and thesis. Dr. E asked that a write up a post to share a little bit about my study with all of you. So where do I begin? Let’s begin at the bottom…aka the feet. I’ve always been very interested in lower extremity function, mechanics, and injury.

During my undergraduate studies I became aware of a very novel and unique silicon insert for spreading and separating the toes. Similar in function to the inserts used for pedicures but vastly different in design, this insert was marked to be worn within shoes and during weight-bearing activities. I became very interested in this product and once I got to graduate school I knew that I would like to potentially study it.

I soon found out that this would be a novel research idea. The premise of this product is to promote and reintroduce a wider foot splay and more natural biomechanical alignment. A large portion of society has terribly deformed foot structure due to poor footwear selection, design, and fit. Here is a picture of two different sets of feet…one is from a person that has never worn footwear (B) and another from a human that had been habitually wearing conventional footwear for most of their life(A).

What impacts do these differences in foot structure have? What foot looks stronger, more robust, and healthier to you? While initial review of foot (B) may appear foreign to many of us it definitely appears to be the more natural of the two. The human foot should we widest at the toes and not the metatarsals.
My literature review found that plenty of research had been done on full-foot orthotics, textured insoles and textured surfaces to investigate their effects on balance. Most studies theorized potential benefit from influencing the afferent input of the somatosensory system and/or potentially influencing structures and biomechanical alignment. So why not investigate what this product could do to dynamic balance, and certain measures of foot structure and mobility. So here is what I did:

Study Design:

3 randomized groups with equal parts men and women. Healthy participants aged 21-29 with no previous history of lower extremity surgery, peripheral artery disease, diabetes, neurological deficits, vertigo, concussion or other potential ailments to equilibrium. Participants must have been physically active for at least 30 minutes of light physical activity at least 3 times a week. Participants also were excluded if they had suffered a significant lower extremity injury in the last 6 months that had removed from physical activity for at least three days or significantly altered ADL’s.
My three groups:
  1.  Intervention Group #1: Foot-Toe Orthosis and Control Shoe
  2.  Intervention Group #2: Control Shoe Only
  3.  Control Group: No Intervention

This was a 4 week study with both acute and follow-up measurements taken. What measures did we want to look at? Well, we wanted a valid and reliable measure of dynamic balance. Upon reviewing the literature regarding the star excursion balance test (SEBT) and the Y-balance test (YBT) we decided that the YBT would be the most reliable, clinically relevant, and time efficient measure of balance. We are also looking at various measures of the foot such as hallux valgus angle, static arch height, and both great toe flexion and extension range of motion.

Our Procedures?

We had subjects come in after being included and randomized for baseline testing of the YBT, and for baseline measures of the feet. Those randomized into the foot-toe orthosis group were then fitted for the insert and were measured again using the YBT for any potential acute effects of wearing the orthosis. Subjects were then fitted for shoes if placed into either of the first two groups and were given a log book for hours of use and comfort of wear. After four weeks- subjects returned for follow up testing of the YBT (with and without the insert) and the aforementioned measures of foot structure and mobility. Subjects spent the first week habituating to the shoes and inserts by increasing wear time by 30 minute incremental segments and weeks 2-4 wearing the products for a minimum of four hours a day. Subjects also attempted to wear the inserts at night while sleeping.

The Control Shoe

We decided that if we were going to be spreading the toes of all of our subjects and testing the effects of doing this then we had better well make sure they all had shoes would accommodate this product. We spoke with the manufacturer of the toe-orthosis and they put us in contact with the creater of Lems Shoes. Lems produces minimalist shoes with wide toe-boxes, void of any arch support or cushion, and is flat from heel to toe. Introducing our subjects to a shoe like this could have a potential influence on our results so that is the reason for our control and shoe only groups to help control these variables. It is also interesting because it means that our study will also be investigating the potential effects of introducing a minimalist shoe for 4 weeks on the various measures.

Hypothesis and Preliminary Findings?

Based upon the previous research regarding influencing balance via cutaneous receptors, mechanoreceptors of the feet and potentially biomechanical alignment I was inclined to believe that this product would have a positive relationship with our selected measures. Please take note that our data is not 100% complete, and is not yet peer reviewed. Therefore, PLEASE take these findings with a heavy grain of salt. So far, our pilot data has showed that all of our measures have been very reliable with ICC’s ranging from .833 - .982. Additionally, we found a statistically significant (n=50 legs, p=.003) increase in the Y-balance test scores when comparing the baseline to acute effects scores(r=.92818). There is still much more data to collect, manuscript writing, and critiquing to be done for this study but it is a very exciting time for me.
What have your experiences been with foot health & deformities, balance, and injury? Do any of you have experience with using splints, manual therapy or exercise to address potential issues?
I just want to thank Dr. E for inviting me to share my research study with all of you. Congratulations to him on the baby girl once again. Thanks for reading and as Dr. E Would say….”Keep it Eclectic”…or something like that.

Edit: I want to thank Adam Kelly for letting me catch up on some much needed rest with my wonderful family, yet keep the regular, quality content flowing as the readers are used to! Looking forward to your study’s completion and the results!


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