Characterization of How a Walking Boot Affects Balance

Abstract

Despite the wide use of offloading orthotic devices in orthopedic and neurologic populations, their influence on postural control has received little attention. We, therefore, tested the hypotheses that a nonpneumatic walking boot (WB) increases body motion during balance tests and that adding a heel lift to the noninvolved limb reduces body motion when wearing a WB by correcting the leg length discrepancy. Twelve healthy subjects performed three different types of balance tests, including quiet stance (eyes open or closed, firm or foam surface), functional reach (anterior or lateral directions), and treadmill walking (unperturbed or perturbed). Perturbed walking was used to specifically challenge balance and was created with a treadmill mounted to a continuously rotating platform at 0.5 and 1.5 Hz. In each condition, subjects wore either athletic shoes (control) or a WB covering the lower leg or a WB with heel lift in the opposite shoe. Frontal and sagittal plane upper-and lower-body motion was measured with tilt sensors. The WB significantly increased root-mean-square body motion in quiet stance and walking conditions and significantly decreased anterior functional reach. Body motion with the heel lift was significantly reduced compared with the WB in quiet stance conditions but was similar to the WB in functional reach and walking. Results suggest that the WB influenced balance across all tests by increasing body motion, but the contributing factors (leg length discrepancy, reduced ankle range of motion, or reduced base of support because of the rocker bottom) differed across test conditions. These conclusions add to our understanding of how an offloading orthotic device impacts balance. (J Prosthet Orthot. 2014;26:54Y60.) Figure 4. A, Sample platform and medial-lateral (ML) upper-body motion from a subject in one unperturbed and one perturbed walking control condition. B, Across-subject means T 1 SE of the root-mean-square (RMS) of upper-body motion in ML and anterior-posterior (AP) directions. RMS was significantly increased when subjects wore the walking boot (WB) compared with control in both perturbed and unperturbed walking. Statistically significant effects of the orthotic conditions are denoted by asterisks.Goodworth et al.

Multivariate Analyses of Balance Test Performance, Vestibular Thresholds, and Age

“…Correlations between thresholds and balance are important because they might help us intervene to prevent falls via (a) warnings (e.g., verbal) from a clinician informing patients about their individual fall risk, (b) rehabilitation/training ( 22 , 23 ), or (c) via the use of prosthetics/aids like canes, balance feedback devices ( 24 ), vestibular prosthesis ( 25 – 28 ), vibro-tactile shoes ( 29 ), stochastic resonance of the vestibular system ( 30 – 33 ), and/or orthotic devices ( 34 ).…”

Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation

“…Specifically, NeuroQoL-assessed postural instability emerged as a symptom strongly associated with poorer off-loading adherence. Goodworth et al (33) noted that even in healthy populations, standing balance, functional reach, and gait all suffer detriments when a walking boot is worn. Considering the neuropathy-related changes that accompany diabetes, it is likely that the biomechanical challenges observed by Goodworth et al are even greater in DFU patients treated with off-loading devices.…”

Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration

“…While a few publications have focused upon the effect of offloading devices upon the users' stability (58)(59)(60), to date there has been a lack of studies investigating ways of improving offloading adherence (61). Most studies evaluating offloading devices focus on the devices' functional capacity to offload wounds.…”