An immediate effect of custom-made ankle foot orthoses on postural stability in older adults

Background: Foot and ankle problems are highly prevalent fall risks in the elderly. Ankle foot orthoses designed to stabilize the foot and ankles have been studied within specific patient groups, but their efficacy with a less restrictive elderly population is unknown. This study investigated if custom-made ankle foot orthoses improve postural stability in older adults. Methods: Thirty ambulatory older adults averaged 73 (standard deviation = 6.5) years completed Romberg's balance (eyes-open/eyes-closed), functional reach, and Timed Up and Go tests while wearing validated kinematic sensors. Each test was completed in standardized shoes with and without bilateral orthoses. Additionally, barefoot trials were conducted for the Romberg's and functional reach tests. Findings: Compared to the barefoot and 'shoes alone' conditions, the orthoses reduced center of mass sway on average by 49.0% (P = 0.087) and 40.7% (P = 0.005) during eyes-open balance trials. The reduction was amplified during the eyes-closed trials with average reductions of 65.9% (P = 0.000) and 47.8% (P = 0.004), compared to barefoot and 'shoes alone' conditions. The orthoses did not limit functional reach distance nor timed-up and go completion times. However, the medial-lateral postural coordination while reaching was improved significantly with orthoses compared to barefoot (14.3%; P = 0.030) and 'shoes alone' (13.5%; P = 0.039) conditions. Interpretation: Ankle foot orthoses reduced postural sway and improved lower extremity coordination in the elderly participants without limiting their ability to perform a standard activity of daily living. Additional studies are required to determine if these benefits are retained and subsequently translate into fewer falls. (C) 2014 The Authors. Published by Elsevier Ltd.