Poor balance can affect anyone, from the tiny toddler learning to walk to the grey nomad climbing in and out of her RV and the middle age ressie’s footballer who has had one too many injuries, poor balance will be experienced at least once in your life time.
Balance is a complex process involving afferent and efferent principles of the central nervous system which aim to keep equilibrium by maintaining the centre of gravity over the base of support. Additionally, proprioception as a mechanism is also associated with balance as a whole in maintaining equilibrium by way of spatial and body awareness. In today’s article we look at the importance of the feet and balance and the impact poor balance may have on an individual.

WARING! The following paragraph gets a little sciencey, feel free to by-pass at will!

The body’s perception of static joint position is dependent on afferent information delivered from Golgi tendon organs, muscle spindles and joint receptors. Specific receptors known as Ruffini receptors and Pacinian corpuscles are stimulated when a joint is moved toward its end range of motion and are important in processing proprioceptive concerns in everything from day to day life, sports and occupational tasks (Paes, et al., 2013).

The ankle joint plays an important part in the process of maintaining postural stability. This can be disrupted in the case that the ankle becomes injured or losses its muscular capacity to protect the joint. To that effect, people who have been identified as having chronic ankle instability have been found to be less sensitive to light touch stimuli and less effective at single-leg stance tasks.

Inefficient balance and postural control has been linked to ageing as a result of reduced somatosensory input such as vestibular, proprioceptive and visual processing; increasing the risk of falls and potential injury. Additionally, five other contributors to falls and balance have been identified; pain, polypharmacy, foot deformity, Flexor Hallucis Longus strength and Footwear. Although there is no standardized method for the prescription or construction of customized foot orthoses when looking to influences patient balance it has been acknowledged that insoles including those without medial arch support or specific padding can influence proprioception. Furthermore, the use of custom orthotics has been used to address lower limb pain and foot deformity inclusive of clawing of the toes. Footwear may affect a client’s proprioception and cutaneous stimuli processing, however, if inappropriate for the individual may act as a tripping hazard as opposed to directly being associated with a person’s postural stability.
A literature review by (Gillespie, et al., 2015), found that both group and home-based exercise programmes reduce the rate and risk of falls in older adults. Similarly, the use of a multifactorial assessment and intervention program was seen to reduce the rate of fall but not the risk of falling.

Balance issues do not only effect the elderly however. The reasons for poor postural stability in a younger age bracket however is more likely be associated directly with injury. Lateral ankle sprains occur in a variety of different activities both competitive and recreational, they have a prevalence of approximately 10% in the sporting community and sequential ankle sprains are probable leading to the development of a chronic ankle instability (Doherty, et al., 2015).
Surprisingly the mechanisms used to adjust for postural sway also differs as one ages. Donath et al; found that young adults (27 years +/- 3) increased their co-activation of both posterior and anterior muscles which cross the ankle to combat inversion actions in single leg stance. Alternately, seniors (70 years +/-) with poor postural control showed an increased tibialis anterior contribution.

Balance is a skill which is learned and can be trained and therefore improved as a result. It is a life skill required to complete even the simplest of tasks. Being aware of our actions, our surroundings and placement of our feet is one thing but there are many other variables which relate to proprioception and balance that need to be taken into consideration. Poor balance is not the only reason for falls either with; foot deformities, pain, multiple medications, footwear choices and flexor strength being highlighted as falls risks.

Until Next Time

Jackson McCosker
Director/ Chief Editor

References

Barbosa, C., Bertolo, M., Neto, J., Coimbra, I., Davitt, M., & Magalhaes, E. (2012). The Effect of foot orthoses on balance and foot pain and disability in elderly women with osteoporosis: A randomized Clinical Trial. Rheumatology, 515 – 522.

Bohannon, R. (2012). Impairments in static and standing balance are highly prevalent among older adults receiving home-based physical therapy. journal of gericatric physical therapy, 145 – 147.

Doherty, C., Bleakley, C., Hertel, J., Caulfield, B., Ryan, J., Sweeney, K., . . . Delahunt, E. (2015). Lower Limb Interjoint Postural Coordination One Year After First Time Lateral Ankle Sprain. Medicine and Science in Sports and Exercise, 2398 – 2405.

Donath, L., Kurz, E., Roth, R., Zahner, L., & Faude, O. (2015). Different Ankle Muscle Coordination Patterns and Co-Activation During Quiet Stance Between Young Adults and Seniors Do Not Change After a Bout of High Intensity Exercise. BMC Geriatrics, 1 – 8.

Forestier, N., Terrier, R., & Teasdale, N. (2015). Ankle Muscular Proprioceptive Signals’ Relevance for Balance Control on Various Support Surfaces. American Journal of Physical and Medicine and Rehabilitation, 20 – 27.

Gillespie, L., Robertson, M., Gillespie, W., Sherrington, C., Gates, S., Clemson, L., & Lamb, S. (2015). Interventions for Prevention falls in older people living in the community . The Cochrane Coolaboration.

Gribble, P., & Hertel, J. (2003). Considerations for Normalizing Measures of the Star Excursion Balance Test. Measurement in Physical education and excerise in science, 89 – 100.

Paes, F., da Silver, R., Freira, A., Politti, F., Chiavegato, L., Geraldes, A., & Amorim, C. (2013). Immediate Effect if Bilateral Talocrural Joint Manipulation of Postural Balance in Healthy Subjects. Ergonomics.

Powell, M., Powden, C., Houston, M., & Hoch, M. (2014). Plantar Cutaneous Sensitivity and Balance in Individuals With and Without Chronic Ankle Instability. Clinical Journal of Sports Medicine, 490 – 496.

Shim, A., Steffen, K., Hauer, P., Cross, P., & Van Ryssegem, G. (2015). The Effects of Balance Training on Stability and Proprioception Scores of the Anklein College Students. International Journal of Kinesiology and Sports Science, 16 – 20.

Wright, W., Ivanenko, Y., & Gurfinkel, V. (2012). Foot Anatomy Specialization for Postural Sensation and Control. Journal of Neurophysiology, 1513 – 1521.