Experimental Brain Research

, Volume 231, Issue 2, pp 201–208 | Cite as

Effect of a textured insole on balance and gait symmetry

  • Alexander S. AruinEmail author
  • Neeta Kanekar
Research Article


Asymmetry of standing balance and gait is common in individuals with neurological disorders, and achieving symmetrical stance and gait is an important goal of rehabilitation. The purpose of this study was to investigate the effect of a novel discomfort-induced approach (that is based on using a single textured insole) on the alteration in the symmetry of gait and balance. Eleven healthy subjects (6 females and 5 males, mean age of 28.0 ± 4.1 years) were tested using the Computerized Dynamic Posturography and GaitRite systems when standing or walking while wearing standard footwear with the textured insole positioned either in the left or in the right shoe, and without the insole. Significant immediate effect of the textured insole was seen in the outcome measures of static (weight bearing) and dynamic (weight symmetry index, strength symmetry) balance tests (p < 0.05) as well as in gait symmetry (single support and swing phases) (p < 0.05). The results of the study indicate that a textured insole can significantly modify the symmetry of stance and gait in healthy individuals. Pilot data from individuals with stroke also showed a reduction in the asymmetry of gait when walking with the single textured insole in the shoe on the unaffected side. This outcome provides support for future studies on the efficacy of the textured insole in minimizing asymmetry of gait and posture in individuals in need.


Gait Balance Asymmetry Textured insole 



We would like to thank Dr. Noel Rao for help with recruiting subjects for the study.


  1. Aruin AS, Hanke T, Chaudhuri G, Harvey R, Rao N (2000) Compelled weight bearing in persons with hemiparesis following stroke: the effect of a lift insert and goal-directed balance exercise. J Rehabil Res Dev 37:65–72PubMedGoogle Scholar
  2. Aruin AS, Rao N, Sharma A, Chaudhuri G (2012) Compelled body weight shift approach in rehabilitation of individuals with chronic stroke. Top Stroke Rehabil 19:556–563PubMedCrossRefGoogle Scholar
  3. Bilney B, Morris M, Webster K (2003) Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture 17:68–74PubMedCrossRefGoogle Scholar
  4. Bohanon R, Andrews A, Smith M (1988) Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res 11:181–182CrossRefGoogle Scholar
  5. Bonan IV, Colle FM, Guichard JP, Vicaut E, Eisenfisz M, Tran Ba Huy P, Yelnik AP (2004) Reliance on visual information after stroke. Part I: balance on dynamic posturography. Arch Phys Med Rehabil 85:268–273PubMedCrossRefGoogle Scholar
  6. Brand RA, Yack HJ (1996) Effects of leg length discrepancies on the forces at the hip joint. Clin Orthop 333:172–180Google Scholar
  7. Brandstater ME, de Bruin H, Gowland C, Clark BM (1983) Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil 64:583–587PubMedGoogle Scholar
  8. Chaudhuri S, Aruin AS (2000) The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis. Arch Phys Med Rehabil 81:1498–1503PubMedCrossRefGoogle Scholar
  9. Corbin DM, Hart JM, McKeon PO, Ingersoll CD, Hertel J (2007) The effect of textured insoles on postural control in double and single limb stance. J Sport Rehabil 16:363–372PubMedGoogle Scholar
  10. Ford-Smith CD, Wyman JF, Elswick RK Jr, Fernandez T, Newton RA (1995) Test–retest reliability of the sensory organization test in noninstitutionalized older adults. Arch Phys Med Rehabil 76:77–81PubMedCrossRefGoogle Scholar
  11. Friberg O (1983) Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine 8:643–651PubMedCrossRefGoogle Scholar
  12. Goel A, Loudon J, Nazare A, Rondinelli R, Hassanein K (1997) Joint moments in minor limb length discrepancy: a pilot study. Am J Orthop 26:852–856PubMedGoogle Scholar
  13. Gross RH (1978) Leg length discrepancy: how much is too much? Orthopedics 1:307–310PubMedGoogle Scholar
  14. Guillebastre B, Calmels P, Rougier P (2009) Effects of rigid and dynamic ankle-foot orthoses on normal gait. Foot Ankle Int 30:51–56PubMedCrossRefGoogle Scholar
  15. Hatton AL, Dixon J, Martin D, Rome K (2009) The effect of textured surfaces on postural stability and lower limb muscle activity. J Electromyogr Kinesiol 19:957–964PubMedCrossRefGoogle Scholar
  16. Hatton A, Dixon J, Rome K, Newton J, Martin D (2012) Altering gait by way of simulation of the plantar surface of the foot: the immediate effect of wearing textured insoles in older adults. J Foot Ankle Res 5:11. doi: 10.1186/1757-1146-5-11 Google Scholar
  17. Hesse S, Reiter F, Jahnke M, Dawson M, Sarkodie-Gyan T, Mauritz KH (1997) Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil 78:719–724PubMedCrossRefGoogle Scholar
  18. Hosoda M, Yoshimura O, Takayanagi K, Kobayashi R, Minematsu A, Sasaki H, Maejima H, Matsuda Y, Araki S, Nakayama A, Ishibashi T, Terazono T (1998) The effects of footwear on standing postural control. J Phys Ther Sci 10:47–51CrossRefGoogle Scholar
  19. Hsu AL, Tang PF, Jan MH (2003) Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 84:1185–1193PubMedCrossRefGoogle Scholar
  20. Ikai T, Kamikubo T, Takehara I, Nishi M, Miyano S (2003) Dynamic postural control in patients with hemiparesis. Am J Phys Med Rehabil 82:463–469; quiz 470–462, 484Google Scholar
  21. Kelleher KJ, Spence WD, Solomonidis S, Apatsidis D (2010) The effect of textured insoles on gait patterns of people with multiple sclerosis. Gait Posture 32:67–71PubMedCrossRefGoogle Scholar
  22. Kubota M, Uchida K, Kokubo Y, Shimada S, Matsuo H, Yayama T, Miyazaki T, Sugita D, Watanabe S, Baba H (2013) Postoperative gait analysis and hip muscle strength in patients with pelvic ring fracture. Gait Posture 38(3):385–390Google Scholar
  23. Leiper CI, Craik RL (1991) Relationships between physical activity and temporal-distance characteristics of walking in elderly women. Phys Ther 71:791–803PubMedGoogle Scholar
  24. Lewek MD, Feasel J, Wentz E, Brooks FP Jr, Whitton MC (2012) Use of visual and proprioceptive feedback to improve gait speed and spatiotemporal symmetry following chronic stroke: a case series. Phys Ther 92:748–756PubMedCrossRefGoogle Scholar
  25. Lewek MD, Bradley CE, Wutzke CJ, Zinder SM (2013) The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke. J Appl Biomech [Epub ahead of print]Google Scholar
  26. Michael KM, Allen JK, Macko RF (2005) Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil 86:1552–1556PubMedCrossRefGoogle Scholar
  27. Mohapatra S, Eviota A, Ringquist K, Muthukrishnan S, Aruin A (2012) Compelled body weight shift technique to facilitate rehabilitation of individuals with acute stroke. ISRN Rehabil 2012. doi: 10.5402/2012/328018
  28. Nurse MA, Hulliger M, Wakeling JM, Nigg BM, Stefanyshyn DJ (2005) Changing the texture of footwear can alter gait patterns. J Electromyogr Kinesiol 15:496–506PubMedCrossRefGoogle Scholar
  29. Olney S, Richards C (1996) Hemiparetic gait following stroke. Part 1: characteristics. Gait Posture 4:136–148CrossRefGoogle Scholar
  30. Palluel E, Nougier V, Olivier I (2008) Do spike insoles enhance postural stability and plantar-surface cutaneous sensitivity in the elderly? Age (Dordr) 30:53–61CrossRefGoogle Scholar
  31. Patterson SL, Forrester LW, Rodgers MM, Ryan AS, Ivey FM, Sorkin JD, Macko RF (2007) Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil 88:115–119PubMedCrossRefGoogle Scholar
  32. Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, Black SE, McIlroy WE (2008) Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil 89:304–310PubMedCrossRefGoogle Scholar
  33. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE (2010) Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 31:241–246PubMedCrossRefGoogle Scholar
  34. Qiu F, Cole MH, Davids KW, Hennig EM, Silburn PA, Netscher H, Kerr GK (2012) Enhanced somatosensory information decreases postural sway in older people. Gait Posture 35:630–635PubMedCrossRefGoogle Scholar
  35. Rao N, Aruin AS (2006) Automatic postural responses in individuals with peripheral neuropathy and ankle-foot orthoses. Diabetes Res Clin Pract 74:48–56PubMedCrossRefGoogle Scholar
  36. Rao AK, Gillman A, Louis ED (2011) Quantitative gait analysis in essential tremor reveals impairments that are maintained into advanced age. Gait Posture 34:65–70PubMedCrossRefGoogle Scholar
  37. Robinson RO, Herzog W, Nigg BM (1987) Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry. J Manip Physiol Ther 10:172–176Google Scholar
  38. Rodriguez GM, Aruin AS (2002) The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. Arch Phys Med Rehabil 83:478–482PubMedCrossRefGoogle Scholar
  39. Sackley CM (1991) Falls, sway, and symmetry of weight-bearing after stroke. Int Disabil Stud 13:1–4PubMedCrossRefGoogle Scholar
  40. Thaut MH, McIntosh GC, Rice RR (1997) Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation. J Neurol Sci 151:207–212PubMedCrossRefGoogle Scholar
  41. Titianova EB, Tarkka IM (1995) Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction. J Rehabil Res Dev 32:236–244PubMedGoogle Scholar
  42. Wunnemann M, Klein D, Rosenbaum D (2011) Effects of the Twin Shoe (Darco) to compensate height differences in normal gait. Gait Posture 33:61–65PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Physical Therapy (MC 898)University of Illinois at ChicagoChicagoUSA

Personalised recommendations