Research Article

Immediate Effect of Textured Insole on Static Balance in Individuals With Flexible Flatfoot


Introduction: Flatfoot is a common orthopedic disorder in the world. Some investigations have demonstrated flatfoot as the cause of many problems such as balance impairment by affecting the proprioception of the soles. Balance reduction can lead to injuries too. In this regard, textured surfaces can be used for stimulating somatosensory system as well as improving proprioception. Therefore, this study aimed to examine the role of textured insole on somatosensory system stimulation and consequently its effect on the balance improvement in individuals with flatfooted.
Material and Methods: This study is a kind of interventional quasi-experimental research. Twenty male students of Iran University of Medical Sciences (Mean [SD] age 22.1 [1.3] years with bilateral flexible flatfoot) were recruited in this study by convenience sampling method. The study variables were as follows: anteroposterior and mediolateral displacements and total velocity of the center of pressure that were measured using a Kistler force plate instrument. Repeated measures ANOVA test was used to compare the test values.
Results: Textured insole reduced the average of all measured parameters in eyes closed condition. This reduction was significant in both anteroposterior displacement and total velocity parameters (P<0.05). Surprisingly, the common arched medical insole leads to balance reduction when used in shoe.
Conclusion: Data analysis demonstrated that using textured insoles can be effective in balance improvement in individuals with flexible flatfooted. This can be the result of extroception and proprioception improvement. On the other hand, we found that common traditional insoles can disturb balance in this group of patients.


Cote KP, Brunet II ME, Gansneder BM, Shultz SJ. Effects of pronated and supinated foot postures on static and dynamic postural stability. Journal of Athletic Training. 2005; 40(1):41-46. PMCID: PMC1088344

Christovão TCL, Neto HP, Grecco LAC, Ferreira LAB, Franco de Moura RC, Eliege de Souza M, et al. Effect of different insoles on postural balance: A systematic review. Journal of Physical Therapy Science. 2013; 25(10):1353–6. doi: 10.1589/jpts.25.1353

Collings R, Paton J, Chockalingam N, Gorst T, Marsden J. Effects of the site and extent of plantar cutaneous stimulation on dynamic balance and muscle activity while walking. The Foot. 2015; 25(3):159–63. doi: 10.1016/j.foot.2015.05.003

Corbin DM, Hart JM, McKeon PO, Ingersoll CD, Hertel J. The effect of textured insoles on postural control in double and single limb stance. Journal of Sport Rehabilitation. 2007; 16(4):363–72. doi: 10.1123/jsr.16.4.363

Feizolahi F, Azarbayjani MA. [Comparison of static and dynamic balance in amateur male athletes (Persian)]. Journal of Rehabilitation Medicine. 2015; 3(4): 89-98.

Hertel J, Gay MR, Denegar CR. Differences in postural control during single-leg stance among healthy individuals with different foot types. Journal of Athletic Training. 2002; 37(2):129-32. PMCID: PMC164334

Woo MT, Davids K, Liukkonen J, Jaakkola T, Chow JY. Effects of textured compression socks on postural control in physically active elderly individuals. Procedia Engineering. 2014; 72:162–7. doi: 10.1016/j.proeng.2014.06.028

Kavounoudias A, Roll R, Roll J-P. The plantar sole is a “dynamometric map” for human balance control. Neuro Report. 1998; 9(14):3247–52. doi: 10.1097/00001756-199810050-00021

Akbari M, Mohammadi M, Saeedi H. [Effects of rigid and soft foot orthoses on dynamic balance in females with flatfoot (Persian)]. Medical Journal of The Islamic Republic of Iran. 2007; 21(2):91-7.

Ali ME, Mohamed MS. [Dynamic postural balance in subjects with and without flat foot (Persian)]. Bulletin of Faculty of Physical Therapy. 2011; 16(1):7-11.

Cobb SC, Tis LL, Johnson BF, Higbie EJ. The effect of forefoot varus on postural stability. Journal of Orthopaedic & Sports Physical Therapy. 2004; 34(2):79–85. doi: 10.2519/jospt.2004.34.2.79

Harrison PL, Littlewood C. Relationship between pes planus foot type and postural stability. Indian Journal of Physiotherapy and Occupational Therapy. 2010; 4(3):21-4.

Khatatbeh M, Dabayebeh I. Effectiveness of specialized small motor games for the improvement of dynamic balance in flexible flat foot. Jordan Medical Journal. 2012; 46(4):321-30.

Mirahmadi M., Karimi MT, Mostamand J. [Stability analysis of patients with various neurological and musculoskeletal disorders based on linear and nonlinear approaches (Persian)]. Journal of Research in Rehabilitation Sciences. 2013; 9(6):969-77.

Rome K, Brown CL. Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clinical Rehabilitation. 2004; 18(6):624–30. doi: 10.1191/0269215504cr767oa

Satvati B, Karimi MT, Tahmasebi Boldaji R, Pool F. [Standing stability evaluation in subjects with flat foot (Persian)]. Journal of Research in Rehabilitation Sciences. 2013; 8(8): 1277-84.

Takata Y, Matsuoka S, Okumura N, Iwamoto K, Takahashi M, Uchiyama E. Standing balance on the ground: The influence of flat feet and insoles. Journal of Physical Therapy Science. 2013; 25(12):1519–21. doi: 10.1589/jpts.25.1519

Tsai LC, Yu B, Mercer VS, Gross MT. Comparison of different structural foot types for measures of standing postural control. Journal of Orthopaedic & Sports Physical Therapy. 2006; 36(12):942–53. doi: 10.2519/jospt.2006.2336

De Morais Barbosa C, Barros Bertolo M, Marques Neto JF, Bellini Coimbra I, Davitt M, de Paiva Magalhaes E. The effect of foot orthoses on balance, foot pain and disability in elderly women with osteoporosis: A randomized clinical trial. Rheumatology. 2012; 52(3):515–22. doi: 10.1093/rheumatology/kes300

Hatton AL, Dixon J, Rome K, Martin D. Standing on textured surfaces: Effects on standing balance in healthy older adults. Age and Ageing. 2011; 40(3):363–8. doi: 10.1093/ageing/afr026

Jamali A, Forghany S, Bapirzadeh Kh. [The effect of textured insole on balance in people with functional ankle instability (Persian)]. Journal of Research in Rehabilitation Sciences. 2014; 10(5):619-26.

Hatton AL, Rome K, Dixon J, Martin DJ, McKeon PO. Footwear interventions. Journal of the American Podiatric Medical Association. 2013; 103(6):516–33. doi: 10.7547/1030516

Orth D, Davids K, Wheat J, Seifert L, Liukkonen J, Jaakkola T, et al. The role of textured material in supporting perceptual-motor functions. PLoS ONE. 2013; 8(4):60349. doi: 10.1371/journal.pone.0060349

McKeon PO, Stein AJ, Ingersoll CD, Hertel J. Altered plantar-receptor stimulation impairs postural control in those with chronic ankle instability. Journal of Sport Rehabilitation. 2012; 21(1):1–6. doi: 10.1123/jsr.21.1.1

Perry SD, Radtke A, McIlroy WE, Fernie GR, Maki BE. Efficacy and effectiveness of a balance-enhancing insole. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2008; 63(6):595–602. doi: 10.1093/gerona/63.6.595

Aruin AS, Kanekar N. Effect of a textured insole on balance and gait symmetry. Experimental Brain Research. 2013; 231(2):201–8. doi: 10.1007/s00221-013-3685-z

Palluel E, Nougier V, Olivier I. Do spike insoles enhance postural stability and plantar-surface cutaneous sensitivity in the elderly. Age. 2008; 30(1):53–61. doi: 10.1007/s11357-008-9047-2

Waddington G. Football boot insoles and sensitivity to extent of ankle inversion movement. British Journal of Sports Medicine. 2003; 37(2):170–5. doi: 10.1136/bjsm.37.2.170

Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: The foot posture index. Clinical Biomechanics. 2006; 21(1):89–98. doi: 10.1016/j.clinbiomech.2005.08.002

Preszner-Domjan A, Nagy E, Szíver E, Feher-Kiss A, Horvath G, Kranicz J. When does mechanical plantar stimulation promote sensory re-weighing: standing on a firm or compliant surface. European Journal of Applied Physiology. 2011; 112(8):2979–87. doi: 10.1007/s00421-011-2277-5

Steinberg N, Waddington G, Adams R, Karin J, Tirosh O. The effect of textured ballet shoe insoles on ankle proprioception in dancers. Physical Therapy in Sport. 2016; 17:38–44. doi: 10.1016/j.ptsp.2015.04.001

IssueVol 10 No 4 (2016) QRcode
SectionResearch Article(s)
Static balance Flexible flatfoot Textured insole

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Nazari A, Hajiaghaei B, Alaee J, Farahmand B. Immediate Effect of Textured Insole on Static Balance in Individuals With Flexible Flatfoot. jmr. 2017;10(4):163-168.