By Josée Gingras, the Lead Pedorthist at The Stride Clinic
The ability for us to walk without thinking about it is due to the foot’s immaculate ability to communicate with the brain to let us know where we are on the ground. Think of the feet as creating a topographical map of our surroundings using different stimuli including texture, vibration, skin stretch, deep pressure, and light touch.
Now think about how difficult it would be to navigate without a map. People with conditions like neuropathy, Parkinson’s disease, and multiple sclerosis (MS) live in this reality.
Within our pedorthic practice, the importance of stability has always been paramount for these individuals. Using external modalities like custom made orthotics, orthopaedic footwear, and bracing have long been the best approach to providing this support. What if we can use these external tools to stimulate the intrinsic (internal) structures of the feet and teach the foot how to begin drawing the map again?
This is the basis of new science developing around the use of texture in orthotics. When we talk about texture, we mean a specially designed material that best stimulates the nerves (mechanoreceptors) of the feet. It is a ridged material that creates very small dimples in the skin.
How Orthotics with Texture Work
We are all too familiar with the feeling of helplessness when our feet are asleep and we need to get up quickly, or at all - it can feel like you have two concrete slabs tied to your legs that just won’t cooperate. Research has demonstrated that when you reduce the sensation to an area of the feet, for example using ice, you’re more hesitant to place weight on your foot so you walk slower and your balance is tricky. The same research also noticed that the foot attempts to adapt to this reduced sensitivity by trying to search for areas of high sensitivity; shifting our weight around in ways that may not always result in steady, balanced standing and walking.
The opposite scenario, adding texture (or stimulus) to the feet, has been shown to increase the activity of the foot muscles which allows for a more responsive base of support and therefore a higher degree of stability and confidence in planting the feet.
Orthotics independently have been shown to provide increased and more coordinated muscle activation, with an important factor being the way the orthotic interacts with the foot to match the individual profiles and provide a total contact surface. Simply put, the orthotic needs to touch your whole foot sole in order to gain these benefits. With the orthotics working their magic, the addition of a textured surface can allow for an even greater foot-to-brain response.
Texture for Peripheral Neuropathy
The research for improving balance and walking in people with various forms of neuropathy is new and exciting.
The more we can prevent falls and keep people active, the more longevity they can expect. Fall prevention includes both the confidence in one’s step as well as the active ability for the foot to keep the body balanced and stable. As the feet are better able to modulate muscle activation, they are better able to respond to changes in the environment, making adjusting your step to the curb ahead more achievable.
Additionally, negative symptoms such as tingling and numbness related to neuropathy, which cannot be treated with medications, have been shown to be improved with the use of textured orthotics since they are designed to directly target the receptors responsible for these annoying sensations.
Toe-Walking and Textured Orthotics
Within our clinic we have seen fantastic responses to the use of textured orthotics.
One example of mind-to-muscle disconnect we see frequently is that of “toe-walking” which can be caused by a number of factors. If there is no physical restriction present, these individuals can often be “coached” to place their heels down, but as they begin walking for longer distances the heel contact will reduce as the brain starts to think of other (more important) things.
It was our goal to find a way to provide a better feedback loop from the heel to the brain so that there was constant communication and activation of muscles without conscious thought:
Client 1:
A relatively active 10-year-old had come in for a pedorthic assessment after trying numerous other therapies including sports rehab and physiotherapy but unfortunately achieved minimal results. This individual had the ability to place heels on the ground and even walk a few paces in a “normal” heel-to-toe manner, however after a few laps of the clinic the heels began to rise.
Our treatment plan included textured custom-made orthotics with a slight heel raise, consistent calf stretching (tightness in the calf muscles is an unfortunate cause and consequence of toe-walking) and orthopaedic footwear. When trying on the orthotics for the first time, immediate heel contact was noted and stayed consistent even after a few laps of the clinic. As they began walking, they remarked “I feel something funny on the back of my foot!”, we couldn’t help but laugh and note, “That’s your heels!”
Client 2:
Our second client to test the textured top cover for toe walking was a 16-year-old who was not able to touch their heels to the ground during barefoot walking. This individual has been working through physiotherapy, stretching diligently, and wearing orthotics with a heel raise over the past 5 years. While the pain in the heel cord that this client experienced has been improved with the orthotics, the toe walking persists. This year we added the texture and there was immediate heel contact that lasted while walking around the clinic. Not only were the feet contacting, but this individual was also able to feel their heels and reported that the texture felt great.
Walking is second nature to most and the ease of movement needed to perform daily activities of living is something we should not take for granted. When we lose this freedom, or we see it in someone we love, navigating ways around it can feel overwhelming.
Advances in orthotic technologies, like using texture, are constantly developing to improve treatment outcomes. There are so many ways that we can help our clients improve their quality of life and we are committed to doing so by keeping up to date and implementing the new and exciting research coming into our field.
To learn more about these new innovative orthotics or to book an assessment, visit The Stride Clinic online or call (705) 735-1013 for their Barrie location or (705) 326-5808 for the Orillia location.
This article was sponsored by The Stride Clinic, a 2023 BarrieToday Reader Favourite.