***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced . Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk . The type of insole best suited to achieve this is unknown . This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet . Method A participant-blinded r and omised controlled trial recruited 119 neuropathic participants with diabetes who were r and omly allocated to custom-made functional or prefabricated insoles . Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system . Primary outcomes were : peak pressure , forefoot pressure time integral , total contact area , forefoot rate of load , duration of load as a percentage of stance . Secondary outcomes were patient perceived foot health ( Bristol Foot Score ) , quality of life ( Audit of Diabetes Dependent Quality of Life ) . We also assessed cost of supply and fitting . Analysis was by intention-to-treat . Results There were no differences between insoles in peak pressure , or three of the other four kinetic measures . The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue ( 27 % vs. 22 % ) , remained more effective at six month follow-up ( 30 % vs. 24 % , p=0.001 ) , but was more expensive ( UK £ 656 vs. £ 554 , p<0.001 ) . Full compliance ( minimum wear 7 hours a day 7 days per week ) was reported by 40 % of participants and 76 % of participants reported a minimum wear of 5 hours a day 5 days per week . There was no difference in patient perception between insoles . Conclusion The custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure . We recommend that where clinical ly appropriate , the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy . Trial registration Clinical trials.gov ( NCT00999635 ) . Note : this trial was registered on completion BACKGROUND Age-related loss of foot-sole cutaneous sensation is very common and is associated with impaired balance control . This study investigated the effect of a balance-enhancing insole ( design ed to facilitate foot-sole sensation ) on lateral gait stability and evaluated its effectiveness in daily life . METHODS Forty community-dwelling older adults ( age 65 - 75 ) with moderate loss of foot-sole sensation ( unrelated to neuropathy ) were fitted with the same model of walking shoes . Half of the participants were assigned , at r and om , to wear the shoes with a facilitatory insole for 12 weeks ; the other participants wore a conventional insole . A gait perturbation protocol , simulating uneven terrain , was performed at baseline and after wearing the assigned insoles for 12 weeks . Participants were tested with both types of insoles during each gait-testing session and sent in weekly postcards with information pertaining to insole comfort , hours of wear , and falls . RESULTS The facilitatory insole improved lateral stability during gait , and this benefit did not habituate after 12 weeks of wearing the insole in daily life . Nine participants who wore conventional insoles experienced one or more falls , whereas only five of the facilitatory group fell . Although there were initial reports of mild discomfort in 10 cases , all but one participant tolerated the facilitatory insole , and most indicated that they would like to continue wearing the insole on a long-term basis . CONCLUSIONS A relatively simple change in insole design can help to counter effects of age-related ( non-neuropathic ) decline in foot-sole sensitivity , and is a viable intervention to enhance balance control This study investigated the effects on st and ing balance of r and om vibrations applied to the plantar side of the feet by vibrating insoles in subjects with neuropathy and nondisabled subjects . In four different conditions ( eyes open or closed and with or without an attention-dem and ing task [ ATD ] ) , subjects with neuropathy secondary to diabetes mellitus ( n = 17 ) and nondisabled subjects ( n = 15 ) stood for 60 s on vibrating insoles placed on a force plate . During each condition , the insoles were turned on for 30 s and off for 30 s ( r and om order ) . The calculated balance measures were mean velocity of the center of pressure displacements and root-mean-square of the velocity of these displacements in the anteroposterior and mediolateral directions . In subjects with neuropathy , an interaction effect between vibration and an ADT was found for balance . No effects of vibration on balance were found in nondisabled subjects .  Vibrating insoles improved st and ing balance in subjects with neuropathy only when attention was distracted . Improvement of the insoles and their activation is needed to make their implementation in daily living possible and effective The objective of the study was to determine whether insoles with a low Shore A value ( 15 ° ) as prescribed for patients with a diabetic neuropathy have a negative effect on posture stability because these insoles may reduce somatosensory input under the feet . It was conducted in the Center for Rehabilitation , University Medical Center Groningen , University of Groningen , Groningen , the Netherl and s The study was observational and conducted on 30 diabetic patients ( aged 37 – 82 years ) with a neuropathy .  Posture stability ( body sway ) was assessed in a shoe without insole , on a flat insole with a low Shore A value ( 15 ° ) and on a flat insole with a higher Shore A value ( 30 ° ) . These assessment s were done under four different conditions : ( 1 ) eyes open , no dual-task , ( 2 ) eyes closed , no dual-task , ( 3 ) eyes open , dual-task ( mental arithmetic ) and ( 4 ) eyes closed , dual-task . Additionally 10 healthy controls ( aged 27 – 51 years ) were assessed similarly . A significantly higher root-mean-square ( rms ) value of the anterior-posterior velocity , Vy , was found in patients compared with controls ( 3.4 cm/s vs. 1.2 cm/s , p < 0.05 ) . Also a significant difference in rms value of the anterior-posterior velocity , Vy , was found between eyes open and eyes closed ( 1.9 cm/s vs. 2.7 cm/s , p < 0.05 ) . No significant effects were found for insoles or dual tasks for the total group . In diabetic patients no significant effect was found of insoles on posture stability . The effect of closed eyes on posture stability was significantly larger for diabetic patients compared to controls . It was found that prescribing insoles with a low Shore A value ( 15 ° ) , compared to insoles with a higher Shore A value ( 30 ° ) has no significant negative effect on posture stability in patients with a diabetic neuropathy OBJECTIVE To evaluate the effect of wearing a dorsiflexion assist orthosis ( DAO ) on walking distance , physiological cost , fatigue , and strength and balance measures after a modified 6-minute walk test ( 6MWT ) in people with multiple sclerosis ( MS ) . DESIGN R and omized crossover trial . SETTING Hospital Movement Laboratory . PARTICIPANTS People with moderate MS and Exp and ed Disability Status Scale score of 3.7±0.7 ( N=34 ; 26 women ) . INTERVENTIONS Modified 6MWT with and without a DAO worn on the weaker leg . MAIN OUTCOME MEASURES Distance walked , perceived fatigue , and the physiological cost of walking were compared between walking conditions . Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and st and ing postural sway with eyes open and closed were compared between walking conditions . RESULTS There were no differences in distance walked or perceived fatigue between the 2 walking conditions . However , there was a reduced physiological cost of walking ( P<.05 ) , a smaller reduction in knee extensor strength ( P<.05 ) , and a smaller increase in st and ing postural sway with eyes open ( P<.01 ) after walking while wearing the DAO compared with walking without wearing the DAO . CONCLUSIONS Despite not increasing walking distance or reducing perceived fatigue , the DAO reduced the physiological cost of walking and maintained knee strength and st and ing balance , which may have important implication s for physical rehabilitation in people with MS . Further trials are required to determine whether the beneficial effects of wearing a DAO found here are maintained for longer periods BACKGROUND One of the more pervasive effects of aging is loss of cutaneous sensation , which appears to correlate with impaired postural control and increased risk of falling . This study examined the potential for compensating for the destabilizing effects of reduced cutaneous sensitivity by placing a raised edge underneath the perimeter of the plantar foot surface , so as to facilitate sensation from the stability boundaries of the base of support . METHODS The main experiment involved 14 healthy older adults ( aged 65 - 73 ) selected because they were known , from a previous study , to have moderate plantar cutaneous insensitivity . We also report results of an initial experiment involving 7 healthy young adults ( aged 23 - 31 ) . In both experiments , we studied effects of the plantar facilitation on control of rapid stepping reactions evoked by unpredictable postural perturbation , applied via sudden platform movement in forward , backward , and lateral directions . We also studied effects on " feet-in-place " responses evoked by continuous pseudor and om platform motion in mediolateral and anteroposterior directions . Subjects were blindfolded in all tests . RESULTS Plantar facilitation reduced the incidence of " extra " limb movements , beyond the initial step , during forward-step reactions in the older adults . There also appeared to be an improved ability to control feet-in-place reactions : young subjects were better able to recover balance without stepping when falling backward ( given instructions to " try not to step " ) , and both young and older subjects reduced the extent to which the center of foot pressure approached the posterior foot boundary during continuous anteroposterior platform motion . CONCLUSIONS This study provides evidence that mechanical facilitation of sensation from the boundaries of the plantar surface of the foot can improve the efficacy of certain types of stabilizing reactions evoked by unpredictable postural perturbation . The results may be directly transferable to the design of special footwear insoles to reduce instability and risk of falling in older adults Background : Recently , additive fabrication has been proposed as a feasible engineering method for manufacturing of customized ankle foot orthoses ( AFOs ) . Consequently , studies on safety , comfort and effectiveness are now carried out to assess the performance of such devices . Objective : Evaluate the clinical performance of customized ( selective laser sintering ) SLS-AFOs on eight subjects with unilateral drop foot gait and compare to clinical ly accepted ( polypropylene ) PP-AFOs . Study Design : Active control trial . Methods : For each subject two customized AFOs were fabricated : one SLS-AFO manufactured following an additive fabrication framework and one thermoplastic PP-AFO manufactured according to the traditional h and craft method .  Clinical performance of both AFOs was evaluated during gait analysis . Results : A significant beneficial effect of both custom-moulded PP-AFO and customized SLS-AFO in terms of spatial temporal gait parameters and ankle kinematic parameters compared to barefoot gait of adults with drop foot gait are observed . No statistically significant difference between the effect of PP-AFO and of SLS-AFO was found in terms of spatial temporal gait parameters and ankle kinematic parameters . Conclusion : AFOs manufactured through the SLS technique show performances that are at least equivalent to the h and crafted PP-AFOs commonly prescribed in current clinical practice . Clinical relevance Manufacturing personalized AFOs with selective laser sintering ( SLS ) in an automated production process results in decreased production time and guarantees the consistency of shape and functional characteristics over different production time points compared to the traditional manufacturing process . Moreover , it reduces the dependency of the appliance on the experience and craftsmanship of the orthopaedic technician Background Fatigue in combination with gait and balance impairments can severely limit daily activities in people with multiple sclerosis ( PWMS ) . Generalised fatigue has a major impact on walking ability , with moderately disabled PWMS experiencing difficulty in walking extended distances . Localised motor fatigue in the ankle dorsiflexors can lead to foot drop , further reducing functional ambulation . The aim of this study is to evaluate the effect of a simple dynamic dorsiflexion assist orthosis on walking-induced fatigue , gait , balance and functional mobility in PWMS . Methods A r and omised cross-over trial will be conducted with 40 community dwelling PWMS with mild to moderate mobility disability . Participants will initially be screened for disease severity , balance , strength , depression and fatigue at the South Australian Motion Analysis Centre . On two non-consecutive occasions , within two weeks , participants will undergo either the 6-minute walk test ( 6MWT ) or the 6MWT while wearing a dorsiflexion ankle orthosis ( with a r and omised condition order ) . Distance walked , perceived exertion , perceived fatigue and the physiological cost of walking ( the primary outcome measures ) will be compared between the two walking conditions . Additional pre- and post-6MWT assessment s for the two conditions will include tests of strength , reaction time , gait and balance . Discussion This study will increase our underst and ing of motor fatigue on gait and balance control in PWMS and eluci date the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS . It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group . Trial Registration OBJECTIVE To evaluate the effect of insoles with medial arch support and metatarsal pad on balance , foot pain and disability in elderly women with osteoporosis . METHODS This was a r and omized controlled clinical trial . Ninety-four elderly women ( > 
    Output:
    
The results of the included studies found that in people with sensory perception loss , postural sway improved with vibrating insoles and AFO , altering the softness and texture of the top cover had no effect on postural sway , wearing footwear over long distances or AFOs improved step-to-step consistency , and no foot and ankle device was reported to have a negative effect on the balance or gait of people with sensory perception loss .
There is limited evidence to suggest that footwear and insole devices can artificially alter postural stability and may reduce the step-to-step variability in adults with sensory perception loss .
Varying the material properties of an insole does not notably affect static balance or gait