Effects of changes in plantar sensory feedback on human gait characteristics: a systematic review

Background: Deficits in motor control can be observed with a decrease in plantar sensation. There is evidence that changing the plantar feedback leads to kinematic, kinetic and neuromuscular adaptations in static as well as dynamic conditions. The effect of changes in plantar feedback on the modulation of gait has not been clarified conclusively. Objectives: The purpose of this paper was to provide a review of studies reporting the effects of changes in plantar feedback on human gait characteristics. Method: The databases Medline (PubMed), Cochrane Central Register of Controlled Trials and PEDro (Physiotherapy Evidence Database) were searched for clinical (CTs) and randomized controlled trials (RCTs) concerning foot sensation and gait. Results: Twenty-three studies were included in the evaluation. Several methods were used to affect the sensitivity of the foot sole. After cooling or sedating the foot sole, predominant changes occur in decreased peak pressures, muscle activities and joint angles, and relocation of the centre of pressure under the foot was found. Walking on uneven surfaces results in a decrease in gait velocity, cadence and step length and also an increase in step variability. The use of textured insoles during walking leads to increased knee, hip and ankle angles, forces and moments in neurological patients with decreased foot sensation. In particular, individuals with sensory deficits show significant gait improvements when using textured or vibrating insoles. Conclusions: Changes in plantar feedback lead to stimulation-specific adaptations of gait characteristics. Further prospective RCTs should be performed to investigate interventions for enhancing plantar receptor feedback for the prevention of falls and the treatment of injuries and movement disorders.