Effects of Pronated and Supinated Foot Postures on Static and Dynamic Postural Stability.

Context: The foot is the most distal segment in the lower extremity chain and represents a relatively small base of support on which the body maintains balance (particularly in single-leg stance). Although it seems reasonable that even minor biomechanical alterations in the support surface may influence postural-control strategies, the implications of a hypermobile or hypomobile foot on balance have received little attention to date.Objective: To determine if supinated and pronated foot types influence measures of static and dynamic balance.Design: Participants were assigned to 1 of 3 groups depending on foot type, as defined by navicular-drop measures: pronated (>/=10 mm), neutral (5-9 mm), or supinated (</=4 mm). Measures of static and dynamic balance were obtained for each participant and compared across groups.Setting: Sports medicine and athletic training research laboratory.Patients or Other Participants: Sixteen individuals with pronated (navicular drop = 13.0 +/- 3.7 mm), neutral (navicular drop = 6.2 +/- 1.1 mm), or supinated (navicular drop = 2.2 +/- 1.7 mm) foot postures volunteered to participate in the study.Main Outcome Measure(s): We used the Chattecx Balance System to measure center of balance, stability index, and postural sway during static single-limb stance under eyes-open and eyes-closed conditions. Center of balance was defined as the point on the foot at which the body weight was equally distributed between the medial-lateral and anterior-posterior quadrants and was recorded in centimeters. Stability index was defined as the mean deviation in sway around the center of balance. Postural sway was expressed as the maximum sway distance recorded (cm) in the medial-lateral and anterior-posterior directions. The Star Excursion Balance Test was used to measure dynamic balance, which was reported as the reach distance (cm) in each of the 8 directions tested. The average of 3 trials of each measure was calculated and normalized to the subject's height.Results: We found no difference in center of balance or postural sway as a function of foot type. The stability index was greater in pronators than in supinators, but neither group was different from those with neutral foot types. Dynamic reach differed among groups but only in some directions. Generally, pronators reached farther in the anterior and anterior medial directions and supinators reached farther in the posterior and posterio-lateral directions. In the lateral direction, supinators reached farther than pronators but not farther than neutrals.Conclusions: Our results suggest that postural stability is affected by foot type under both static and dynamic conditions. These differences appear to be related to structural differences as opposed to differences in peripheral input. These effects should be considered when clinicians use such balance measures to assess injury deficits and recovery.