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Literature Review
Literature Review
The literature review chapter summarizes information about the connection between the practice of the footbed instruments’ application and the development of the human body posture. Body posture is one of the elements that determine the overall health and well-being of a human, balance in the development of specific musculoskeletal system elements, and functional productivity of the human body (Carini et al., 2017, p.12). Failures in the maintenance of the posture balance might cause the loss of body functionality, additional pain, and excessive resource expenses for the completion of specific body movement activities. From this perspective, the search for specific means of resolving posture problems is recognized as one of the important tasks for the maintenance and recovery of the human body’s health.
In this literature review, specific attention had been paid to the analysis of the insoles’ utility for the preservation and restoration of the posture balance in the human body. Application of the footbed instrument is one of many measures applied for the recovery of the posture balance. It was important to assess the utility of this method for the treatment of different elements of the posture-balancing system in the human body. First, the definition of the posture and postural balance condition was presented to describe the object of the study. Later, the role of the insoles in the treatment of specific elements of the posture-balancing system was discussed. It was important to show the interconnected nature of the posture-balancing system and the need for the application of measures useful for each element of the balance. The results of the literature review contributed to the definition of existing knowledge on the study theme and the specific knowledge gaps that will have to be addressed in the future.
Definition of Posture and Postural Balance
In the discussion of the influence of the footbed on human body posture, the notion of body posture should be presented. It is crucial both to consider the concept of body posture as it is perceived in modern medical science and to determine the key elements of the human body system involved in the process of body posture regulation. A clear definition of the study object, including key elements of the human body impacting it, will contribute to the detailed assessment of the footbed’s influence on the human posture.
The term posture describes the position of the human body in space. Posture is recognized as the automatic and unconscious position of the human body in space, which has the purpose of maintaining the body balance under conditions of permanent reaction to the force of gravity (Carini et al., 2017, p.12). Posture is any type of body position that guarantees the maintenance of balance “with maximum stability, minimal energy consumption and minimal stress of the anatomical structures” (Carini et al., 2017, p.12). The human body automatically adapts to the changing environment by selecting the optimal posture form, both under static and dynamic conditions. Balance in the human posture is a result of interaction between truck muscles and joints, including ankles, knees, and hips (Lou et al., 2018, p.1). It is sensible to describe the mechanism contributing to the adaptive maintenance of posture balance in the human body.
The definition of the key posture elements leads to the need for discussion of the posture control function in the human body. Posture control is the isometric and motor behavior, which forms a stable starting point at the beginning of the movement (Carini et al., 2017, p.12). The key anatomical structures involved in the posture control process include “vestibular organs, cerebellum, cerebral cortex and reticular formation, … exteroceptors, (tactile and pressure) located under the foot, visual receptors and proprioceptors located in tendons, joint capsules and muscles” (Carini et al., 2017, p.12). Disorders taking place within any of these elements could cause critical failures in the transmission of information necessary for the maintenance of body posture balance and posture control (Lou et al., 2018, p.2). From this perspective, it is necessary to assess the effects of the footbed on each element of the posture control mechanism.
Impact of Footbed on Foot Posture
The analysis of footbed’s influence on human body posture should start from the discussion of its direct influence on the foot posture. Foot posture is the characteristic that describes the position of the flat feet on the ground. Specialists mainly distinguish static and dynamic foot posture to assess the role of foot posture in the functioning of the human body (Neal et al., 2014, p.2). The findings of the recent study indicated a strong correlation between the pronated foot posture condition and the medial tibial stress syndrome (MTSS) as one of the key signs of lower limb overuse injury (Neal et al., 2014, p.1). Pronated foot posture condition was also associated with the increased risk of low back pain in women, which is a sign of serious damage caused to human body posture and health by foot posture problems (Menz et al., 2013, p.2276). Foot posture disorder conditions were also found to be influencing the worsening static balance level in the aging population (Hemmati et al., 2014, p.1), and worsening dynamic balance in different age groups (Koura et al, 2017, p.3). In this context, it is important to determine the role of footbed regulation for the mitigation of the foot posture problems.
The significance of footbed instrument application for foot posture disorders’ treatment was recognized and supported via a long list of academic publications. The study by Gherghel et al. (2018) found that the early detection of foot posture modifications in childhood and their treatment using different methods, including specialized footbed, could contribute to substantial improvement of patients’ life quality. A similar result was got in the study by Castro-Mendez et al. (2013), which highlighted substantial improvement in foot posture pronation and reduction of chronic lower back pain due to the usage of custom-made foot orthosis, including the footbed (p.384). A similar finding was made in the later study by a similar research group, which focused on of the footbed’s influence on foot posture and chronic lower back pains (Castro-Mendez et al., 2021, p.2). Altogether, the positive effects of insoles’ application for foot posture and patients’ health improvement were determined.
Another publication by Andreasen et al. (2013) suggested high utility of the custom-made insoles for treatment of patients with excessive pronation and chronic foot pain (p.23). Nevertheless, this study argued that the positive effect caused by the application of the customized insoles was limited. As a result, a study of the relationship between two factors – insoles application and foot posture disorders leading to chronic pain was suggested (Andreasen et al., 2013, p.27). From this perspective, further research on the relationship between the two terms is necessary. The further study should include a more reliable sample of patients and varied methods of treatment interventions, including different forms of custom-made insoles.
The Influence of Footbed on Ankle
It is important to structure the discussion of the insoles’ influence on posture balancing from the perspective of different elements of the body movement structure. Following the foot posture system, the analysis of the insoles’ influence on the health and functioning of the ankle should be performed. Ankle joint complex is the compound biomechanical system comprising the lower leg and the foot that allows the lower leg to interact with the ground surface (Brockett and Chapman, 2016, p.232). This element of the body movement system faces substantial pressure during gait and other daily activities, bearing high compressive and shear forces. This element of the body movement system is far less vulnerable to degenerative processes as compared to hip or knee, which are considered later in this chapter (Brockett and Chapman, 2016, p.232). One of the main factors of ankle’s performance impacted by age and other sources of dysfunction risk is the range of motion (ROM) (Watanabe et al., 2011, p.190). From this perspective, it is important to show how the application of footbed instruments can contribute to the improvement of ankle’s functioning and stability.
From the perspective of insoles’ application for treatment of ankle dysfunction problems, different studies presented quite contradictory results. The study by Ashkar et al. (2022) demonstrated low utility of the footbed instrument utilization for the treatment of ankle disorders or pains. The authors argued that the application of the custom-made insoles was not productive enough for the prevention and treatment of ankle disorders in different age groups of patients. In contrast, in their study, Gupta et al. (2020) stated that the application of the insoles could be productive for mitigation and treatment of functional disorders of the ankle. Nevertheless, Gupta et al. (2020) also argued that the orientation on insoles was a less productive solution as compared to the stretching exercises and treatment with heat (p.31). Altogether, similar to the situation with the foot posture improvement, the effect generated by the footbed is quite contradictory. Additional study of the phenomenon is necessary in order to reach both constructive and reliable conclusions on this matter.
Impact of Footbed on Knee
The following element of the posture-balancing system that should be considered from the perspective of footbed application is the knee. Knee plays an important role in dynamic postural control by impacting the center of mass and quality of leg muscles development (Sabashi et al., 2021, p.1). Knee osteoarthritis was recognized as one of the health conditions that has the most severe negative influence on the dynamic postural control thus creating barriers for daily living activities in patients (Sabashi et al., 2021, p.1). Knee dysfunction can also have a serious negative effect on the static postural balance by reducing kinematic and lower extremity muscle activity in patients (Fu et al., 2021, p.1). Patients with knee osteoarthritis were found to be facing higher risk of leg muscle degradation and the need to spend more resources on the preservation of static and dynamic postural balance (Fu et al., 2021, p.1). Altogether, different forms of knee dysfunctions should be considered with high attention to reduce the negative influence on patients and improve the life quality of individuals.
In terms of knee dysfunction treatment using different types of footbed, recent findings demonstrated low effectiveness of this treatment option. The study by Zhang et al. (2018) stated that the lateral wedge insoles could serve as a productive option for improvement of knee femorotibial angle, while the same option is mainly useless for treatment of pain and improvement of knee functions in the case of knee osteoarthritis (p.8). Nevertheless, the scholars argued that the study had serious sample bias limitations. Therefore, additional research is necessary.
Another recent publication by Yu et al. (2021) explored the effects of the orthopedic insoles on patients with knee osteoarthritis. The study’s results correlated with the arguments provided by Zhang et al. (2018) that demonstrated the low utility of insoles for treatment of knee dysfunction and mitigation of pain caused by knee osteoarthritis. Similar to the previous study, Yu et al. (2021) stated that the recent publications lacked heterogeneity and generalization in discussion of the relationship between the practice of insoles’ application and knee osteoarthritis treatment (p.7). This argument shows that further research on this theme is necessary to provide a more detailed and balanced review of the problem. Otherwise, there is a risk of biased vision of the insoles’ role in treatment of knee dysfunction problems.
The Influence of Footbed on Hip
The hip is the following element of the posture-balancing system considered in the literature review. High level of connection between the posture characteristics and the hip health was recognized in different academic sources. The publication by Lewis et al. (2015) described the role of posture characteristics in the development of anterior hip pain. The study argued that the problems with the body posture could cause dramatic shifts in hip angles at gait thus leading to the increased demand of force required to run anterior hip structures also causing hip pain (Lewis et al., 2015, p.176). This finding contributes to the understanding of the overall complex nature of the human body posture system, in which the loss of balance could cause critical health and well-being outcomes.
Certain problems with the hip structure performance might also lead to the failures in the posture balancing. In their study, Ferrer-Pena et al. (2020) stated that improper hip-joint posture was a factor of dynamic stability level reduction in human posture together with the increased risk of critical damage for the hip (p.613). Taken together, the need to pay attention to hip balancing and development was highlighted by many scholars. It is crucial to consider the role of different forms of insole for the treatment and prevention of the potential hip development problems.
The role of footbed products in management of hip problems and improvement of the overall human body posture was discussed in many studies. The research by Murphy et al. (2016) focused on the role of the insoles’ application for the treatment of knee and hip osteoarthritis. The results of the research demonstrated low effectiveness of insoles’ application for treatment of hip dysfunction (Murphy et al., 2016, p.299). In contrast, another publication by Marin et al. (2021) reported that the use of specialized insole-based visual feedback system was a proper tool for managing patients undergoing total hip replacement (p.1). Such a finding is an example of useful knowledge about alternative means of footbed instrument application for treatment of posture-related health problems.
Taken together, contradictions in the vision of the footbed utility for treatment of hip problems are present. While the conservative means of insoles’ utilization for treatment of specific posture problems were found to be ineffective, the alternative means of this instrument’s application were discussed as promising for future implementation. This finding shows that the traditional means of posture problems’ treatment should not be rejected only due to lower effectiveness in the context of traditional usage scenarios. Alternative solutions and strategies for the application of the well-known instrument could also be determined.
The Influence of Footbed on Lower Limb Muscle Action
The following element of discussion in the context of the insoles’ applicability included the assessment of the insoles’ role for lower limb muscles development. The discussion of different elements of the posture-balancing system in previous sections of the literature review has demonstrated that the quality of human life and posture balance depends on harmonized performance of a wide range of elements, namely the ankle, knee, and hip. Another valuable element of the posture-balancing system considers lower limb muscles. They can be either balanced and well-developed or degenerating due to improper performance of the previously described elements.
The main theme discussed in the context of the lower limb muscles’ impact on posture quality included the analysis of different forms of musculoskeletal alterations of lower limbs and their influence on the posture. The study by Mendes et al. (2020) analyzed different forms of lower limb muscle action and development disorders. The study results demonstrated high utility of different types of insoles in the treatment of lower limb muscle disorders (Mendes et al., 2020, p.31). Another publication by Huang et al. (2020) paid attention to the lower limb muscle development problems experienced by aged female patients. The results of the study suggested that the modification of footwear conditions, including the use of special insoles, could substantially improve the quality of posture balance and reduce pressure on the lower limb muscles during action (Huang et al., 2020, p.2). Taken together, specific types of insole products in the treatment of lower limb muscle disorders were associated with the reduction of excessive pressure on muscles in the action mode. As an outcome, the patients could benefit from reduced pressure on over-exploited muscles thus allowing healthcare specialists to perform muscle-recovering therapy more effectively.
A specific finding that should be considered in this section is related to the role of foot ankles in the development of lower limb muscles. The study by Cobb et al. (2014) demonstrated that the change of foot ankles in dynamic posture mode could cause a serious unbalancing in the development of the lower limb muscles. While certain types of muscles face excessive pressure and have to adapt more actively, a part of the complex muscle system is not properly involved, leading to its degeneration and loss of functionality (Cobb et al., 2014, p.174). Under these conditions, the role of specialized insoles is associated with the restoration of the lower limb muscles balance, removal of excessive pressure from the exploited muscles, and activation of the earlier ignored muscle groups. Specific effects of the footbed products on the quality of the lower limb muscles’ development should be considered in more detail.
The Influence of Footbed on Back
Previous discussion of the connection between the footbed instrument and the quality of human body posture demonstrated that the majority of posture balancing problems emerged as a result of imbalance in the development of specific elements of the posture-balancing system. An important role in the balancing of the human body is played by the back musculoskeletal system. If the lower limb posture-balancing system does not work properly, a part of the pressure is distributed in favor of the back skeleton and muscles. An interesting conclusion in the context of this question was given in the study by Menez et al. (2020). This publication reviewed the role of orthotic insoles’ application in the reduction of back pain in patients with mild leg length discrepancy. The study found that the imbalance in the development of lower limb musculoskeletal systems had a direct influence on the quality of back performance thus causing pain and damage risks (Menez et al., 2020). At the same time, the application of specialized insoles demonstrated low universal effectiveness of this treatment method. Insoles were found to be a productive instrument, but the high level of instrument’s specialization according to the needs of a specific patient was highlighted as a factor of success (Menez et al., 2020). The objective of the insoles’ application was associated with the search of means to balance the previously unbalanced posture system.
An important argument in the discussion of the question about the effectiveness of insoles for low back pain treatment is related to the limited quality of previously performed studies. A systematic literature review performed by Chuter et al. (2014) determined the fact of low reliability of the previously performed studies on this theme. The reduced quality of previous publications was associated with low heterogeneity of the sample materials, limited sample size, and the lack of biased data review (Chuter et al., 2014, p.2). An example of the study arguing for the need of the insoles’ application in the treatment of low back pain was provided in the study by Cambron et al. (2017). This publication suggested the high utility of the specialized insoles for removal of the low back pain based on the review of professional healthcare interventions (Cambron et al., 2017, p.1754). In the future, it will be important to perform additional study on this theme, include a wider sample, and use reliable methodological instruments to guarantee high applicability and reliability of the study results.
The Influence of Footbed on Shoulders
The final element of the body posture-balancing system reviewed in the literature considers shoulders. While shoulders are located in the upper part of the body, they also influence the overall positioning of the human body in space, forming pressure on earlier considered elements of the posture-balancing system. The research by Lee et al. (2017) demonstrated the high importance of shoulders and head positioning in the overall effectiveness of the posture-balancing system performance (p.1825). Another study by Guduru et al. (2022) found that positioning of shoulders could influence the tone, stiffness, and elasticity of upper body muscles (p.1). This finding shows that the overall performance of the upper body musculoskeletal system is highly interconnected with the proper operations of shoulders. Without attention to the positioning of shoulders, it would be difficult to guarantee the stability of the human body and mitigate a potentially excessive pressure on earlier considered elements of the posture-balancing system.
An important finding of the literature review is the low attention to the study of the insoles’ role in the treatment of shoulder positioning problems. The research by Ma et al. (2018) was a complex study targeting the question about the effects of insoles on the overall static balancing of the human body posture. Nevertheless, this publication paid extremely low attention to the problem of shoulder system balancing in the context of the overall posture. A similar problem was experienced in another complex study by Moon et al. (2020). The results of the literature review show that the modern scholars do not recognize the strong relationship between the application of insoles and the improvement of the shoulder balancing in the context of the posture system. This knowledge gap should be properly addressed. If no strong relationship between these parameters is present, the conclusion should be presented in the format of academic publication. Nevertheless, if the appropriate hypothesis is approved with the help of the scientific research method, additional reliable study should be performed.
The Influence of High Heels on Posture
The discussion of the specific elements of the postural balancing system in relation to the applicability of the footbed instrument demonstrated high interconnection between specific elements of the balancing process. The final step of the literature review included the assessment of the influence of high heels on the posture balancing process and its outcomes. High heels present a popular footwear trend, especially relevant in females. It is important to show how this trend influences the posture of the human body and what health outcomes are the most relevant for people wearing high heels.
The question about the impacts of high heels on the quality of posture was discussed in different academic publications. The study by Wiedemeijer and Otten (2018) reviewed the effects of high heels from the perspective of human body biomechanics. The study outcomes included the recognition of the strong influence of high heels on the knee ankle positioning and lordosis of the lower back (Wiedemeijer and Otten, 2018, p.423). Other findings included the recognition of considerably higher levels of muscle activation in the hip and shoulder zones as an outcome of using high heels (Wiedemeijer and Otten, 2018, p.425). Altogether, scholars recognized high heels as a factor that forced the posture-balancing system to adapt thus causing undesirable long-term outcomes.
Another study by Wang et al. (2016) compared the impacts of the high-heel and low-heel shoes on the changes in the posture of female patients. The outcomes of the study demonstrated small changes in natural posture format caused by the low-heel shoes, while the application of high heels was associated with a more significant change of movement ankles during gait and risks for patients (Wang et al., 2016, p.7). While the risks associated with wearing high-heel shoes were demonstrated to be higher as compared to traditional footwear, the damaging influence should not be overestimated (Wang et al., 2016, p.14). This conclusion shows the need for objective assessment of the study problem.
An interesting finding in the context of the high heels problem was revealed by Kannan et al. (2019). This study found that the use of high heels in daily activity caused the reduction of muscular activity in shoulder and neck zones of the posture-balancing system (Kannan et al., 2019, p.87). This result shows that high heels bring an important change to the postural balancing system. This shift is associated with the altered distribution of pressure between specific muscles in the system. While the lower limb musculoskeletal system faces excessive pressure during the acts of high heels use, the upper body muscles could experience a dangerous degeneration process thus resulting in the loss of functionality, flexibility, and adaptability in the upper body musculoskeletal system.
In their study, Cowley et al. (2009) presented the outcomes of the literature review concerning the theme of high heels and posture. The scholars discussed a variety of foot posture pathologies associated with the use of high heels, including the following: “general discomfort to hallux valgus and plantar calluses” (Cowley et al., 2009, p.512). The need to develop balance while wearing high-heel shoes forces humans to change the postural balancing process thus leading to the undesired outcomes for the posture, in general. Other specific outcomes of high heels utilization included increased oxygen consumption, higher consumption of energy, and reduced reflex and response rates, as well as the loss of muscle phaticity and strength (Cowley et al., 2009, p.516). Altogether, the damaging influence of using high heels was demonstrated by a variety of scholars.
The negative role of high heels in the form of worth postural control quality was reported by Emmanouil and Rousanoglou (2018). This study also supported the earlier stated idea about the need for a new stability format for a person wearing high heels. Another publication by Walker (2018) presented a direct recommendation for the avoidance of using high heels by females (p.4). This argument shows the existing consensus among the scholars about the problem of the high heels’ influence on human posture.
Despite the concerns shared by specialists, high heels remain an important element of the modern footwear fashion and public culture. Detailed discussion of the insoles’ influence on the postural balancing system should demonstrate specific means for the improvement of health conditions in patients suffering from posture imbalances. While the practice of high heels should be eventually eradicated from modern culture, it is crucial to consider ways of effective recovery of people affected by the practice of wearing high heels.
Summary
The literature review allowed defining the current knowledge base in the context of the selected research question. The discussion of the posture term and the structure of the postural balancing system revealed the highly interconnected and interdependent existence of the system. Each element of the postural balancing system is highly dependent on proper operation of other elements. The failure of any of the critical points is likely to cause severe damage to the posture in the long-term. Therefore, the restoration of healthy posture of human body requires attention to each element of the system instead of focusing on individual elements.
This logic formed the basis of the literature review. The findings of the analysis demonstrated the effectiveness and applicability of the footbed instrument for resolving specific problems on each step of the posture balancing process. It was determined that the insoles can be quite effective in management of problems with specific elements of the posture balancing system. Nevertheless, for other elements of the system, the positive outcomes were not found to be so clear and definite. The highest level of concern is associated with the applicability of insoles for the treatment of posture problems caused by imbalances in the upper body musculoskeletal system. The literature review outcomes demonstrated the need for more comprehensive and reliable review of the question about the role of insoles in the recovery of the postural balancing system, in general. Instead of concentrating on individual elements of the system, scholars should consider the system as a whole in its relation to the applied footbed instrument. The achievement of this objective should be considered in further research in this paper.
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