Correct Toes & Balance

Users of Correct Toes toe spacers experience many health benefits, including improved toe alignment and foot structure, increased intrinsic foot muscle strength, enhanced foot and toe circulation, and the successful treatment and prevention of a variety of chronic foot problems. One benefit of this device that’s sometimes overlooked is its ability to improve balance—a particularly important benefit for athletes and the elderly. This article discusses in detail a research study that was performed to assess the effects of Correct Toes on balance.

Researcher & Study Background

Adam Kelly, a researcher with a PhD from the University of Miami, examined the effects of Correct Toes on balance for his graduate school research study and thesis. Kelly had become familiar with Correct Toes during his undergraduate studies and knew that he wanted to potentially study the device once he got to graduate school. According to Kelly, he wanted to study Correct Toes’ effect on balance so that he might gain a better understanding of its potential role in lower extremity injuries, including lateral ankle sprains—a foot health problem that effects 23,000 people in the United States every day. Having long been interested in lower extremity function, mechanics, and injury, Kelly also wanted to test the device in a lab setting to see if results supported the large amount of anecdotal evidence from customers and patients regarding its foot health benefits.

Decreased balance in healthy test subjects has proven to be a key risk factor for acute ankle injury, and decreased balance in previously injured individuals is a risk factor for re-injury. So, balance is a key factor in lower extremity health, but it’s important to note the difference between balance and dynamic balance, especially for this study. Dynamic balance is one of the key measures Kelly examined in this controlled laboratory study with randomization that he entitled “The Effects of a Foot-Toe Orthosis on Dynamic Balance and Hallux Valgus Angle.” Balance, broadly defined, is the ability of a person to maintain his or her center of mass over a base of support, whereas dynamic balance is the ability of a person to maintain his or her center of mass stability with movement.

Purpose of Study

The purpose of this study was to determine the effects of a “foot-toe orthosis” (i.e., Correct Toes) and minimalist control shoe on dynamic balance and hallux valgus angle, or the angle of the big toe relative to its corresponding metatarsal bone.

Hypotheses

Kelly hypothesized that dynamic balance would improve and that hallux valgus angle would decrease in the groups receiving interventions.

Based on the previous research regarding balance interventions, Kelly was inclined to believe that Correct Toes would have a positive relationship on the selected measures.

Interventions

Past studies that have sought to assess effects on balance have used a variety of interventions, including textured insoles, textured surfaces, and foot orthotics. Results, by and large, have been mixed. Certain interventions may increase balance in test participants, but it’s very difficult to compare outcomes because of poor standardization across the studies.

The principle interventions in Kelly’s study included a “foot-toe orthosis” (i.e., Correct Toes) in combination with a “control shoe” of the minimalist variety and the control shoe alone. The control shoe used in this study was the Lems Primal 2. It was important for Kelly that he select a true minimalist shoe based on actual criteria (e.g., a shoe lacking cushioned heels, arch support, and rigid soles) instead of selecting a shoe based on various companys' marketing claims. Not all minimalist shoes are created equal.

Inclusion & Exclusion Criteria

Participants were included in this study if they engaged in moderate physical activity for a minimum of three times per week for at least 30 minutes, were aged 18 to 29 years, had no serious health concerns, and had a size match with the control shoe and Correct Toes. Prospective participants were excluded from this study if they had a previous lower extremity injury (and therefore reduced physical activity levels) within the last 6 months, a known history of concussion, inner ear issues, or another pathology that could potentially influence equilibrium or neuromuscular control within the previous 5 months. Prospective study participants were also excluded if they had uncorrected vision or any previous history of lower extremity surgery.

Participants were recruited via in-class announcements and flyers. A total of 65 people successfully volunteered for the study, and these volunteers were randomly allocated (in equal parts men and women) to one of the three main testing groups:

• Intervention Group #1: Foot-Toe Orthosis and Control Shoe (FTO)
• Intervention Group #2: Control Shoe Only (SO)
• Control Group: No intervention (CG)

Only two volunteers failed to complete the study.

Testing Procedures

After participants were recruited, completed pre-participation questionnaires, and were randomly allocated to groups, they were sized for Correct Toes and Lems Primal 2 shoes. The Shoe Liner Test was used to help determine proper shoe size and toe box space for participants in the intervention groups. Baseline measures were then taken, the intervention and instructions given, and then follow-up testing was performed 4 weeks later to assess the effects of the interventions.

The main testing procedure Kelly used to assess dynamic balance in his study was the Y-balance test (YBT). This test is an effective way to assess dynamic balance, or balance with movement, and is sensitive to injury risk. Kelly determined that the YBT was the most reliable, time-efficient, and clinically relevant measure of balance for this particular study. Subjects in the FTO group were tested using the YBT with and without Correct Toes. Subjects in the FTO group were also habituated to the shoes and toe spacers by gradually increasing wear time in 30-minute increments, and by weeks 2 to 4 of the study were using the toe spacing device and minimalist shoes for a minimum of 4 hours per day. Study participants in the FTO group also attempted to wear Correct Toes at night while sleeping.

To measure hallux valgus angle, Kelly used a goniometer.

Results

This study found significant differences between the groups for dynamic balance. The effect sizes were “strong” for the FTO group and “moderate” for the SO group, meaning that the group who used Correct Toes in combination with Lems Primal 2 shoes experienced a greater improvement in dynamic balance than both the Lems Primal 2 shoes only group and control group. The Lems Primal 2 only group experienced a greater improvement in dynamic balance than the control group.

This study found no significant differences in hallux valgus angle between any of the groups.*

No significant differences existed between the FTO and SO groups concerning the average wear-time of the minimalist footwear.

*This finding is not surprising, given the following:

1. The relatively short (4-week) time period of the study: Most hallux valgus deformities occur slowly, over a period of many years or decades. Just as it takes a lot of time for the problem to occur, so too does it take some time for natural interventions, including Correct Toes, to have a significant effect.
2. The relatively young and healthy population tested in this study: Most folks with hallux valgus deformities are older, though deviations of the hallux in younger individuals can and does occur.
3. The inability to use radiographic imaging (i.e., X-rays) to determine hallux valgus angle: Radiographic imaging is the gold standard in determining hallux valgus angle, but this study instead used goniometric measurements, which are not as accurate as measurements taken from radiographic images.

Discussion

The purpose of this study was to investigate the influence of a foot-toe orthosis (Correct Toes) and minimalist shoe (Lems Primal 2) on dynamic balance and hallux valgus angle. This study was the first to show that the use of Correct Toes and/or Lems Primal 2 shoes causes an increase in dynamic balance (in 4 weeks of wear) in a healthy young adult population.

These results are similar to those of other investigators who attempted to influence balance or postural stability, but differences in the intervention applied, study methodologies, measures of balance or postural stability assessed, and study populations make direct comparison between the studies extremely challenging.

One question that came out of this study is the following: Why might Correct Toes cause this favorable effect on dynamic balance?

The two main theories as to why this is so are:

1. Correct Toes causes increased afferent or sensory feedback.
2. The biomechanical toe alignment enabled by Correct Toes widens the base of support.

Study Limitations

Kelly has noted that several limitations exist with this study, including the following:

• The fact that both tester and subjects were not blinded to group allocation.
• The fact that the study itself was of a relatively short duration (a longer period of time may be needed).
• The fact that the study used only young, healthy test subjects, which makes it tough to generalize the results to an elderly population who may benefit most from Correct Toes for balance.

Lack of control for foot type, changes in foot width or soft tissues, and individual kinematic differences (i.e., Correct Toes did not fit all study participants equally) were also limitations in this study.

Prospective research is needed to explore the following as it concerns the various interventions given in this study:

• Injury rates
• Athlete economy and power
• Influence on intrinsic foot musculature (Does the intrinsic foot musculature change or grow with long-term application of the intervention?)

Movement pattern tests are also needed to see how the interventions modify how people move objectively.

Conclusion

Use of a foot-toe orthosis (Correct Toes) and minimalist shoe (Lems Primal 2) may increase dynamic balance in a healthy and college-aged population. Future research should look at the effects of this study’s interventions on the elderly, the injured, or patients with central nervous system (CNS) damage. This information could help researchers and clinicians investigate potential treatments or develop prophylactic approaches for patients and athletes.