Vibrating insoles improve balance and gait speed in people with diabetic peripheral neuropathy

Aims: To investigate the acute effect of vibrating insoles on balance and gait quality in individuals with diabetic peripheral neuropathy (DPN).

Methods: Twenty-two (22) adults with type 2 diabetes and DPN were recruited in the U.K. into this randomized controlled crossover design. DPN was confirmed using vibration perception threshold (VPT). The intervention was a vibrating insole (designed by Walk With Path, PathFeel, Waltham Abbey, U.K.) with seven vibrating insole conditions, compared to placebo. The vibration conditions varied in terms of vibration frequency (0-240 Hz), type of activation and delivery, and addition of white noise. Each condition lasted approximately 10 minutes, with 15 minutes of rest without vibration between conditions and 5 minutes of acclimatization to each new vibration setting. Data on gate kinematics were collected during standing, walking and stair negotiation. The primary outcomes were changes in gait speed and dynamic balance.

Results: Participants had a mean age of 68 (± 7.8) years, mean duration of diabetes 17 (± 10) years, VPT 27 (±10) V and a modified neuropathy disability score of 8 (± 2) points, on a scale of 0-10 with 10 denoting severe neuropathy. Also, 18.2% of participants had a history of a diabetic foot ulcer and there was a mean Falls Self-Efficacy Scale score of 29, suggesting participants were moderately concerned about falling. All vibration conditions improved gait speed during walking compared to control (p <0.005). Moreover, three of the seven vibration conditions led to improvements during stair ascent and descent speed. The improvements in level walking speed were between 7-10% and stair ascent 8-16% and descent 11-25%. Postural balance improved during quiet standing with eyes closed also in these vibration conditions plus one additional condition, but there was no difference in dynamic balance on walking.

Conclusions: Vibrating insoles are effective at acutely improving postural balance and gait quality during walking in people with DPN.

Comments. People with DPN have slower walking speeds, impaired balance and an increased risk of falling, which can lead to bone fractures, but there are few evidence-based treatments. Vibrating insoles have been shown to improve vibrotactile foot sensation and reduce postural sway in DPN, but this is the first study to determine their capacity to improve gait quality and balance during tasks. Despite the short duration of applying the smart insole system there were immediate improvements in gait speed and in balance in some vibration conditions. The study was performed in a small number of participants, and the walking and balance variables were assessed in a controlled laboratory setting. Now that the study has identified vibration conditions which are acutely effective, now prospective clinical trials are necessary in a larger cohort to determine whether these insoles can translate to a lower incidence of falling in addition to improving gait and balance. Moreover, further studies would be interesting to determine the mechanisms underlying vibration stimulation and improvement in gait/balance. This study opens new lines of research, and the potential of an exciting new ‘smart device’ which may reduce falls in people with DPN.

Gordon Sloan

Reference. Orlando G, Brown S, Jude E, Bowling FL, Boulton AJM, Reeves ND. Acute Effects of Vibrating Insoles on Dynamic Balance and Gait Quality in Individuals With Diabetic Peripheral Neuropathy: A Randomized Crossover Study. Diabetes Care. 2024 Jun 1;47(6):1004-1011. doi: 10.2337/dc23-1858. PMID: 38536962; PMCID: PMC11116908.

https://diabetesjournals.org/care/article/47/6/1004/154404/Acute-Effects-of-Vibrating-Insoles-on-Dynamic