The role of plantar cutaneous sensation in unperturbed stance

Considerable evidence shows that sensation from the feet and ankles is important for standing balance control. It remains unclear, however, to what extent specific foot and ankle sensory systems are involved. This study focused on the role of plantar cutaneous sensation in quasi-static balance control. Iontophoretic delivery of anesthesia was used to reduce the sensitivity of the forefoot soles. In a follow-up experiment, subjects received intradermal injections of local anesthetic into the entire weight-bearing surface of the foot soles. Properties of the center-of-foot-pressure (COP) trajectories and ground reaction shear forces were analyzed using stabilogram-diffusion analysis and summary statistics. Effects of foot-sole anesthesia were generally small and mostly manifested as increases in COP velocity. Magnitude of COP displacement was unaffected by foot-sole anesthesia. Forefoot anesthesia mainly influenced mediolateral posture control, whereas complete foot-sole anesthesia had an impact on anteroposterior control. During bipedal stance, statistically significant effects of foot-sole anesthesia on COP were present only under eyes-closed conditions and included increases in COP velocity (11-12%) and shear force root-mean-square (13%), the latter indicating increases in body center-of-mass accelerations due to the foot-sole anesthesia. Similar effects were seen for unipedal stance in addition to an increase in anteroposterior COP median frequency (36%). Changes in stabilogram-diffusion parameters were confined to the short-term region suggesting that sensory information from the foot soles is mainly used to set a relevant background muscle activity for a given posture and support surface characteristic, and consequently is of little importance for feedback control during unperturbed stance. In general, this study demonstrates that plantar sensation is of moderate importance for the maintenance of normal standing balance when the postural control system is challenged by unipedal stance or by closing of the eyes. The impact of reduced plantar sensitivity on postural control is expected to increase with the loss of additional sensory modalities such as the concomitant proprioceptive deficits commonly associated with peripheral neuropathies.