Work Type




Faculty Advisor

Jennifer Hastings, PT, PhD, NCS




Background: Parkinson’s Disease (PD) is a progressive, neurodegenerative condition that results in resting tremors, slowed movement (bradykinesia), rigidity, and postural instability. People with PD develop a standing alignment often referred to as a “stooped posture”; flexed hips, kyphotic spine, forward shoulders, forward head, and downward head tilt. Concurrently, this population has high prevalence of impaired standing and dynamic balance, decreased muscle strength, slower gait, and slower anticipatory and reactionary body adjustments. We propose plantarflexion contractures contribute to instability by causing an altered alignment and decreasing the available range for reactive excursion in lower extremity.

Purpose: To investigate if postural alignment, perceived stability and balance is impacted by accommodating plantar flexion (PF) contractures, with a heel lift, in individuals with Parkinson’s disease (PD). To investigate the correlation of the Falls Efficacy Scale (FES) to PF contracture severity in order to predict postural instability.

Design: Pre-test post-test with no follow up

Participants: Convenience sampling of 32 participants. Inclusion Criteria: diagnosed with PD, and independently ambulate 20 ft. without assistive devices. Exclusion Criteria: cannot understand English, and any comorbidities impacting postural stability.

Interventions: Participants were assessed for talocrural dorsiflexion ROM. Patients filled in a self-reported Falls Efficacy Scale (FES). Then were assessed for the following outcome measures with and without the use of heel lifts: Sagittal Posture Photo Analysis, Visual Analog Perceived Stability Scale, Tekscan Pressure Sway Map, and Functional Reach Test (FRT). Heel lift size was assigned based on PF contracture severity.

Results: Significant findings (p<0.05) include increase in height (mean 1.00 cm) an anterior translation of the hips (mean 2.3cm) and a more upright trunk (mean 1.37 degrees) and head angle (mean 2.61 degrees). The perceived stability increased (mean 0.75) and functional reach decreased (mean 2.22cm). Correlations (R=0.36-0.50) were found between the degree of PF contracture and the reported fear of falling for questions on the FES that involved ADLs that required ambulation.

Conclusion: Accommodating PF contractures, on individuals diagnosed with PD, with heel lifts significantly improves perceived stability, upright postural alignment, but also decreases forward reach.

Clinical Significance: Heel lifts are a useful treatment to improve postural alignment in the PD population; however, it should be considered an adjunct treatment to joint mobilization and muscle lengthening techniques.


  1. Bartonek A, Lidbeck CM, Pettersson R, Weidenhielm EB, Eriksson M, Gutierrez- Farewik E. Influence of heel lifts during standing in children with motor disorders. Gait Posture. 2011;34(3):426-431. doi:10.1016/j.gaitpost.2011.06.015.

  2. Gross MT, Mercer VS, Lin F-C. Effects of foot orthoses on balance in older adults. J Orthop Sports Phys Ther. 2012;42(7):649-657. doi:10.2519/jospt.2012.3944.

  3. Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-376. doi:10.1136/jnnp.2007.131045.

  4. Klamroth S, Steib S, Devan S, Pfeifer K. Effects of Exercise Therapy on Postural Instability in Parkinson Disease: A Meta-analysis. J Neurol Phys Ther JNPT. 2016;40(1):3-14. doi:10.1097/NPT.0000000000000117.

  5. Rogers ME, Page P, Takeshima N. Balance Training for the Older Athlete. Int J Sports Phys Ther. 2013;8(4):517-530.


University of Puget Sound