Work Type



Fall 2020

Faculty Advisor

Jennifer Hastings, PT, PhD




Background: One classic symptom of Parkinson’s Disease (PD) is a “stooped posture” characterized by multiple postural malalignments, which increases fall risk. In 2018, we addressed this posture with in-shoe heel lifts (HLs) and found significant improvements to static postural alignment and perceived stability as well as a correlation between the Falls Efficacy Scale and plantarflexion (PF) contractures. These findings are consistent with a Wright & DiBello (2020) study that found HLs can promote a normalization of joint alignment up the kinetic chain.

Purpose: To validate our prior findings and determine if HLs can improve dynamic measures of gait such as step length, gait speed, turning behavior, perceived stability, and balance confidence in individuals with PD.

Methods: (N=18). The Activities-Specific Balance Confidence (ABC) scale, sagittal view photographs, numeric analog scale for perceived stability, and Time Up and Go Test (TUG) were measured with and without HLs in place, at two data collection dates. ImageJ software was used to analyze postural joint angles and TUG video recordings were analyzed for gait parameters and turning behavior.

Results: Head tilt angle and turn time significantly improved (p = .03 and p = .002, respectively) with HLs. Turn time correlated to overall balance confidence (r = -.802, p = .000). Overall balance confidence correlated to fall history (r = -.501, p = .041).

Conclusion: Accommodating PF contractures with an in-shoe HL significantly improves head tilt angle and decreases turn time compared to without HLs, and thereby can promote fall reduction in this population.


University of Puget Sound