While design modifications present on work boots improve safety, they may not always provide optimal human performance during work tasks. Understanding the impact of these different design features on biomechanical and physiological postural control and locomotion variables can aid in better design modifications that can provide a safe and efficient human performance. This brief review focuses on a series of studies conducted by the current research team, that have tested three different work boots (SB: high-top steel-toed work boots; TB: high-top tactical work boots; SR: low-top slip-resistant work boots). The series of studies included testing of these work boots or combinations of them under acute and chronic simulated occupational workloads, assessing biomechanical variable such as postural stability, gait, slips, and muscle activity, as well as physiological variables such as heart rate, energy expenditure, oxygen consumption, and pain perception. The impact of each of the work boots and their design feature on postural control and locomotion are summarized from these studies’ previously published literature. Finally, work boot design suggestions for optimal human performance are provided for better work boot selection, modification, and design.

Compression socks are used by a very diverse group of individuals and may potentially have a greater impact on physically diminished or impaired individuals as opposed to healthy individuals. The purpose of this study was to compare the effects of sub-clinical (SC) and clinical (CL) compression socks among healthy (CON), copers (COP), and individuals with chronic ankle instability (CAI). Postural stability was evaluated in 20 participants (11 males and 9 females) using Balance Tracking System Balance platform (BTrackS™) during the modified clinical test of sensory integration in balance (mCTSIB) and limits of stability (LOS) tests. Postural sway parameters were analyzed using a mixed model repeated measures analysis of variance 3 (group: CON, COP, and CAI) by 3 (compression condition: BF, SC, and CL) × 4 (balance condition: EO, EC, EOF, and ECF) for mCTSIB and a 3 (group: CON, COP, and CAI) by 3 (compression condition: BF, SC, CL) × 4 (balance condition: FL, BL, BR, FR) for LOS. Results revealed significantly greater postural stability with both SC and CL compression socks when compared to barefoot conditions. However, no significant differences were observed among groups for compression socks grades. Both SC and CL compression socks may be effective in increasing postural stability.

The Star Excursion Balance Test (SEBT) is a common assessment used across clinical and research settings to test dynamic standing balance. The primary measure of this test is maximal reaching distance performed by the non-stance limb. Response time (RT) is a critical cognitive component of dynamic balance control and the faster the RT, the better the postural control and recovery from a postural perturbation. However, the measure of RT has not been done in conjunction with SEBT, especially with musculoskeletal fatigue. The purpose of this study is to examine RT during a SEBT, creating a modified SEBT (mSEBT), with a secondary goal to examine the effects of muscular fatigue on RT during SEBT. Sixteen healthy young male and female adults [age: 20 ± 1 years; height: 169.48 ± 8.2 cm; weight: 67.93 ± 12.7 kg] performed the mSEBT in five directions for three trials, after which the same was repeated with a response time task using Blazepod™ with a random stimulus. Participants then performed a low-intensity musculoskeletal fatigue task and completed the above measures again. A 2 × 2 × 3 repeated measures ANOVA was performed to test for differences in mean response time across trials, fatigue states, and leg reach as within-subjects factors. All statistical analyses were conducted in JASP at an alpha level of 0.05. RT was significantly faster over the course of testing regardless of reach leg or fatigue state (p = 0.023). Trial 3 demonstrated significantly lower RT compared to Trial 1 (p = 0.021). No significant differences were found between fatigue states or leg reach. These results indicate that response times during the mSEBT with RT is a learned skill that can improve over time. Future research should include an extended familiarization period to remove learning effects and a greater fatigue state to test for differences in RT during the mSEBT.

This study aims to quantify wearers’ perceived sensory/tactile comfort responses to clinical and sub-clinical compression socks before, during, and after several activities (postural stability tasks, donning, and doffing). Through purposive sampling, the researchers recruited 20 participants (11 male and 9 female) aged 21.5 ± 2 years. Among all participants, 40% had chronic ankle instability, 30% were copers, and 30% were healthy control groups. Sensory/tactile and movement comfort were assessed using a comfort 8-item questionnaire in a wear trial. The findings exhibit that the tested clinical socks are more comfortable than subclinical socks regardless of the participant types. The strongest positive correlation was between material appearance and hand feel (r = 0.84, ** p < 0.01) and between ‘no red marks’ and non-itchiness (r = 0.72, ** p < 0.01). Additionally, no statistically significant differences in comparisons of comfort assessment measures were reported. However, due to the consistency of the trends in differences, the researchers suggest that these findings warrant additional research using a more robust sampling technique. According to the findings of this study, a higher-pressure level compression sock may be preferable for patients with ankle stability issues, as there is no significant evidence for a comforting outcome.

Postural instability and the inability to regain balance during slip-induced events are the leading causes of falls on the same level in occupational environments. Virtual reality (VR) provides the potential to be immersed in a realistic environment, exposing themselves to fall-risk hazards without the risk of injury real-world exposure may cause. Therefore, the purpose of this study was to compare the lower extremity joint kinematics of the slipping leg during real and virtually generated slip hazards. A secondary purpose was to investigate dynamic postural stability following acute exposure to real (REAL) and virtual (VR) environmental conditions. A total of 14 healthy participants’ (7 men, 7 women; age: 23.46 ± 3.31 years; height: 173.85 ± 8.48 cm; mass: 82.19 ± 11.41 kg; shoe size (men’s): 9.03 ± 2.71) knee and ankle joint kinematics were compared during exposure to both REAL and VR environments. Participants then completed a series of Timed Up-and-Go (TUG) variations (standard, cognitive, manual) at the beginning and the end of exposure to each environment. TUG-C involved backwards counting and TUG-M involved walking with an anterior load. Environmental exposure was selected in a counterbalanced order to prevent an order effect. Knee and ankle joint kinematics were analyzed separately using a 2 × 3 repeated measure ANOVA to compare environments as well as gait types at an alpha level of 0.05. TUG variations were also analyzed separately using a 3 × 3 repeated-measures ANOVA to compare TUG variations and environment. No significant differences were observed for knee or ankle joint kinematics between environments or gait types. There were also no significant interactions between environments and gait types. However, significant differences were observed for TUG-C following VR environmental conditions (p = 0.027). Post hoc comparisons revealed significantly lower times for TUG-C following VR exposure (p = 0.029). No significance was observed for TUG-S or TUG-M. Current findings suggest the potential effectiveness of VR as a means of fall prevention training for occupational populations based on improved TUG-C and similar lower extremity joint kinematics in REAL and VR conditions.

Background: Current methods of postural control assessments and interventions to improve postural stability and thereby prevent falls often fail to incorporate the hazardous perturbation situations that frequently accompany falls. Virtual environments can safely incorporate these hazards. The purpose of the study was to identify if virtual slip and trip perturbations can be used as an exposure paradigm in place of real slip and trip perturbations to improve postural control. Methods: Fifteen healthy young adults were included in this study. Two paradigms, real gait exposure (real) and virtual environment gait exposure (virtual), consisting of real and virtual slip and trip trials, were performed by each participant in a counterbalanced order to avoid order effects. At baseline and following real and virtual paradigms, the modified clinical test for sensory integration and balance (mCTSIB), limits of stability (LOS), and single-leg stance (SLS) using BTracks balance plate were administered. Separate one-way (baseline vs. Real vs. Virtual) repeated measures analysis of variance were conducted on response variables. Results: In the posterior left quadrant of the LOS, significant differences were found after the real paradigm compared to baseline (p = 0.04). For the anterior left quadrant and total LOS, significant differences post real paradigm (p = 0.002 and p < 0.001) and virtual paradigm (p = 0.007 and p < 0.001) compared to baseline were observed. For the SLS, the left-leg significant differences were observed post real paradigm (p = 0.019) and virtual paradigm (p = 0.009) compared to BL in path length, while significant main effects were found for mean sway velocity for the left leg only (p = 0.004). For the right leg, significant differences were only observed after the virtual paradigm (p = 0.01) compared to BL. Conclusions: Both virtual and real paradigms were identified to improve postural control. The virtual paradigm led to increased postural control in the right-leg SLS condition, while the real paradigm did not, without any adverse effects. Findings suggest virtual reality perturbation exposure acutely improves postural control ability compared to baseline among healthy young adults.