Ankle-foot orthosis has limited effect on walking test parameters among patients with peripheral ankle dorsiflexor paresis

Abstract

The aim of this study was to determine the relationship between ankle dorsi exor strength and performances on several walking tests and to determine the effect of anklefoot orthosis (AFO) use on walking tests. The following tests were used: 10-metre walking test (with and without three stairs), a complex walking task (6-minute walk with cognitive loading) and a subjective evaluation (SIP68 mobility scale and questionnaire). Isometric strength of the ankle dorsi exors was measured. All walking tests were performed with and without AFO in random order. When relating torque values to walking performances, the highest correlation was found with the "10 metre" and "10 metre with stairs" test (r = ¡0.51, i.e. an inverse relationship). No threshold in the degree of paresis was found below which walking disability suddenly increased. No signi cant improvement could be demonstrated from AFO use on the 10-metre tests. Improvement on the 6-minute test was nearly signi cant (p = 0.06), the questionnaire revealed a positive opinion on AFO use related to overall walking function and effort. Thus, we have to conclude that these walking tests do not aid the clinician in estimating the severity of (progression of) the paresis nor to detect differences in degree of paresis between subjects.

Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research

“…This suggests that the ability to voluntarily activate TA and GS muscles may be maintained, or even improved by a period of FES use compared with AFO. Previous non-RCT studies and systematic reviews support this suggestion, as they have shown increased TA muscle activity, force and size with FES use (57)(58)(59)(60) with the opposite occurring in AFO (4,28,30,31). Further trials examining EMG following FES and AFO use are therefore needed if this potential mechanism-of-effect is to be more fully understood.…”

“…In contrast, an AFO is a purely mechanical device and there appears to be an assumption that the effects of AFO on walking are seen only when the device is worn (27). In addition, some studies suggest that AFO use may lead to muscle weakening (4,(28)(29)(30)(31), whereas FES has been suggested to improve volitional muscle activation (25).…”

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects

“…Current practice in the treatment of foot-drop normally involves a form of ankle foot orthosis (AFO) (11). Functional electrical stimulation (FES) is also used but less frequently (9).…”

Long-Term Effect of an Anterior Ankle-Foot Orthosis on Functional Walking Ability of Chronic Stroke Patients

“…Geboers et al 36 studied the effect of the use of the P-AFO on patients with dorsiflexor paresis. They found that the 6MWT with a cognitive task tended to show a significant improvement when the P-AFO was used.…”