Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles: a systematic review

Dymphy van der Wilk^, Pieter Ubele Dijkstra^, Klaas Postema, Gijsbertus Jacob Verkerke^, Juha Markus Hijmans

Highlights

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Elastic ankle foot orthoses improve energy efficiency (dorsiflexor paresis).

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Dorsal ankle foot orthoses improve energy efficiency and comfortable walking speed (plantarflexor paresis both with and without a dorsiflexor paresis).

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Circular- and elastic ankle foot orthoses are more suitable for dorsiflexor paresis.

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Dorsal ankle foot orthoses are more suitable for plantarflexor paresis both with and without a dorsiflexor paresis.

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Abstract

Background

People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles aids in clinical decision making and may improve adherence.

Methods

Studies published before October 27th 2014 were searched in Pubmed, Embase, Cinahl, and Cochrane Library. Studies evaluating effects of ankle foot orthoses on body functions and/or activities in people with floppy paretic ankle muscles were included. Studies solely focusing on people with spastic paretic ankle muscles were excluded. Study quality was assessed using a custom made scale. Body functions and activities were defined according to the International Classification of Functioning, Disability and Health.

Findings

Twenty-four studies were included, evaluating 394 participants. Participants were grouped according to paresis type (i) dorsiflexor paresis, (ii) plantar flexor paresis, (iii) both dorsiflexor- and plantar flexor paresis. Dorsal- circular- and elastic ankle foot orthoses increased dorsiflexion during swing (by 4-6°, group i). Physical comfort with dorsal ankle foot orthoses was lower than that with circular ankle foot orthoses (groups i&iii). Dorsal ankle foot orthoses increased push-off moment (by 0.2-0.5 Nm/kg), increased walking efficiency, and decreased ankle range of motion (by 12-30°, groups ii&iii).

Interpretation

People with dorsiflexor paresis benefit more from circular- and elastic ankle foot orthoses while people with plantar flexor paresis (and dorsiflexor paresis) benefit more from dorsal ankle foot orthoses.

Source: http://www.sciencedirect.com/science/article/pii/S0268003315002545