The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

You'll have to ask your doctor what this means in layperson terms. (p = 0.038) means nothing  to me. It was never explained to me why I ended up getting a hinged AFO.  I see nothing here that they even measured the extent of dropfoot being corrected. What was the clearance rate without the AFO?
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0382-y

• Kannit Pongpipatpaiboon,
• Masahiko MukainoEmail authorView ORCID ID profile,
• Fumihiro Matsuda,
• Kei Ohtsuka,
• Hiroki Tanikawa,
• Junya Yamada,
• Kazuhiro Tsuchiyama and
• Eiichi Saitoh

Journal of NeuroEngineering and Rehabilitation201815:41

https://doi.org/10.1186/s12984-018-0382-y

©  The Author(s). 2018

Received: 1 September 2017

Accepted: 3 May 2018

Published: 23 May 2018

Abstract

Background

Ankle–foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase.

Methods

This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction.

Results

Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs).

Conclusions

Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings.

Trial registration

UMIN000028946. Registered 31 August 2017 (retrospectively registered).