Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait

I was just immediately given an AFO, then a hinged AFO.  I seriously believe that an AFO actually hinders recovery, you do no training of your dorsiflexion while wearing an AFO.  I went cold turkey on using one on a 21 day canoe trip in Canada and Alaska, 3 years after stroke. It forced me to immediately strengthen my ankle to keep it from rolling and get toe clearance. Didn't fall on that trip. 

 

Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait

Tsuchiyama K¹,

Mukaino M²,

Ohtsuka K¹,

Matsuda F¹,

Tanikawa H¹,

Yamada J³,

Pongpipatpaiboon K⁴,

Kanada Y¹,

Saitoh E⁵,

Otaka Y⁵

Author information

European Journal of Physical and Rehabilitation Medicine, 09 Sep 2021,
DOI: 10.23736/s1973-9087.21.07048-9 PMID: 34498833 

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Abstract 

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Background

Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability.

Aim

To investigate the effects of ankle-foot orthoses on post-stroke gait stability.

Design

An experimental study with repeated measurements of gait parameters with and without orthosis.

Setting

Inpatients and outpatients in the Fujita Health University Hospital.

Population

Thirty-two patients (22 males; mean age 48.3±20.0 years) with poststroke hemiparesis participated in the study.

Methods

Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared.

Results

In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041).

Conclusions

Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated.