Short take on AFO effectiveness

Meta-analysis demonstrates AFOs improve gait, balance in stroke.

Henning with WalkOn Reaction AFO. Otto Bock.

Lower Extremity Review November 2021

In a recently published systematic review and meta-analysis, researchers from Korea looked at the effectiveness of ankle-foot orthosis (AFO) use on improving gait function and balance in patients with stroke. Their analysis covered a total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use.

The researchers found that after wearing an AFO, the participants in the respective studies showed improvements in walking speed, cadence, step length, stride length, TUG test, and FAC score. Furthermore, the ankle sagittal plane angle at initial contact and knee sagittal plane angle at toe-off also increased.

Specifically, when patients wore AFOs, significant improvements were found in the following (standardized mean difference [SMD]):

  • in walking speed (SMD, 0.50; 95% CI 0.34–0.66; P < 0.00001)
  • cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001)
  • step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003)
  • stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003)
  • Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01)
  • functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001)
  • ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001)
  • knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03)

Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (P = 0.74, P = 0.07, P = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement.

According to the research team, AFO use can increase gait function and balance (walking speed, cadence, step length, stride length, TUG, and FAC) and improve gait kinematic parameters (ankle sagittal plane angle at initial contact and knee sagittal plane angle at toe-off). They wrote that an AFO improves gait function and corrects gait abnormalities by supporting dorsiflexion of the ankle and restricting plantarflexion and inversion.

They concluded that AFOs are useful for improving the gait function of patients with stroke, specifically, walking speed, cadence, step length, and stride length, particularly in patients with stroke with impairment of ankle dorsiflexion or hyper-plantarflexion in the swing phase. Moreover, the meta-analysis shows that AFOs are beneficial in enhancing gait stability and general ambulatory ability and may be able to normalize gait patterns.

Source Lower Extremity Review


Effectiveness of an ankle-foot orthosis on walking in patients with stroke: a systematic review and meta-analysis, Sci Rep. 2021 Aug 5;11(1):15879. doi: 10.1038/s41598-021-95449-x. Full text, PDF

  Further reading

A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing, Nikamp CDM, Hobbelink MSH, van der Palen J, Hermens HJ, Rietman JS, Buurke JH. Gait Posture. 2017 Jun;55:15-22. doi: 10.1016/j.gaitpost.2017.03.028. Epub 2017 Mar 30. Full text

The immediate effects of fitting and tuning solid ankle-foot orthoses in early stroke rehabilitation, Carse B, Bowers R, Meadows BC, Rowe P. Prosthet Orthot Int. 2015 Dec;39(6):454-62. doi: 10.1177/0309364614538090. Epub 2014 Jun 17.

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