Abstract
Purpose: In neuromuscular conditions, ankle foot orthoses (AFO) prevent deformity and improve functional balance by increasing the base of support, stabilizing the ankle joint and influencing the kinematics of more proximal joints; this study was designed to evaluate the role of fixed AFOs on balance in spastic diplegic children.
Methods: 12 children (age 7–15yrs) with spastic diplegia were recruited. All were community ambulators (GMFCS II/III). All had used AFOs for 12 months. Each child walked along the GAITRite electronic walkway at their preferred speed: barefoot, in shoes, and in AFOs with shoes. The order of the walks was randomized limiting the effects of fatigue and confidence. Normalized velocity, cadence, stride length and percentage of gait cycle in single leg support were selected as surrogate measures of stability. The child’s balance during other functional activities was assessed with the paediatric balance scale (PBS).
A two-way analysis of variance (ANOVA) explored differences in gait between the various walks. Fried-man’s test tested for differences in PBS scores between subjects and conditions.
Results: Significant improvements were seen in mean values for normalized velocity (p=0.02), stride length (p< 0.01) and percentage of gait cycle in single leg support (p< 0.01) in footwear-AFO compared to barefoot. Whilst there were also improvements in mean values for these parameters in shoes alone compared to barefoot, only the difference in stride length reached statistical significance (p< 0.01). There were no significant differences in PBS scores in shoes alone or with AFOs compared with walking barefoot.
Conclusions: AFOs improved balance during gait but had no effect on balance during other activities. Whilst shoes alone had a positive impact on gait, the most significant effects were seen in the AFO-footwear combination.
Significance: Advice regarding AFO use and footwear choice should consider the effects on gait as well as prevention of deformity.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
