Advertisement

State of the Prescription Process for Dynamic Ankle-Foot Orthoses

  • Corey Koller
  • Elisa S. Arch
Musculoskeletal Rehabilitation (J Friedly, Section Editor)
  • 72 Downloads
Part of the following topical collections:
  1. Topical Collection on Musculoskeletal Rehabilitation

Abstract

Purpose of Review

Dynamic ankle-foot orthoses (AFOs) are assistive devices that can be prescribed to individuals with mobility limitations to support and align joints. Dynamic AFOs are a category of passive AFOs that can control ankle motion to address both ankle joint range of motion limitations and ankle muscle weakness. This control of motion is achieved through the dynamic AFO’s functional characteristics, namely bending stiffness, which need to be customized to each individual’s needs. However, current conventions for customizing dynamic AFOs for each individual are variable and often not clearly documented. The purpose of this review was to synthesize the current state of customizing functional characteristics of dynamic AFOs to provide a foundation for ultimately optimizing the prescription of AFOs.

Recent Findings

Dynamic AFO bending stiffness, bending axis, alignment, and footplate design were identified as key functional characteristics that can be customized. Studies showed that customizing these dynamic AFO functional characteristics has the ability to alter gait, and customizing multiple functional characteristics at once is key to improving individual outcomes.

Summary

Researchers have continued to expand their knowledge on how dynamic AFO functional characteristics can impact individual outcomes. Continued research should work towards developing guidelines for prescribing dynamic AFO functional characteristics based on individuals’ level of needs. Additionally, researchers and clinicians need to work together to ultimately translate these scientific findings into clinical practice.

Keywords

Ankle-foot orthosis Stiffness Alignment Axis Footplate 

Notes

Compliance with Ethical Standards

Conflict of Interest

Corey Koller declares no conflicts of interest.

Elisa S. Arch has a United States Patent No. 8,538,570 issued.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Courtney-Long E, Carroll D, Zhang Q, Stevens A, Griffin-Blake S, Armour B, et al. Prevalence of disability and disability type among adults — United States, 2013 [Internet]. 2015. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a2.htm. Accessed Oct 5 2017
  2. 2.
    Webber SC, Porter MM, Menec VH. Mobility in older adults: a comprehensive framework. Gerontologist. 2010;50:443–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Patzkowski JC, Rivera JC, Ficke JR, Wenke JC. The changing face of disability in the US Army: the Operation Enduring Freedom and Operation Iraqi Freedom effect. J Am Acad Orthop Surg. 2012;20:S23–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Owen E. The importance of being earnest about shank and thigh kinematics especially when using ankle-foot orthoses. Prosthetics Orthot Int. 2010;34:254–69.CrossRefGoogle Scholar
  5. 5.
    Arch ES, Stanhope SJ. Passive-dynamic ankle–foot orthoses substitute for ankle strength while causing adaptive gait strategies: a feasibility study. Ann Biomed Eng. 2015;43:442–50.CrossRefPubMedGoogle Scholar
  6. 6.
    AOPA Fact Sheet [Internet]. AOPA Am. Orthotic Prosthet. Assoc. Available from: http://www.aopanet.org/media/fact-sheet/. Accessed 5 Oct 2017.
  7. 7.
    Masini BD, Waterman SM, Wenke JC, Owens BD, Hsu JRFJ. Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2009;23:261–6.CrossRefPubMedGoogle Scholar
  8. 8.
    DaVanzo J, El-gamil A, Heath S, Pal S, Li J, Luu P, et al. Projecting the adequacy of workforce supply to meet patient demand. [Internet]. 2015. Available from: http://www.iiofoandp.org/PDF/2015_Work_Study.pdf. Accessed 5 Oct 2017.
  9. 9.
    Whiteside S, Allen M, Barringer W, Beiswenger W, Brncick M, Bulgarelli T, et al. Practice analysis of certified practitioners in the disciplines of orthotics and prosthetics. Alexandria Am. Board Certif. Orthot. Prosthetics Inc. [Internet]. 2007. Available from: https://www.abcop.org/individual-certification/Documents/ABCPracticeAnalysisoftheDisciplineofOrthoticsandProsthetics.pdf. Accessed 5 Oct 2017.
  10. 10.
    Bregman DJJ, De Groot V, Van Diggele P, Meulman H, Houdijk H, Harlaar J. Polypropylene ankle foot orthoses to overcome drop-foot gait in central neurological patients: a mechanical and functional evaluation. Prosthetics Orthot Int. 2010;34:293–304.CrossRefGoogle Scholar
  11. 11.
    Brehm MA, Harlaar J, Schwartz M. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy. J Rehabil Med. 2008;40:529–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Harlaar J, Brehm M, Becher JG, Bregman DJJ, Buurke J, Holtkamp F, et al. Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence. Prosthetics Orthot Int. 2010;34:327–35.CrossRefGoogle Scholar
  13. 13.
    Condie DN. The modern era of orthotics. Prosthetics Orthot Int. 2008;32:313–23.CrossRefGoogle Scholar
  14. 14.
    Shorter KA, Xia J, Hsiao-Wecksler ET, Durfee WK, Kogler GF. Technologies for powered ankle-foot orthotic systems: possibilities and challenges. IEEE/ASME Trans. Mechatronics. 2013; p. 337–47.Google Scholar
  15. 15.
    Malas BS. What variables influence the ability of an AFO to improve function and when are they indicated? Clin Orthop Relat Res. 2011;469:1308–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Bean J, Walsh A, Frontera W. Brace modification improves aerobic performance in Charcot-Marie-Tooth disease: a single-subject design. Am J Phys Med Rehabil. 2001;80:578–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Bregman DJJ, Rozumalski A, Koops D, de Groot V, Schwartz M, Harlaar J. A new method for evaluating ankle foot orthosis characteristics: BRUCE. Gait Posture [Internet]. 2009;30:144–9. Available from: http://www.sciencedirect.com/science/article/pii/S0966636209001465. Accessed Oct 5 2017
  18. 18.
    Sumiya T, Suzuki Y, Kasahara T. Stiffness control in posterior-type plastic ankle-foot orthoses: effect of ankle trimline. Part 2: orthosis characteristics and orthosis/patient matching. Prosthet Orthot Int [Internet]. 1996;20:132–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8876008. Accessed Oct 5 2017
  19. 19.
    Schrank ES, Hitch L, Wallace K, Moore R, Stanhope SJ. Assessment of a virtual functional prototyping process for the rapid manufacture of passive-dynamic ankle-foot orthoses. J Biomech Eng. 2013;135:101011–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Davis RB, DeLuca PA. Gait characterization via dynamic joint stiffness. Gait Posture. 1996;4:224–31.CrossRefGoogle Scholar
  21. 21.
    Hansen AH, Childress DS, Miff SC, Gard SA, Mesplay KP. The human ankle during walking: implications for design of biomimetic ankle prostheses. J Biomech. 2004;37:1467–74.CrossRefPubMedGoogle Scholar
  22. 22.
    • Arch E, Reisman DS. Passive-dynamic ankle-foot orthoses with personalized bending stiffness can enhance net plantarflexor function for individuals post-stroke. J Prosthetics Orthot. 2016;28:60–7. This study investigated if dynamic AFO bending stiffness customized to account for an individual’s level of plantarflexor deficit could replace lost plantarflexor function for individuals post-stroke. This study indicated that while walking with dynamic AFOs with a customized bending stiffness, the net (individual + AFO) peak plantarflexion moment increased; however, typical moments were not fully reached. This study supports the feasibility of objectively personalizing dynamic AFO bending stiffness to assist with plantarflexor weakness in individuals post-stroke . CrossRefGoogle Scholar
  23. 23.
    Yamamoto S, Fuchi M, Yasui T. Change of rocker function in the gait of stroke patients using an ankle foot orthosis with an oil damper: immediate changes and the short-term effects. Prosthetics Orthot Int. 2011;35:350–9.CrossRefGoogle Scholar
  24. 24.
    Kobayashi T, Leung AKL, Akazawa Y, Hutchins SW. The effect of varying the plantarflexion resistance of an ankle-foot orthosis on knee joint kinematics in patients with stroke. Gait Posture. 2013;37:457–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Singer ML, Kobayashi T, Lincoln LS, Orendurff MS, Foreman KB. The effect of ankle-foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke. Clin Biomech Elsevier Ltd. 2014;29:1077–80.CrossRefGoogle Scholar
  26. 26.
    Kobayashi T, Singer ML, Orendurff MS, Gao F, Daly WK, Foreman KB. The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke. Clin Biomech Elsevier Ltd. 2015;30:775–80.CrossRefGoogle Scholar
  27. 27.
    Kobayashi T, Orendurff MS, Singer ML, Gao F, Foreman KB. Contribution of ankle-foot orthosis moment in regulating ankle and knee motions during gait in individuals post-stroke. Clin Biomech. 2017;45:9–13.CrossRefGoogle Scholar
  28. 28.
    Perry J, Burnfield JM. Gait analysis: normal and pathological function. 2nd ed. Thorofare: Slack Inc.; 2010.Google Scholar
  29. 29.
    Sutherland DH, Cooper L, Daniel D. The role of the ankle plantar flexors in normal walking. J Bone Joint Surg Am. 1980;62:354–63.CrossRefPubMedGoogle Scholar
  30. 30.
    Kerkum YL, Buizer AI, Van Den Noort JC, Becher JG, Harlaar J, Brehm MA. The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS One. 2015;10.Google Scholar
  31. 31.
    • Kerkum YL, Harlaar J, Buizer AI, Van Den Noort JC, Becher JG, Brehm MA. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion. Gait Posture Elsevier BV. 2016;46:104–11. This study investigated the efficacy of a ventral dynamic AFO to reduce knee flexion and walking energy cost by customizing dynamic AFO stiffness in children with CP. Results showed a median reduction of 9% in net energy cost and reduced knee flexion when compared to a shoes-only condition. This study used objective parameters, such as peak knee extension angle during single support and walking energy cost, to customize stiffness.CrossRefGoogle Scholar
  32. 32.
    •• Kobayashi T, Orendurff MS, Hunt G, Lincoln LS, Gao F, LeCursi N, et al. An articulated ankle–foot orthosis with adjustable plantarflexion resistance, dorsiflexion resistance and alignment: a pilot study on mechanical properties and effects on stroke hemiparetic gait. Med Eng Phys Elsevier Ltd. 2017;44:94–101. This study analyzed the effect plantarflexion stiffness, dorsiflexion stiffness, and alignment had on ankle and knee joint kinematics and kinetics in individuals post-stroke. This study found that optimizing dynamic AFO alignment can improve the heel rocker to achieve normal kinematics and kinetics, tuning plantarflexion stiffness can optimize the heel rocker, and dorsiflexion stiffnesses can reduce peak push-off ankle power. This study customized two functional characteristics, bending stiffness and alignment.CrossRefGoogle Scholar
  33. 33.
    Harper NG, Esposito ER, Wilken JM, Neptune RR. The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments. Clin Biomech Elsevier Ltd. 2014;29:877–84.CrossRefGoogle Scholar
  34. 34.
    Haight DJ, Russell Esposito E, Wilken JM. Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses. Gait Posture Elsevier BV. 2015;41:750–6.CrossRefGoogle Scholar
  35. 35.
    Russell Esposito E, Choi HS, Owens JG, Blanck RV, Wilken JM. Biomechanical response to ankle-foot orthosis stiffness during running. Clin Biomech Elsevier BV. 2015;30:1125–32.CrossRefGoogle Scholar
  36. 36.
    Schrank ES, Stanhope SJ. Dimensional accuracy of ankle-foot orthoses constructed by rapid customization and manufacturing framework. J Rehabil Res Dev. 2011;48:31.CrossRefPubMedGoogle Scholar
  37. 37.
    Stanhope S, Schrank E. Process and system for manufacturing a customized orthosis. United States Patent No 8,538,570; 2013.Google Scholar
  38. 38.
    Sumiya T, Suzuki Y, Kasahara T, Ogata H. Instantaneous centers of rotation in dorsi/plantar flexion movements of posterior-type plastic ankle-foot orthoses. J Rehabil Res Dev. 1997;34: 279–85.Google Scholar
  39. 39.
    Leardini A, Aquila A, Caravaggi P, Ferraresi C, Giannini S. Multi-segment foot mobility in a hinged ankle-foot orthosis: the effect of rotation axis position. Gait Posture. 2014;40:274–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Ranz EC, Russell Esposito E, Wilken JM, Neptune RR. The influence of passive-dynamic ankle-foot orthosis bending axis location on gait performance in individuals with lower-limb impairments. Clin Biomech Elsevier Ltd. 2016;37:13–21.CrossRefGoogle Scholar
  41. 41.
    Russell Esposito E, Ranz EC, Schmidtbauer KA, Neptune RR, Wilken JM. Ankle-foot orthosis bending axis influences running mechanics. Gait Posture Elsevier. 2017;56:147–52.CrossRefGoogle Scholar
  42. 42.
    Owen E. Shank angle to floor measures of tuned “ankle-foot orthosis footwear combinations” used with children with cerebral palsy, spina bifida and other conditions. Gait Posture. 2002;16:132–3.Google Scholar
  43. 43.
    Eddison N, Chockalingam N. The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy. Prosthetics Orthot Int. 2013;37:95–107.CrossRefGoogle Scholar
  44. 44.
    Owen E. A clinical algorithm for the design and tuning of AFO footwear combinations based on shank kinematics. 12th World Congr. Int. Soc. Prosthetics Orthot; 2007, p. 181.Google Scholar
  45. 45.
    Kerkum YL, Houdijk H, Brehm MA, Buizer AI, Kessels MLC, Sterk A, et al. The shank-to-vertical-angle as a parameter to evaluate tuning of ankle-foot orthoses. Gait Posture Elsevier BV. 2015;42:269–74.CrossRefGoogle Scholar
  46. 46.
    Brown SE, Russell Esposito E, Wilken JM. The effect of ankle foot orthosis alignment on walking in individuals treated for traumatic lower extremity injuries. J Biomech Elsevier Ltd. 2017;61:51–7.CrossRefGoogle Scholar
  47. 47.
    Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia. Arch Phys Med Rehabil. the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. 2009;90:810–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Brown D, Wertsch JJ, Harris GF, Klein J, Janisse D. Effect of rocker soles on plantar pressures. Arch Phys Med Rehabil. 2004;85:81–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Fong DTP, Pang KY, Chung MML, Hung ASL, Chan KM. Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis. Clin Biomech. 2012;27:1072–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Biomechanics and Movement Science Interdisciplinary ProgramUniversity of DelawareNewarkUSA
  2. 2.Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkUSA

Personalised recommendations