Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles: a systematic review.
BACKGROUND
People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles aids in clinical decision making and may improve adherence.


METHODS
Studies published before October 27th, 2014, were searched in Pubmed, Embase, Cinahl, and Cochrane Library. Studies evaluating effects of ankle foot orthoses on body functions and/or activities in people with floppy paretic ankle muscles were included. Studies solely focusing on people with spastic paretic ankle muscles were excluded. Study quality was assessed using a custom-made scale. Body functions and activities were defined according to the International Classification of Functioning, Disability and Health.


FINDINGS
Twenty-four studies were included, evaluating 394 participants. Participants were grouped according to paresis type (i) dorsiflexor paresis, (ii) plantar flexor paresis, (iii) both dorsiflexor and plantar flexor paresis. Dorsal, circular, and elastic ankle foot orthoses increased dorsiflexion during swing (by 4-6°, group i). Physical comfort with dorsal ankle foot orthoses was lower than that with circular ankle foot orthoses (groups i and iii). Dorsal ankle foot orthoses increased push-off moment (by 0.2-0.5 Nm/kg), increased walking efficiency, and decreased ankle range of motion (by 12-30°, groups ii and iii).


INTERPRETATION
People with dorsiflexor paresis benefit more from circular and elastic ankle foot orthoses while people with plantar flexor paresis (and dorsiflexor paresis) benefit more from dorsal ankle foot orthoses.
['van der Wilk|Dymphy|D|', 'Dijkstra|Pieter Ubele|PU|', 'Postema|Klaas|K|', 'Verkerke|Gijsbertus Jacob|GJ|', 'Hijmans|Juha Markus|JM|']
D000843:Ankle Joint D005528:Foot D061826:Foot Orthoses D006801:Humans D010291:Paresis D016059:Range of Motion, Articular D016138:Walking
Paretic ankle muscles Systematic Review International classification of functioning Disability and Health Ankle foot orthosis