Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 5 , Pages 810-818, May 2009

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Presented to the International Society for Prosthetics and Orthotics, July 29–August 30, 2007, Vancouver, BC, Canada; the American Academy of Orthotists and Prosthetists, March 21–24, 2007, San Francisco, CA; the American Academy of Orthotists and Prosthetists, March 1–4, 2006, Chicago, IL; the American Academy of Orthotists and Prosthetists, March 16–19, 2005, Orlando, FL; International Society for Prosthetics and Orthotics, August 1–6, 2004, Wanchai, Hong Kong, China; the Gait and Clinical Movement Analysis Society, April 21–24, 2004, Lexington, KY; and the American Congress of Rehabilitation Medicine, October 23–26, 2003, Tucson, AZ.

  • Stefania Fatone, PhD

      Affiliations

    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
    • Corresponding Author InformationReprint requests to Stefania Fatone, PhD, NUPRL & RERP, 345 E Superior St, Room 1441, Chicago, IL 60611
    • ,
  • Steven A. Gard, PhD

      Affiliations

    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Biomedical Engineering, Northwestern University, Chicago, IL
    • Jesse Brown Veterans Affairs Medical Center, Chicago, IL
    • ,
  • Bryan S. Malas, MHPE, CO

      Affiliations

    • Moira Tobin Wickes Orthotics Program, Children's Memorial Hospital, Chicago, IL

Abstract 

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate–conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe–heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate–¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.

Key Words: Gait, Hemiplegia, Orthotic devices, Rehabilitation, Stroke

List of Abbreviations: AFO, ankle-foot orthosis, CAFO, conventionally aligned ankle-foot orthosis, COP, center of pressure, HHCAFO, heel-height compensated ankle-foot orthosis, ¾ AFO, ¾ length heel-height compensated ankle-foot orthosis

 

 Supported by the Office of Research and Development (Rehabilitation R&D Service), Department of Veterans Affairs (merit review #A2676I) and administered by the Jesse Brown VA Medical Center.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00122-1

doi:10.1016/j.apmr.2008.11.012

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 5 , Pages 810-818, May 2009

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