scholarly journals Studies Examining the Efficacy of Ankle Foot Orthoses should Report Activity Level and Mechanical Evidence

2010 ◽  
Vol 34 (3) ◽  
pp. 327-335 ◽  
Author(s):  
Jaap Harlaar ◽  
Merel Brehm ◽  
Jules G. Becher ◽  
Daan J. J. Bregman ◽  
Jaap Buurke ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Relevant Information ◽  
Current Treatment ◽  
Activity Level ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Ankle Foot Orthoses

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

scholarly journals Individual stiffness optimization of dorsal leaf spring ankle–foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Niels F. J. Waterval ◽  
Merel-Anne Brehm ◽  
Jaap Harlaar ◽  
Frans Nollet
Keyword(s):  
Muscle Weakness ◽  
Energy Cost ◽  
Activity Level ◽  
Calf Muscle ◽  
Leaf Spring ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
The Individual ◽  
Optimal Stiffness ◽  
Walking Energy Cost

Abstract Background In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle–foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier’s recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (− 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 ± 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 ± 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness. Conclusions In people with calf muscle weakness, current supplier’s recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes. Trial registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170.

Carbon Fiber Based Twisted and Coiled Artificial Muscles (TCAMs) for Powered Ankle-Foot Orthoses (AFO)

2021 ◽  
Author(s):  
Parth Kotak ◽  
Jason Wilken ◽  
Kirsten Anderson ◽  
Caterina Lamuta
Keyword(s):  
Carbon Fiber ◽  
Low Cost ◽  
Input Voltage ◽  
Input Power ◽  
Artificial Muscles ◽  
Specific Work ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
Low Cost Manufacturing

Abstract Ankle foot orthoses (AFOs) control the position and motion of the ankle, compensate for weakness, and correct deformities. AFOs can be classified as passive or powered. Powered AFOs overcome the limitations of passive AFOs by adapting their performance to meet a variety of requirements. However, the actuators currently used to power AFOs are typically heavy, bulky, expensive, or limited to laboratory settings. Thus, there is a strong need for lightweight, inexpensive, and flexible actuators for powering AFOs. In this technical brief, Carbon Fiber/Silicone Rubber (CF/SR) Twisted and Coiled Artificial Muscles (TCAMs) are proposed as novel actuators for powered AFOs. CF/SR TCAMs can lift up to 12,600 times their weight with an input power of only 0.025 W cm-1 and are fabricated from inexpensive materials through a low-cost manufacturing process. Additionally, they can provide a specific work of 758 J kg-1 when an input voltage of 1.64 V cm-1 is applied. A mechanical characterization of CF/SR TCAMs in terms of length/tension, tension/velocity, and active-passive length/tension is presented, and results are compared with the performance of skeletal muscles. A gait analysis demonstrates that CF/SR TCAMs can provide the performance required to supplement lower limb musculature and replicate the gait cycle of a healthy subject. Therefore, the preliminary results provided in this brief are a stepping stone for a dynamic AFO powered by CF/SR TCAMs.

Snowboarder's Talus Fracture

2005 ◽  
Vol 33 (6) ◽  
pp. 871-880 ◽  
Author(s):  
Victor Valderrabano ◽  
Thomas Perren ◽  
Christian Ryf ◽  
Paavo Rillmann ◽  
Beat Hintermann
Keyword(s):  
Surgical Treatment ◽  
Subtalar Joint ◽  
External Rotation ◽  
Sport Activity ◽  
Treatment Algorithm ◽  
Activity Level ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Lateral Process

Background Fracture of the lateral process of the talus is a typical snowboarding injury. Basic data are limited, particularly with respect to treatment and outcome. Hypothesis As the axial-loaded dorsiflexed foot becomes externally rotated and/or everted, fracture of the lateral process of the talus occurs. Primary surgical treatment may improve the outcome of this injury, reducing the risk of secondary subtalar joint osteoarthritis. Study Design Cohort study; Level of evidence, 2. Methods We recorded details of the treatment and evaluation of 20 patients (8 female and 12 male; age at trauma, 29 years [range, 17-48 years]) who sustained a lateral process of the talus fracture while snowboarding. The injury pathomechanism was documented. The patients were treated either nonsurgically or surgically based on a fracture-type treatment algorithm. The evaluation at most recent follow-up (mean, 42 months [range, 26-53 months]) included clinical and functional examination, follow-up of sport activity, and radiological assessment (radiograph, computed tomography scan). Results The injury mechanism included axial impact (100%), dorsiflexion (95%), external rotation (80%), and eversion (45%). Using the American Orthopaedic Foot and Ankle Society hindfoot score, the patients obtained a mean of 93 points; the surgically treated group (n = 14) scored higher (97 points) than did the nonoperative group (n = 6; 85 points) (P <. 05). Degenerative disease of the subtalar joint was found in 3 patients (15%; operative, 1 patient; nonoperative, 2 patients). All but 4 (20%, all after nonsurgical treatment) patients reached the same sport activity level as before injury. Conclusion The snowboarding-related lateral process of the talus fracture represents a complex hindfoot injury. In type II fractures, primary surgical treatment has led to achieving better outcomes, reducing sequelae, and allowing patients to regain the same sports activity level as before injury.

Computational and experimental evaluation of the mechanical properties of ankle foot orthoses: A literature review

2019 ◽  
Vol 43 (3) ◽  
pp. 339-348
Author(s):  
Alessio Ielapi ◽  
Malcolm Forward ◽  
Matthieu De Beule
Keyword(s):  
Mechanical Properties ◽  
Literature Review ◽  
English Language ◽  
Computational Models ◽  
Real Life ◽  
Relevant Information ◽  
Gait Pattern ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
Gaining Insight

Background: Ankle foot orthoses are external medical devices applied around the ankle joint area to provide stability to patients with neurological, muscular, and/or anatomical disabilities, with the aim of restoring a more natural gait pattern. Study design: This is a literature review. Objectives: To provide a description of the experimental and computational methods present in the current literature for evaluating the mechanical properties of the ankle foot orthoses. Methods: Different electronic databases were used for searching English-language articles realized from 1990 onward in order to select the newest and most relevant information available. Results: A total of 46 articles were selected, which describe the different experimental and computational approaches used by research groups worldwide. Conclusion: This review provides information regarding processes adopted for the evaluation of mechanical properties of ankle foot orthoses, in order to both improve their design and gain a deeper understanding of their clinical use. The consensus drawn is that the best approach would be represented by a combination of advanced computational models and experimental techniques, capable of being used to optimally mimic real-life conditions. Clinical relevance In literature, several methods are described for the mechanical evaluation of ankle foot orthoses (AFOs); therefore, the goal of this review is to guide the reader to use the best approach in the quantification of the mechanical properties of the AFOs and to help gaining insight in the prescription process.

Energy expenditure and walking ability in stroke patients: Their improvement by ankle-foot orthoses

2009 ◽  
Vol 17 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Noriaki Maeda ◽  
Junichi Kato ◽  
Yuji Azuma ◽  
Sou Okuyama ◽  
Satoshi Yonei ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Stroke Patients ◽  
Ankle Foot Orthoses

A Treatment Algorithm for Neuropathic (Charcot) Midfoot Deformity

Foot & Ankle ◽  
1993 ◽  
Vol 14 (4) ◽  
pp. 189-197 ◽  
Author(s):  
Michael S. Pinzur ◽  
Ronald Sage ◽  
Rodney Stuck ◽  
Shari Kaminsky ◽  
Ann Zmuda
Keyword(s):  
Soft Tissues ◽  
Treatment Algorithm ◽  
Walking Ability ◽  
Cast Immobilization ◽  
Ankle Foot Orthoses ◽  
Hind Foot ◽  
Neuropathic Foot ◽  
Selective Surgery

Forty-nine feet in 47 patients with midfoot neuropathic foot deformity were referred for care to a comprehensive foot salvage clinic and followed for an average of 3.6 years. Twenty-three initially presented without open ulcers. Two underwent elective Syme's ankle disarticulation amputation, and the others were kept ambulatory with a combination of periods of nonweightbearing cast immobilization, accommodative extra-depth shoes with custom orthotics, and ankle-foot orthoses. Twenty-six of the feet initially presented for care with open ulcers and/or chronic osteomyelitis. Twenty-two of these patients underwent 32 surgical procedures. Sixteen underwent debridement of the infected bone and surrounding soft tissues. Excision of large, nonaccommodative boney prominence, termed ex-ostectomy, was performed in eight. Partial excision of the deformed midfoot combined with boney stabilization and attempted arthrodesis, termed partial tarsectomy, were performed in seven. All surgical patients were managed postoperatively with long-term custom accommodative bracing. Follow-up at an average of 3.6 years revealed that all but one of the patients remained ambulatory. Six walk with accommodative shoe gear and persistent stable chronic open ulcers. None required below-knee amputation. Five amputations were performed, three at the Syme's ankle disarticulation level, one at the Chopart's hind-foot level, and one at the mid-foot level. Neuropathic midfoot deformity is a disabling disorder that requires thorough patient education and compliance, prolonged palliative monitoring and care, accommodative orthotic shoe management, and selective surgery. It can markedly limit the patient's walking ability and independence. With careful monitoring and selective surgery to maintain a plantigrade foot, foot salvage and walking ability can be maintained. A treatment algorithm is presented to guide patient care.

Comparison of the Efficacy of Two Different Medial Linkage Mechanisms in Knee-Ankle-Foot Orthoses on Walking Ability in Subjects with Spinal Cord Injury

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hanieh Seyyedzadeh ◽  
Mokhtar Arazpour ◽  
Hassan Saeedi ◽  
Mohammad Ebrahim Mousavi ◽  
Navid Golchin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Cord Injury ◽  
Ankle Foot Orthoses

An Orthotic Joint Design for Enhancing Ankle Mobility With Ankle Foot Orthoses Use

2020 ◽  
Vol 14 (4) ◽  
Author(s):  
Eileen Baker ◽  
Philip Voglewede ◽  
Thomas Current ◽  
Barbara Silver-Thorn
Keyword(s):  
Ankle Joint ◽  
Initial Contact ◽  
Walking Ability ◽  
Foot Orthoses ◽  
The Novel ◽  
Drop Foot ◽  
Current Form ◽  
Ankle Foot Orthoses ◽  
Ankle Mobility ◽  
Mobility Impaired

Abstract Articulated ankle foot orthoses (AFOs) are prescribed to treat drop-foot, a common neuromuscular weakness observed after a stroke. These assistive devices prevent the toe from dragging during swing (drop-foot) by providing a resistive moment at the ankle. However, existing ankle joint designs for articulated AFOs introduce additional gait pathologies as they also constrain ankle mobility during stance. A novel ankle joint for AFOs to prevent drop-foot during swing and improve ankle mobility during stance was developed, thereby reducing compensatory knee motion during stance. The design intent was to mimic the unconstrained kinematic response of a nonpathologic ankle at initial contact while preventing drop-foot during swing. The design incorporated two modes of operation: locked during swing for support and unlocked during stance for enhanced range of motion. Proof of concept testing with able-bodied subjects was conducted to test walking ability over level ground based on kinetic and kinematic parameters. The comparative tests confirmed the ability of the novel design to prevent drop-foot and its potential for enhanced ankle mobility during stance. Preliminary results indicate that the novel ankle joint should be refined to facilitate smooth and consistent unlocking but can be safely used in its current form with mobility impaired individuals.

scholarly journals Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey

2021 ◽  
Author(s):  
Bart Raijmakers ◽  
Roelofine A. Berendsen-de Gooijer ◽  
Hilde E. Ploeger ◽  
Fieke S. Koopman ◽  
Frans Nollet ◽  
...  
Keyword(s):  
Daily Life ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Ankle Foot Orthosis ◽  
Custom Made ◽  
Ankle Foot Orthoses ◽  
Polio Survivors ◽  
Foot Orthosis

Objective: To investigate the use of custom-made knee-ankle-foot-orthoses in daily life and differences in usability factors of knee-ankle-foot-orthoses between users and discontinued users. Design: Cross-sectional survey study. Subjects: A total of 163 polio survivors provided with a knee-ankle-foot-orthosis at an outpatient clinic of a university hospital. Methods: Use and usability of knee-ankle-foot-orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard. Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot-orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot-orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot-orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot-orthosis-related aspects (p < 0.001). Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot-orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot-orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot-orthosis in polio survivors. 

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