ORLANDO, Fla. — Slightly tuning the tibial alignment in an ankle
foot orthosis-footwear combination (AFO-FC) changed a patient’s overall
outcome, according to a paper presented by Stefania Fatone, PhD, BPO (Hons),
from Northwestern University, at the
2011 Annual Meeting of the American Academy of Orthotists and
Prosthetists and Scientific Symposium.
The patient had suffered a right stroke resulting in left hemiplegia,
and 6 months later, was not progressing with the usual therapies as identified
in the literature.
“The original treatment wasn’t very effective,” Fatone
She collaborated with her co-authors when they decided to attempt an
AFO-FC to treat the patient, and at 8 months post-stroke, he
was fit with modified footwear, as well as wedges under the heel to adjust the
angle of the device.
At 11 months post-stroke, Fatone re-evaluated the patient to see if his
condition had improved. Although the patient refused to attempt ambulation
without his AFO-FC, the team was able to evaluate his progress and determine
that his gait improved modestly with the AFO-FC. They collected gait data using
body markers, eight real-time motion capture cameras and six motion plates in
the floor of the lab.
At 16 months post-stroke, the patient received a change to his device,
reducing tibial inclination by 3°. Finally, at 17 months post-stroke, the
patient agreed to attempt walking without the AFO-FC but with a four-point
cane, and Fatone discovered that his gait returned to baseline when the AFO-FC
In contrast, with the AFO-FC, the patient made substantial gains in step
length and walking speed, and he was weight-bearing more effectively on his
Since gait returned to baseline when the AFO-FC was removed, this
suggests that orthotic management made a considerable difference in the
patient’s treatment, Fatone said.
The study also raised questions about the best time to determine the
effectiveness of an orthosis, she said, and noted that this is an area for
additional study.— by Stephanie Z. Pavlou
It is such an excellent area for research, mainly
because it’s such a new concept and people are starting to grasp onto this
idea … We are seeing nice, significant changes clinically, so to get the
research to support it is fantastic. It was a nice pilot study for people to
— Brigid Driscoll, PT, CO
therapist and orthotist, Children’s Memorial Hospital