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Ankle Foot Orthoses May Offer Stability Benefits for Older Adults

Older adults using custom-made ankle foot orthoses for the first time showed an immediate reduction in postural sway and improved lower extremity coordination.

The study, which was published in Clinical Biomechanics, was conducted on volunteers from the general elderly population, according to study co-authors Sai Vikas Yalla, PhD, and Ryan Crews, MS, CCRP. Both researchers are assistant professors at the Center for Lower Extremity Ambulatory Research (CLEAR) in the Department of Podiatric Surgery and Applied Biomechanics at Rosalind Franklin University of Medicine and Science.

“Ankle foot orthoses in general [have been shown to be] fairly effective in certain populations, like Parkinson’s patients or brain injury patients, but we wanted to see if these would be helpful in a general population,” Yalla told O&P Business News. “So we went for the 65 [years] and older population to see if [AFOs] would be helping them in terms of stabilizing the ankle and improving their balance.”

Study participants needed to meet eligibility requirements including the ability to walk 20 meters without an assistive device. They were then measured for shoe size and casted with their feet on a contoured footboard and knees at 90° for an AFO with a custom-made footplate and arch support with flexibility for plantar-dorsi flexion. The AFO used in the study had “a flexible, open ankle posterior leaf style gauntlet design, which is intended to allow ankle stabilization without inhibiting sagittal plane motion,” according to published results. Before wearing the device, patients also completed a questionnaire in which they reported previous history of falls in the past year and rated their fear of falling. Participants had no prior experience using an AFO.

“This was an initial evaluation at initial presentation of the device,” Crews said. “We immediately evaluated how they performed with and without the device. We definitely saw improvements in balance and stability, which ultimately could lead to a reduction in falls due to [participants] being more stable.”

Tests included balance and functional reach assessments in three conditions: barefoot, standardized shoes and with AFO in standardized shoes, as well as timed-up and go tests in the “shoe alone” and “shoe + AFO” conditions. The order of conditions (“shoe alone” v. “shoe + AFO”) was randomized for each participant to prevent any learning or practice bias.

Results of the study showed an improvement in performance in all balance-related assessments.

“We did see that the ankle was very well stabilized … The overall, immediate effect was very good,” Yalla said.

The researchers were most surprised by the results of the reach test, as they had expected the AFO to have a negative effect.

“We thought [AFOs] might restrict the forward reach, but surprisingly they did not. I feel this is because of the flexibility of the foot orthosis,” Yalla said.

Crews said the AFOs also theoretically could have negatively affected the timed-up and go test, but they did not.

“It certainly was not faster, but we did not see that the AFO slowed them down either,” he said.

Some data from the study still is being analyzed for a possible future publication. Additionally, the researchers hope to continue the study by gathering long-term results on fall reduction.

“Now we want to look prospectively at the long-term effects [such as] how it would help [participants] with fall prevention, especially when they keep using [AFOs] for a longer duration of time,” Yalla said.

Crews said, “The initial study tends to support the idea that there could be long-term benefits, so that is where we want to go now, to look at – based on these changes in stability and balance – [whether] they actually make a meaningful difference if people continue to use the device long term.”

He added that patient response to the device was positive but does not prove whether they would continue use over the long term.

“In general, they responded favorably to the use of the device. But this is just the initial exposure to the device so we still do not know long term what would be the compliance, how likely would patients be to use these daily for a long time. Another thing to look into, even if these devices work, in order for them to work we need to make sure that patients are regularly using them.” — by Amanda Alexander

For more information:
Yalla SV. Clinical Biomechanics. 2014; doi:10.1016/j.clinbiomech.2014.10.007

Disclosure: Funding support for the study was provided by Langer Biomechanics Inc., the parent company of the manufacturer of the AFOs. Neither the manufacturer nor parent company had any role in the collection of data, analysis of data nor the preparation of the published results.

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