Posts Tagged ankle-foot orthosis

[WEB SITE] Foot Drop: Causes, Prevention and How You can Treat It

What is foot drop & what causes it?

Foot drop is a simple name but its cause and treatment may be less than simple.

If you are unable to lift your foot up at the ankle and it makes walking difficult, you may have something called foot drop. This could be due to weakness in one of the muscles responsible for lifting, or dorsiflexing, your foot. It could also be caused by tightness or spasticity in the calf muscles of your leg that cause your toes to point downward.

The cause of foot drop can be from several different sources – neurological, muscular, a side effect from medication, or from a lack of movement.

People with stroke, multiple sclerosis, acquired brain injury, spinal cord injury, or cerebral palsy have a central neurological reason causing weakness, tightness or spasticity. People with peripheral neurologic disease may also have foot drop. These diagnoses could include neuropathy, injury to the lower spinal cord, nerve damage, or illnesses like Guillain-Barre syndrome.

Those who have a traumatic accident or muscular damage could also suffer from foot drop because of damage from swelling and compression.

Certain medications are known to potentially cause foot drop. Talk to your doctor about your medications.

Foot drop can also occur in people who are in bed for a prolonged amount of time. When lying on your back, gravity pulls down your foot, and can cause weakness and overstretch the muscles and nerves on the front of your lower leg.

Can foot drop be prevented?

If you or your loved one is required to be on bedrest or immobile, you can help to prevent foot drop by using a padded splint, by doing stretching, and by doing active exercises like ankle pumps.

If you have an underlying condition, it may be impossible to fully prevent foot drop from occurring. But often you can improve the flexibility and strength in your leg, or use an orthosis or splint to help maintain your foot in a position that will allow you to walk and move safely.

How can foot drop be treated?

The treatment of foot drop depends on the cause and the symptoms you have. Below are some suggestions on what you can do, but make sure to talk to your doctor, therapist or orthotist about the best treatment options for you.

Keep your foot and ankle flexible:

  • Use a foot splint at night

  • Complete daily stretches. The ProStretch gives a great stretch

Improve the tone in your leg:

  • Use an orthosis that puts your ankle in a slight stretch

Strengthen your leg:

  • Use neuromuscular electrical stimulation

  • Complete exercises against gravity or with resistance like a Theraband

  • Stand on a variety of surfaces like an Airex balance pad or a Bosu ball to challenge your muscles in your legs. Hold onto something sturdy or have someone nearby to help

Improve the safety of your walking and prevent falls:

  • Use an ankle foot orthosis to keep your toes up when walking. Depending on your strength level, you may need a flexible one or a rigid one

  • Walk with an assistive device, like a walker or cane

  • Modify your home to prevent you from tripping or falling – consider removing rugs and floor clutter, sitting on a shower chair instead of standing, and observe your home for other potential hazards

Prevent skin problems with the use of splints and orthotics:

  • Make sure to check your skin after you’ve been wearing it, and more often if you have impaired sensation in your legs, diabetes, or a history of wounds. Use a hand held inspection mirror to help

Keep the rest of yourself of healthy:

  • Consider activities like stationary biking or swimming to complete overall strengthening and conditioning

  • Strengthen your core muscles to improve your overall balance and stability

What are the dangers of not treating foot drop?

The biggest risk of not treating foot drop is tripping and falling. Falls lead to injury and other unnecessary treatments or hospitalizations. In order to clear your toes to avoid falling, you will have to change the way you walk. Over time, this could lead to pain or discomfort in your back or legs. Also, if your ankle loses flexibility and you cannot move it at you may need surgery.

Most importantly, without treatment you will have more difficulty doing the things in life that you enjoy doing. Unfortunately, there may be no cure, but there are things you can do to help improve the quality of your life.

Who should I ask for more information?

If you have already been diagnosed or are concerned about your risk for foot drop, you should speak with your healthcare provider about what you can do to prevent and treat it.

Source: Foot Drop: Causes, Prevention and How You can Treat It

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[ARTICLE] Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients – Full Text PDF

Abstract.

[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment.

[Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention.

[Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s).

[Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.

 

INTRODUCTION

The mobility of many stroke survivorsislimited, and most identify walking as a top priority for rehabilitation1) . One way to manage ambulatory difficulties is with an ankle-foot orthosis (AFO) or a foot-drop splint, which aims to stabilize the foot and ankle while weight-bearing and lift the toes while stepping1) . In stroke rehabilitation, various approaches, including robotic assistance, strength training, and task-related/virtual reality techniques, have been shown to improve motor function2) . The benefits of a high intensity stroke rehabilitation program are well established, and although no clear guidelines exist regarding the best levels of intensity in practice, the need for its incorporation into a therapy program is widely acknowledged2) . Repetitive facilitative exercises (RFE), which combine a high repetition rate and neurofacilitation, are a recently developed approach to rehabilitation of stroke-related limb impairment2–5) . In the RFE program, therapists use muscle spindle stretching and skin-generated reflexes to assist the patient’s efforts to move an affected joint5) . Previous studies have shown that an RFE program improved lower-limb motor performance (Brunnstrom Recovery Stage, foot tapping, and lower-limb strength) and the 10-m walk test in patients with brain damage3) . An AFO is an assistive device to help stroke patients with hemiplegia walk and stand. A properly prescribed AFO can improve gait performance and control abnormal kinematics arising from coordination deficits6) . Gait training with an AFO has been also reported to improve gait speed and balance in post-stroke patients7, 8) . Therefore, we hypothesized that short-term physiotherapy combining RFE and orthotic treatment would improve both lower-extremity motor performance and functional ambulation. The present study aimed to confirm the efficacy of a combination therapy consisting of RFE for the hemiplegic lower limb and gait training with AFO.

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[ARTICLE] A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design – Full Text

Improving ankle-foot orthosis design can best be done by implementing a user-centered approach.

To provide insight into the ideas of ankle-foot orthosis users with flaccid ankle muscle paresis on the importance of activities and suggestions for an improved ankle-foot orthosis design.

A focus-group discussion with eight ankle-foot orthosis users (57 ± 5 years, 50% female).

Main inclusion criteria were as follows: ⩾18 years, unable to stand on tip-toe and unable to lift toes. Main exclusion criterion was spasticity of lower extremity muscles. Transcribed data were coded according to the International Classification of Functioning, Disability and Health. Thematic analysis with inductive approach was chosen to order and interpret codes.

Ankle-foot orthosis users ranked walking the most important activity followed by sitting down/standing up from a chair. Their opinion was that ankle-foot orthoses facilitate walking and standing. Ankle-foot orthosis users suggested that an improved ankle-foot orthosis design should balance between stability and flexibility.

Current ankle-foot orthoses facilitate walking which was the most important activity according to ankle-foot orthosis users. An improved ankle-foot orthosis design should enable walking and should optimize between stability and flexibility dependent on the activity and the paresis severity.

Experienced users of ankle-foot orthosis agreed that matching ankle-foot orthosis functions to daily-life activities is a trade-off between stability and flexibility. An improved ankle-foot orthosis design should at least enable level walking.

 

People with flaccid ankle muscle paresis generally experience problems during walking due to reduced dorsiflexion strength (needed for clearance and controlled plantarflexion during loading response) and/or plantarflexion strength (needed for push-off).1 To improve functioning, an ankle-foot orthosis (AFO) can be prescribed.2 The function of an AFO determines what it must do.3 For people with flaccid paresis, the main AFO function is to compensate for muscle weakness, while for people with spastic paresis, this function is to re-align the joint.2 Due to these function differences, different AFOs can be used depending on the paresis, and therefore, these paresis types should be evaluated separately.

AFOs prescribed for people with flaccid ankle muscle paresis can improve walking.4 However, using an AFO can also come with disadvantages.4 Dorsal AFOs, for example, limit ankle range of motion (ROM).4 This can hamper activities that require a large ankle ROM such as slope walking.5 Improving AFO design can be done best by implementing a user-driven design process as the factors that are most important to users will be taken into account.6 User-driven design is more and more applied in product design to improve acceptance of an innovation by the user.7 In this case, when an AFO fits the needs of users better, adherence to using AFOs can improve.8,9Especially, a qualitative study design can reveal the most important factors since AFO users are not limited by pre-specified questions as is usually the case in quantitative study designs.10 More specifically, a focus-group discussion allowing users to interact is likely to reveal common issues.11 We found one study that evaluated experiences with AFOs.9 However, as they included people with spastic paresis, findings may not be applicable to people with flaccid paresis.

The aim of this explorative study was to provide insight into the ideas of AFO users with flaccid ankle muscle paresis, on the importance of activities and suggestions for an improved AFO design. Providing insight into the importance of activities requires ranking activities according to importance and exploring experiences with these activities.

Figure 3. Thematic map on suggestions for an improved AFO design.

Continue — > A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design – Jan 18, 2017

 

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[ARTICLE] Effect of ankle foot orthosis on gait parameters and functional ambulation in patients with stroke – Full Text PDF

ABSTRACT

Objectives: This study aims to investigate the effect of ankle foot orthosis (AFO) on temporospatial parameters, ankle kinematics, and functional ambulation level in patients with stroke.

Patients and methods: Records of 286 adult patients with stroke assessed in the gait and motion analysis laboratory between April 2005 and January 2013 were reviewed. The data of 28 patients (16 males, 12 females; mean age 43.2±15.9 years; range 20 to 72 years) who were analyzed with and without AFO during the same session were selected for the study. Temporospatial parameters (walking speed, cadence, opposite foot contact, double support time, single support time, step time, and step length) and ankle kinematics (ankle dorsiflexion at initial contact and midswing) were measured using the Vicon 512 motion analysis system. The video and medical records of patients were examined to determine their ambulation level according to Functional Ambulation Category.

Results: Walking speed, cadence, and ankle dorsiflexion at initial contact and midswing were significantly increased while walking with AFO compared to walking barefoot (p<0.05). There were significant reduction in step time and significant increase in step length and opposite foot contact with AFO on the affected side (p<0.05). Single support time reduced significantly with AFO on the unaffected side (p<0.05). Functional Ambulation Category score improved significantly with use of AFO (p<0.05).

Conclusion: The use of AFO has positive effects on gait parameters and functional ambulation in patients with stroke.

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[ARTICLE] Functional electrical stimulation during post stroke walk: Latest developments

After stroke some residual gait deficits can remain and are prevalent. Foot drop is one of the common impairment which affects around 20% of stroke survivors. This impairment is caused by a paresis (total or partial) of the muscles involved in ankle dorsiflexion. This muscle weakness makes the ground clearance problematic during the swing phase of gait. This default can be compensated by ankle foot orthosis (AFO) but also by functional electrical stimulation.

This is an ancient technique that has benefited from recent advances in technology: wireless link, implanted stimulation, replacement of the heel switch by an inclinometer (System Walkaid)… The SEF is effective in improving walking parameters including walk speed but despite these recent technological improvements, it does not show that it is a more effective device than ankle foot orthoses in a recent study [1]. An inertial node combining an accelerometer, a gyroscope and a magnetometer placed on one of the two legs, is used to estimate the continuous walking cycle [2]. This can advantageously replace the switch in the heel to improve reliability to determine when to start or end the stimulation and also allow for example to start the stimulation at any time, including before the heel off the ground. Moreover, this inertial node should also estimate a number of walking parameters including the quality of ankle dorsiflexion and walking type (normal walk but also pass an obstacle, turn around or climbing stairs) and thus to propose an adaptive functional electrical stimulation in an intelligent way.

The purpose of the presentation is to provide an update on the latest clinical studies and develop perspectives brought by the use of inertial nodes coupled with a wireless stimulator to integrate decision algorithms.

Source: Functional electrical stimulation during post stroke walk: Latest developments

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[ARTICLE] Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke

Abstract

Background. Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle foot orthoses (AFO) for treatment of foot drop poststroke, but few long-term, randomized controlled comparisons exist.

Objective. Compare changes in gait quality and function between FES and AFOs in individuals with foot drop poststroke over a 12-month period.

Methods. Follow-up analysis of an unblinded randomized controlled trial (ClinicalTrials.gov #NCT01087957) conducted at 30 rehabilitation centers comparing FES to AFOs over 6 months. Subjects continued to wear their randomized device for another 6 months to final 12-month assessments. Subjects used study devices for all home and community ambulation. Multiply imputed intention-to-treat analyses were utilized; primary endpoints were tested for noninferiority and secondary endpoints for superiority. Primary endpoints: 10 Meter Walk Test (10MWT) and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test (6MWT), GaitRite Functional Ambulation Profile, and Modified Emory Functional Ambulation Profile (mEFAP). Results. A total of 495 subjects were randomized, and 384 completed the 12-month follow-up. FES proved noninferior to AFOs for all primary endpoints. Both FES and AFO groups showed statistically and clinically significant improvement for 10MWT compared with initial measurement. No statistically significant between-group differences were found for primary or secondary endpoints. The FES group demonstrated statistically significant improvements for 6MWT and mEFAP Stair-time subscore.

Conclusions. At 12 months, both FES and AFOs continue to demonstrate equivalent gains in gait speed. Results suggest that long-term FES use may lead to additional improvements in walking endurance and functional ambulation; further research is needed to confirm these findings.

Source: Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke

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[ARTICLE] Design of a quasi-passive 3 DOFs ankle-foot wearable rehabilitation orthosis – OPEN ACCESS

Abstract

Muscular rigidity and atrophy caused by long-term underactivity usually lead to foot drop, strephenopodia, foot extorsion or some other complications for the lower limb movement disorders or lower limb surgery sufferers. The ankle-foot orthosis can help patients conduct the right ankle motion mode training, inhibit spasm and prevent ankle complications.

In this paper, a quasi-passive 3 DOFs ankle-foot wearable orthosis was designed on the basis of kinematics and dynamics analysis of the ankle joint. Ankle joint trajectory and dynamic characteristics similar to those of natural gait can be obtained by the combination of passive energy storage and additional power complement. In terms of function, the orthosis has shock absorption and low energy consumption. Given its excellent characteristics of comfortableness, lightweight, and anthropomorphic construction, the orthosis can be used in medical institutions for rehabilitation training or as a daily-walking auxiliary equipment for surgery sufferers.

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[WEB SITE] SureStep: A Revolutionary Bracing Concept

AFO Mechanics

surestep-2SureStep manufactures a variety of products but is primarily known for the SMO (Supra malleolar orthosis) and pediatric AFOs (ankle foot orthosis). The SureStep SMO is meant for patients up to 80 pounds with hypotonic presentations. The purpose is to control the side to side movements of the ankle. The trim lines can be extended longer laterally or medially depending on whether the patient is pronating or supinating. As patients grow older there is a device called the Big Shot that accommodate children and adults weighing over 80 pounds. What makes the SureStep SMO so unique is the dynamic function that the brace allows. It uses compression to create alignment, unique trim-lines to allow freedom of motion where needed, and made from a material that travels together along with the foot.

Controling the Tri-Planar Deformities

This works under compression to maintain stability through midline. In young patients with CMT they can possibly present with a more over pronated foot position because of the low muscle tone (hypotonia) prior to developing a high arch foot presentation. This can been seen in CMT patients who have some symptoms of the disease but have not developed a high arch otherwise known as pes cavus foot. The SMO holds the heel in vertical alignment, giving stability in a coronal plane (side to side) position. An SMO is not necessarily for a patient who has weaknesses pushing up or down the ankle, just poor side-to-side movement.

Improving Stability During Gait

The device is designed to allow for motion to still occur from in and out of the midline position but limits the extremes that the foot would go to, in other words the extreme rolling inward our outward of the ankle. The goal is to improve balance and stability, or limit orthopedic injury. This helps limit out toeing or in toeing as well by improving the position to foot is landing on the ground. Having improved alignment may also utilize remaining strength for dorsiflexion or plantarflexion because the line of pull that these muscles are in has improved line of progression.

Fitting the Device

The trim-lines of the SureStep SMO are designed to be either longer on the lateral border for pronation or medial border for patient who supinate excessively and the orthotist should make the appropriate selection based on the patient’s mechanics. These trim-lines are critical to the successful outcome of this device. Although the SureStep SMO is primarily designed for a younger population as children get older or adults who still have need for such a device the same mechanism of function can be accomplished using the BigShot SMO manufactured by SureStep.

Continue —>  SureStep: A Revolutionary Bracing Concept | Lower Extremity Review Magazine.

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[WEB SITE] Allard USA: Get Back Up Today! | Lower Extremity Review Magazine

What is the treatment for foot drop?

The most common treatment is an ankle-foot orthosis (AFO) which provides support to the ankle and foot. The AFO helps control foot drop and ankle instability by providing a better sense of balance. Often times, individuals are fit with a custom molded plastic AFO, however, there are other orthotic options available that provide superior function and performance.

The goal of orthotic treatment options is to help you maximize your mobility and independence. Chances are your most important need is to be able to walk better, without assistance and for longer periods of time without getting exhausted. Hundreds of thousands of people with foot drop have experienced a mobility rebirth thanks to the stability and dynamic assistance provided when wearing ToeOFF®, a unique patented carbon fiber composite AFO.

What is ToeOFF and how does it work?

Allard ToeOFF FantasyThe ToeOFF product line is made of ultra-light weight materials including carbon fiber, fiberglass and Kevlar®. The light weight is especially important to those individuals affected with neuro-muscular deficits from CMT. ToeOFF provides a natural biomechanical response similar to the movement of your own muscles. The footplate and “open heel” design are major contributors to the function of the ToeOFF. When your heel strikes the ground, energy passes down the side of the AFO to create a dynamic response that reflects the energy to the footplate to prevent “foot slap” and lift up the forefoot, much like the spring of a swimming pool diving board. The design and materials allow for enough strength to control the position of your foot as you swing your leg, making walking easier with less energy consumption. Unlike a custom molded plastic AFO that covers and immobilizes the ankle, the ToeOFFs open heel design allows your heel to move freely as it normally would, allowing proper biomechanics to occur in the foot.

What are the benefits of ToeOFF?

ToeOFF provides a stable, fluid, propulsive and symmetrical walking pattern. ToeOFF can improve your quality of life by:

  • Restoring balance and improving stamina – ToeOFFs strong and durable design allows you to move on uneven surfaces and climb stairs or ramps more confidently and independently, without stumbling or falling. Studies have shown that ToeOFF users can walk further in ToeOFF than in conventional molded plastic AFOs.
  • Decreasing risk of muscle atrophy – A recent study revealed that plastic AFOs can lead to ankle immobilization which resulted in calf muscle atrophy.
  • Fits well into good support shoes without having to increase shoe size – The thin and lightweight carbon fiber design ensures that you can wear your AFO inside any standard shoe that provides good support – without increasing your shoe size!
  • Providing function with fashion – Ask your orthotist about our Fantasy line that offers ToeOFF in ivory, purple, black or dark blue, or the removable SoftSHELL covers that are offered in beige or dark brown.

How do I obtain a ToeOFF?

ToeOFF Products require a prescription from your physician and must be fit by a certified orthotist who will go through an eight-step customization process. The ToeOFF product line offers a variety of AFOs with graded stability to accommodate for different individual’s needs, sizes, and stabilizing properties. While the ToeOFF products are state-of-the-art in both materials and design, not every individual may be a candidate for ToeOFF.   Allard USA offers a 30 day “Try It – You’ll Like It” Patient Satisfaction Guarantee for you to “test” that the ToeOFF will work for you. Talk to your physician about specifying “Allard ToeOFF – no substitutions” on the prescription and specifically ask for Allard ToeOFF with your Orthotist – this will ensure that you are offered the unique patented design of the ToeOFF. ToeOFF products are covered by Medicare and most insurance companies.

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Continue —> Allard USA: Get Back Up Today! | Lower Extremity Review Magazine.

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[ARTICLE] Role of ankle foot orthoses in functional stability of individuals with stroke

Abstract

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke.

Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO.

Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p < 0.05).

Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

Implications for Rehabilitation

  • Functional stability is impaired in individuals with stroke.
  • Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.
  • Individuals with stroke improved their functional stability while they were provided with AFOs.
  • Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

Keywords

Ankle foot orthosis, functional stability, stroke

via Role of ankle foot orthoses in functional stability of individuals with stroke, Disability and Rehabilitation: Assistive Technology, Informa Healthcare.

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