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To reduce gait problems in individuals with non-spastic calf muscle weakness, spring-like ankle-foot orthoses (AFOs) are often applied, but they are not individually optimized to treatment outcome. The aim of this proof-of-concept study was to evaluate the effects of modifying the stiffness for two spring-like AFO types with shoes-only as reference on gait outcomes in three individuals with calf muscle weakness due to polio.
We assessed 3D gait biomechanics, walking speed and walking energy cost for shoes-only and five stiffness conditions of a dorsal-leaf-spring AFO and a spring-hinged AFO. Outcomes were compared between stiffness conditions in the two AFOs and three subjects.
Maximum ankle dorsiflexion angle decreased with increasing stiffness in both AFOs (up to 6–8°) and all subjects. Maximum knee extension angle changed little between stiffness conditions, however different responses between the AFOs and subjects were observed compared to shoes-only. Walking speed remained unchanged across conditions. For walking energy cost, we found fairly large differences across stiffness conditions with both AFOs and between subjects (range 3–15%).
Modifying AFO stiffness in individuals with non-spastic calf muscle weakness resulted in substantial differences in ankle biomechanics and walking energy cost with no effect on speed. Our results provide proof-of-concept that individually optimizing AFO stiffness can clinically beneficially improve gait performance.
Additional file 1: Gait biomechanics of subject A (calf muscle strength MRC 4). Shoes-only (1) is performed at the DLS-AFO testing day, Shoes-only (2) is performed at the SH-AFO testing day. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 1005 kb)13047_2019_348_MOESM1_ESM.tif
Additional file 2: Gait biomechanics of subject B (calf muscle strength MRC 4). Since all AFO conditions were tested at one day there is only one shoes-only (Shoes-only (1)) condition performed. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 995 kb)13047_2019_348_MOESM2_ESM.tif
Additional file 3: Gait biomechanics of subject C (calf muscle strength MRC 0). Shoes-only (1) is performed at the DLS-AFO testing day, Shoes-only (2) is performed at the SH-AFO testing day. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 1057 kb)13047_2019_348_MOESM3_ESM.tif
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- Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness – a proof-of-concept study
Hilde E. Ploeger
Niels F. J. Waterval
Sicco A. Bus
- BioMed Central