The impact of ankle-foot orthotics on selective motor control during gait in children and adolescents with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) often exhibit altered selective motor control during gait (SMCg). Ankle-foot-orthoses (AFOs) are used in this population to improve gait, by reducing the degrees of freedom at the ankle joint. However, the specific impact of AFOs on SMCg and whether this effect is more related to gait deviations or motor development remains unclear. RESEARCH QUESTION: Do AFOs impact SMCg, and is the change related to joint kinematics or age? METHODS: Gait analysis data from 53 children and adolescents with spastic CP, walking both barefoot and with AFOs, were included. Electromyography data from six lower-limb muscles, and lower limb joint kinematics were analyzed for both walking conditions. SMCg was quantified by the total variance in electromyography activity accounted for by one synergy (tVAF1), where an increase in tVAF1 indicates a decrease in SMCg. Kinematic gait deviation was assessed using the Gait-Profile-Score (GPS) and sagittal plane ankle Gait-Variable-Score (ankle-GVS). All analyses were performed for the more clinically involved leg only. RESULTS: Walking with AFOs resulted in a mean increase in tVAF1 of 0.02±0.07 (p=0.015) and a median increase in ankle-GVS of 3.4º (p>0.001). No significant changes were observed in GPS, and no correlation was found between the changes in tVAF1 and ankle-GVS. A significant positive moderate correlation was found between the change in tVAF1 and age, even with ankle-GVS as a covariate (r=0.45; p>0.001). SIGNIFICANCE: Walking with an AFO resulted in a small decrease in SMCg, with large inter-participant variability. Younger participants showed a greater decrease in SMCg, which may indicate greater neuromuscular plasticity in early developmental stages.

The effect of ankle-foot orthoses on gait characteristics in people with Charcot-Marie-Tooth disease: A systematic review and meta-analysis.

INTRODUCTION: Ankle-foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. METHODS: Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random-effects meta-analyses. RESULTS: A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta-analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small-to-moderate and non-significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. CONCLUSION: Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment.

Low Back Pain Caused by Traction Peripheral Neuropathy Due to Chronic Ankle Instability: Three Clinical Cases.

Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.

The impact of shoes versus ankle-restricted orthoses on sit-to-stand kinematics and centre of mass trajectories in adults with myelomeningocele.

BACKGROUND: Individuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. RESEARCH QUESTION: How are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? METHODS: Twenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. RESULTS: The AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74-81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17-41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12-24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6-15 % of the STS cycle). SIGNIFICANCE: The differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.

The ankle dorsiflexion kinetics demand to increase swing phase foot-ground clearance: implications for assistive device design and energy demands.

BACKGROUND: The ankle is usually highly effective in modulating the swing foot's trajectory to ensure safe ground clearance but there are few reports of ankle kinetics and mechanical energy exchange during the gait cycle swing phase. Previous work has investigated ankle swing mechanics during normal walking but with developments in devices providing dorsiflexion assistance, it is now essential to understand the minimal kinetic requirements for increasing ankle dorsiflexion, particularly for devices employing energy harvesting or utilizing lighter and lower power energy sources or actuators. METHODS: Using a real-time treadmill-walking biofeedback technique, swing phase ankle dorsiflexion was experimentally controlled to increase foot-ground clearance by 4 cm achieved via increased ankle dorsiflexion. Swing phase ankle moments and dorsiflexor muscle forces were estimated using AnyBody modeling system. It was hypothesized that increasing foot-ground clearance by 4 cm, employing only the ankle joint, would require significantly higher dorsiflexion moments and muscle forces than a normal walking control condition. RESULTS: Results did not confirm significantly increased ankle moments with augmented dorsiflexion, with 0.02 N.m/kg at toe-off reducing to zero by the end of swing. Tibialis Anterior muscle force incremented significantly from 2 to 4 N/kg after toe-off, due to coactivation with the Soleus. To ensure an additional 4 cm mid swing foot-ground clearance, an estimated additional 0.003 Joules/kg is required to be released immediately after toe-off. CONCLUSION: This study highlights the interplay between ankle moments, muscle forces, and energy demands during swing phase ankle dorsiflexion, offering insights for the design of ankle assistive technologies. External devices do not need to deliver significantly greater ankle moments to increase ankle dorsiflexion but, they should offer higher mechanical power to provide rapid bursts of energy to facilitate quick dorsiflexion transitions before reaching Minimum Foot Clearance event. Additionally, for ankle-related bio-inspired devices incorporating artificial muscles or humanoid robots that aim to replicate natural ankle biomechanics, the inclusion of supplementary Tibialis Anterior forces is crucial due to Tibialis Anterior and Soleus co-activation. These design strategies ensures that ankle assistive technologies are both effective and aligned with the biomechanical realities of human movement.

Effects of ankle-foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial.

BACKGROUND: Ankle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO. METHODS: Twenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed. RESULTS: All 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05). CONCLUSIONS: Post-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis.

Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.

Determination of Gait Events and Temporal Gait Parameters for Persons with a Knee-Ankle-Foot Orthosis.

Gait event detection is essential for controlling an orthosis and assessing the patient's gait. In this study, patients wearing an electromechanical (EM) knee-ankle-foot orthosis (KAFO) with a single IMU embedded in the thigh were subjected to gait event detection. The algorithm detected four essential gait events (initial contact (IC), toe off (TO), opposite initial contact (OIC), and opposite toe off (OTO)) and determined important temporal gait parameters such as stance/swing time, symmetry, and single/double limb support. These gait events were evaluated through gait experiments using four force plates on healthy adults and a hemiplegic patient who wore a one-way clutch KAFO and a pneumatic cylinder KAFO. Results showed that the smallest error in gait event detection was found at IC, and the largest error rate was observed at opposite toe off (OTO) with an error rate of -2.8 ± 1.5% in the patient group. Errors in OTO detection resulted in the largest error in determining the single limb support of the patient with an error of 5.0 ± 1.5%. The present study would be beneficial for the real-time continuous monitoring of gait events and temporal gait parameters for persons with an EM KAFO.

The Rehabilitation Interventions and Adaptive Technologies Used for Treating Patients With Cerebral Palsy.

Cerebral palsy (CP) is one of the most common disorders in pediatric patients. The prevalence of CP is 2-3 in 1,000 live births, but various changes in some trends are seen in different groups. This article is a systematic review of multiple sources available for interventions and new adaptive techniques used for treating patients for their better lifestyles. With recent advancements, it is possible to diagnose a child who is below six months to two years. For achieving goals, proper interventions and techniques are necessary in the early stages of the disease. This article summarizes the rehabilitation and interventions available for treating these children with the best procedures.

Enhancing Functional Rehabilitation Through Orthotic Interventions for Foot and Ankle Conditions: A Narrative Review.

Non-surgical, conservative approaches to foot and ankle conditions are of important consideration. Orthotics play a significant role in treating these conditions, preventing progression, and alleviating pressure on affected areas, thereby promoting normal gait. This article aims to assess the utility and effectiveness of various orthotic treatments in different clinical scenarios. We reviewed 27 peer-reviewed articles using electronic databases, employing keywords such as "orthoses," "orthotic treatment," "arthritis," "neuropathy," and "foot and ankle trauma." Studies conducted in recent decades have explored the effectiveness of orthoses in various conditions, including connective tissue disorders, tendon and ligament injuries, foot arthritis, neuropathic and inflammatory wounds, and sports-related recurrent injuries. Orthotic management has proven effective across diverse foot and ankle conditions. Integrating orthotic treatment with systemic approaches benefits patients with foot and ankle disorders. We believe this review can be utilised by clinicians in the management of foot and ankle disorders.

Ankle-foot orthoses among children with cerebral palsy: a cross-sectional population-based register study of 8,928 children living in Northern Europe.

BACKGROUND: Cerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age. METHOD: Aggregated data on 8,928 participants in the national follow-up programs for CP for the respective countries were used. Finland does not have a national follow-up program for individuals with CP and therefore a study cohort was used instead. Use of AFOs were presented as percentages. Logistic regression models were used to compare the use of AFOs among countries adjusted for age, CP subtype, GMFCS level, and sex. RESULTS: The proportion of AFO use was highest in Scotland (57%; CI 54-59%) and lowest in Denmark (35%; CI 33-38%). After adjusting for GMFCS level, children in Denmark, Finland, and Iceland had statistically significantly lower odds of using AFOs whereas children in Norway and Scotland reported statistically significantly higher usage than Sweden. CONCLUSION: In this study, the use of AFOs in children with CP in countries with relatively similar healthcare systems, differed between countries, age, GMFCS level, and CP subtype. This indicates a lack of consensus as to which individuals benefit from using AFOs. Our findings present an important baseline for the future research and development of practical guidelines in terms of who stands to benefit from using AFOs.

Parent experience with ankle-foot orthoses for their young children with cerebral palsy: a qualitative study.

PURPOSE: This study explored the experiences of parents of young children with cerebral palsy who used Ankle-Foot Orthoses (AFOs). MATERIALS AND METHODS: Parents of children with cerebral palsy (n = 11; age range 2-6 years) who used solid or hinged AFOs participated. Interpretive Description, a qualitative methodological approach focused on the application of findings to clinical practice, was used. Semi-structured interviews were conducted, and themes were developed using thematic analysis. RESULTS: Four themes described parent experience with their children's AFOs: 1) "Hear what I am saying": Collaborative decision-making with families, 2) "Is my child going to be excluded because of AFOs?": Parent and child adjustment was a journey, 3) AFOs created financial and practical challenges, 4) The perceived benefits of AFO use. CONCLUSIONS: Adjusting to AFOs was a challenging and time-consuming process for parents and children, which may have resulted in lower frequency and duration of use than anticipated by clinicians. Clinicians must be aware of the physical and psychosocial adjustment process as children and families adapt over time and work with families to ensure AFO use is optimized and individualized.

IMPLICATIONS FOR REHABILITATIONClinical practice will be enhanced by understanding  parent experience with their children's receipt and use of Ankle-Foot Orthoses (AFOs).Clinicians should work with families to establish and monitor individualized wear-time schedules that align with family routines.Information about AFOs, including appearance and alternative clothing requirements, should be provided to families in advance of receiving AFOs.

Design and Additive Manufacturing of a Passive Ankle-Foot Orthosis Incorporating Material Characterization for Fiber-Reinforced PETG-CF15.

The individualization of patient-specific ankle joint orthoses is becoming increasingly important and can be ideally realized by means of additive manufacturing. However, currently, there are no functional additively manufactured fiber-reinforced products that are used in the field of orthopedic treatment. In this paper, an approach as to how additively manufactured orthopedic products can be designed and produced quickly and flexibly in the future is presented. This is demonstrated using the example of a solid ankle-foot orthosis. For this purpose, test results on PETG-CF15, which were determined in a previous work, were integrated into a material map for an FEA simulation. Therewith, the question can be answered as to whether production parameters that were determined at the test specimen level can also be adapted to real, usable components. Furthermore, gait recordings were used as loading conditions to obtain exact results for the final product. In order to perfectly adapt the design of the splint to the user, a 3D scan of a foot was performed to obtain a perfect design space for topology optimization. This resulted in a patient-specific and stiffness-optimized product. Subsequently, it was demonstrated that the orthosis could be manufactured using fused layer modelling. Finally, a comparison between the conventional design and the consideration of AM-specific properties was made. On this basis, it can be stated that the wearing comfort of the patient-specific design is very good, but the tightening of the splint still needs to be improved.

Long-term use of an ankle-foot orthosis intervention in patients with peripheral artery disease using the integrated promoting action on research implementation in health services (i-PARIHS) framework.

BACKGROUND: Peripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. PURPOSE: The purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. DESIGN: A convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. SETTING: Vascular surgery clinic and biomechanics research laboratory. PARTICIPANTS: Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. INTERVENTIONS: A certified orthotist fit participants with an AFO that was worn for 3 months. MAIN OUTCOME MEASURES: Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. RESULTS: The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. CONCLUSIONS: Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle. CLINICAL TRIAL REGISTRATION NO: NCT02902211.

Human-Robot Joint Misalignment, Physical Interaction, and Gait Kinematic Assessment in Ankle-Foot Orthoses.

Lower limb exoskeletons and orthoses have been increasingly used to assist the user during gait rehabilitation through torque transmission and motor stability. However, the physical human-robot interface (HRi) has not been properly addressed. Current orthoses lead to spurious forces at the HRi that cause adverse effects and high abandonment rates. This study aims to assess and compare, in a holistic approach, human-robot joint misalignment and gait kinematics in three fixation designs of ankle-foot orthoses (AFOs). These are AFOs with a frontal shin guard (F-AFO), lateral shin guard (L-AFO), and the ankle modulus of the H2 exoskeleton (H2-AFO). An experimental protocol was implemented to assess misalignment, fixation displacement, pressure interactions, user-perceived comfort, and gait kinematics during walking with the three AFOs. The F-AFO showed reduced vertical misalignment (peak of 1.37 ± 0.90 cm, p-value < 0.05), interactions (median pressures of 0.39-3.12 kPa), and higher user-perceived comfort (p-value < 0.05) when compared to H2-AFO (peak misalignment of 2.95 ± 0.64 and pressures ranging from 3.19 to 19.78 kPa). F-AFO also improves the L-AFO in pressure (median pressures ranging from 8.64 to 10.83 kPa) and comfort (p-value < 0.05). All AFOs significantly modified hip joint angle regarding control gait (p-value < 0.01), while the H2-AFO also affected knee joint angle (p-value < 0.01) and gait spatiotemporal parameters (p-value < 0.05). Overall, findings indicate that an AFO with a frontal shin guard and a sports shoe is effective at reducing misalignment and pressure at the HRI, increasing comfort with slight changes in gait kinematics.

Review of ankle rehabilitation devices for treatment of equinus contracture.

INTRODUCTION: Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery. AREAS COVERED: This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market. EXPERT OPINION: This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.

Numerical and Experimental Mechanical Analysis of Additively Manufactured Ankle-Foot Orthoses.

Growing age and different conditions often require the replacement of orthoses, and FDM-based 3D printing can produce them quickly with less investment. In today's market for orthotics, these characteristics are highly desired. Therefore, this study is fully focused on the optimization and strength analysis of FDM 3D-printed ankle-foot orthoses (AFO) fabricated using PLA and PLA reinforced with carbon fiber (PLA-C). An increase in ankle plantar-flexor force can be achieved by reinforcing thermoplastic AFOs with CFs. Specially designed mechanical strength tests were conducted at the UTM to generate force-displacement curves for stored elastic energy and fracture studies. The mechanical behavior of both AFOs was predicted with the help of an FEA. The model predictions were validated by comparing them with mechanical strength testing conducted under the same loading and boundary conditions as the FEA. In both the prediction and experimental analysis, the PLA-C-based AFOs were stiffer and could withstand greater loads than the PLA-based AFOs. An area of high stress in the simulation and a fracture point in experimentation were both found at the same location. Furthermore, these highly accurate models will allow the fabrication of AFOs to be improved without investing time and resources on trials.

Research and Development of Ankle-Foot Orthoses: A Review.

The ankle joint is one of the important joints of the human body to maintain the ability to walk. Diseases such as stroke and ankle osteoarthritis could weaken the body's ability to control joints, causing people's gait to be out of balance. Ankle-foot orthoses can assist users with neuro/muscular or ankle injuries to restore their natural gait. Currently, passive ankle-foot orthoses are mostly designed to fix the ankle joint and provide support for walking. With the development of materials, sensing, and control science, semi-active orthoses that release mechanical energy to assist walking when needed and can store the energy generated by body movement in elastic units, as well as active ankle-foot orthoses that use external energy to transmit enhanced torque to the ankle, have received increasing attention. This article reviews the development process of ankle-foot orthoses and proposes that the integration of new ankle-foot orthoses with rehabilitation technologies such as monitoring or myoelectric stimulation will play an important role in reducing the walking energy consumption of patients in the study of human-in-the-loop models and promoting neuro/muscular rehabilitation.

Standardised classification system for bespoke thermoplastic ankle foot orthoses.

PURPOSE: To validate a new classification system for bespoke thermoplastic ankle foot orthoses (AFOs). METHODS: Inter- and intra-observer reliability study. A classification system based on the design and function of AFOs was created. Sixty-three independent observers classified thirty-six photographs of different AFOs, according to the proposed classification system via an online questionnaire. Approximately two weeks later, the same AFOs were classified again by fifty-three of the same participants. All participants were health care professionals, researchers, or technicians with experience in referring for, prescribing, fitting, reviewing, researching or manufacturing AFOs. RESULTS: The mean inter- and intra-observer agreement Fleiss' kappa was 0.932 and 0.944, respectively. 98.3% of participants reported that the classification system was very easy or moderately easy to use, with 85.7% reporting they would use the classification system. 90.5% of participants reported that the proposed AFO classification system was clear, with 84% stating it was useful. CONCLUSION: The proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care.

Injuries to the Spring Ligament: Nonoperative Treatment.

The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and talonavicular joints. Acute isolated rupture of the spring ligament has been reported in association with an eversion ankle sprain. Attenuation and failure of the spring ligament causes complex 3D changes called the progressive collapsing foot deformity (PCFD). This deformity is characterized by hindfoot eversion, forefoot supination, collapse of the medial longitudinal arch, and forefoot abduction. Nonoperative treatment of an isolated spring ligament rupture and PCFD using various designs of orthoses have shown promising results.