A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke.

OBJECTIVE: To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke. DATA SOURCES: The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data. REVIEW METHODS: Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model. RESULTS: Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001-0.0002); knee kinematics in stance phase (P < 0.0001-0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18-0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only. CONCLUSIONS: An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.

Flatfoot and obesity in school-age children: a cross-sectional study.

Childhood obesity exerts abnormally high stresses on developing foot structures which can lead to structural deformity of the foot. Screening for foot problems in children with overweight helps detect interior risks restricting normal lifestyle in these individuals. The purpose of this study was to investigate the effects of excess weight on the structure and function of the developing foot in students aged 7-14 years. A total of 667 participants were recruited for this cross-sectional study via a multi-level cluster sampling method (randomization was used within each cluster). All subjects (340 boys and 327 girls) attended primary and secondary schools in Isfahan City, Iran. The children's feet were evaluated using clinical assessments and footprint-based measures whilst fully weight bearing. Significant differences were observed in the frequency of flatfoot between normal weight, overweight and obese groups (P < 0.001); participants who were more overweight had flatter feet. Children with higher weight also had a more pronated heel, less dorsiflexion range and higher reported pain within physical activity. This study indicated that childhood obesity is associated with structural foot and ankle deformities and activity-related foot pain.