Comparison of ankle-foot orthoses with plantar flexion stop and plantar flexion resistance in the gait of stroke patients: A randomized controlled trial.

BACKGROUND: The effect of plantar flexion resistance of ankle-foot orthoses on the ankle and knee joints is well known, but its effect on the hip joint and upper body movement during the gait of stroke patients remains unclear.

OBJECTIVES: To compare the effect of an ankle-foot orthosis with plantar flexion stop and an ankle-foot orthosis with plantar flexion resistance on the gait of stroke patients in the subacute phase.

STUDY DESIGN: Randomized controlled trial.

METHODS: A total of 42 stroke patients (mean age = 59.9 ± 10.9 years, 36 men and 4 women) in the subacute phase were randomized to each ankle-foot orthosis group in a parallel controlled trial with no blinding. Patients received gait training from physiotherapists using the specified ankle-foot orthosis for 2 weeks. Shod gait without an ankle-foot orthosis before training and gait with an ankle-foot orthosis after training were measured by three-dimensional motion analysis.

RESULTS: A total of 20 patients were analyzed in each group. Significant differences were found in pelvic and thoracic tilt angles between the two groups. Compared with the gait without an ankle-foot orthosis, the pelvis showed forward tilt when patients walked with an ankle-foot orthosis with plantar flexion stop, and the thorax showed decreased forward tilt when the patients walked with an ankle-foot orthosis with plantar flexion resistance.

CONCLUSION: The difference in ankle-foot orthosis function in sagittal plantar flexion resistance affected the alignment of the upper body and the pelvis during the gait of stroke patients in the subacute phase. Clinical relevance Maintaining upright posture is important in gait rehabilitation. The findings of this study suggest that the ankle-foot orthosis with plantar flexion resistance facilitated better alignment of the upper body and pelvis during the gait of stroke patients in subacute phase. This type of ankle-foot orthosis could be beneficial for patients with malalignment of the upper body and pelvis.