Commentary on "Effect of an Ankle Foot Orthosis Intervention for Children With Non-Central Nervous System Cancers: A Pilot Study".

Abstract

“How should I apply this information?” The number of children receiving vincristine as a chemotherapeutic agent may be rising, with the children developing the related adverse effects. One adverse effect is peripheral neuropathy, including foot drop. Foot drop affects functional performance of activities such as walking and climbing stairs. To minimize these functional problems, children with cancer may require some type of orthotic intervention. Clinically, many practitioners use ankle foot orthoses (AFOs) to manage neuropathic foot drop and to improve function, but few clinical trials have prospectively described their effectiveness. Although traditional orthotic intervention includes fixed ankle AFOs or hinged ankle AFOs, many newer types of orthotics are available on the market. The authors describe the use of the 2 piece custom-molded, total contact, fixed ankle AFO as an intervention. The purpose of this study was to assess the feasibility of this newer type of AFO in children with non–central nervous system cancer. Results of this study add to our body of knowledge to the variety of available orthotic options. “What should I be aware of in applying this information?” This is a preliminary study with only 6 subjects, with varying types of cancer. The type of orthoses used in the study is described, but other details that deserve attention include length of wearing time, discontinuing use of the device when appropriate, possible devices for night use, and testing of all the muscles around the ankle, including plantarflexors. Although the purpose of assessing the feasibility of this newer type of orthosis has been met, caution should be used when attempting to generalize to other populations, including children with other types of cancer. Further research would be beneficial to determine whether this novel orthotic better optimizes motor ability, function, and balance than do conventional orthoses. Minal Jain, PT, DSc, PCS CAPT Michaele Smith, PT, MEd Mark O. Hatfield Clinical Research Center National Institutes of Health Bethesda, Maryland