Early Observations of the Effects of Lateral Wedge Orthoses on Lower Limb Muscle Length and Potential for Exacerbating Spasticity

Abstract

Lateral wedge orthoses are often prescribed to correct varus deformity after stroke. Spasticity is implicated in varus deformity and is caused by velocity-related muscle length changes, so a lateral wedge may affect spasticity by manipulating foot and ankle kinematics which, in turn, may alter the length of these muscles. We sought to test this theory in healthy participants. Eight volunteers walked with no wedge and with lateral wedges of 5 and 8.5 degrees in both shoes. Qualysis motion capture system collected kinematic data and SIMM musculoskeletal modeling software calculated muscle tendon length of plantarflexor and peroneal muscle groups using 3-D ankle and knee joint angle data. The wedges increased ankle eversion (p < 0.0001) and total excursion of tibialis posterior, peroneus longus and brevis by 13-29% (p < 0.05). Muscle length of peroneus longus and brevis increased by <1% (p < 0.005). Potentially clinical meaningful effects were found for tibialis posterior (15%), peroneus brevis (23%) and peroneus tertius (13%). Further research is required to be conclusive and to explore the effects of lateral wedge orthoses in patients with stroke. If such changes are seen in people with stroke, a change in orthotic prescription practice could be indicated as lateral wedge orthoses may exacerbate spasticity.