LONG-TERM BENEFIT OF CUSTOM-MADE ANKLE-FOOT ORTHOSES (AFO) TO IMPROVE GAIT AND BALANCE IN OLDER ADULTS

Abstract

Objective: It is well established that ankle-foot-orthoses (AFO) is an effective footwear intervention to stabilize ankle joint, which in turn could improve balance and self-confidence during walking in older adults. However, its long term benefit, daily use acceptability, and mechanism of action are still debated. Methods: Ambulatory older adults (n=44, age=74.7 ± 6.4, BMI: 28.5 ± 5.6, 70% female, 64% history of fall) were randomly assigned (ratio=1:1) to AFO intervention + New-Balance shoes (AFO-G: Moor-Balance Brace with custom-made footplate) or New-Balance shoes alone (Shoe-G). Both groups were asked to wear the received footwear daily, for one year. Gait and balance were measured using validated devices at baseline, 6-month follow-up, and conclusion of the program. Results: Improvement in gait was significant at 6-month follow-up in the AFO-G with the largest effect size observed for stride velocity (16%, Cohens’ d=0.51, p=0.016). Small but none-significant improvement in gait was observed for the Shoe-G. Among balance parameters, large effect sizes were observed for both ankle-stability and center-of-mass (COM) sway in the AFO-G (d=1.08–1.24, p 0.050). The daily average of wearing the received footwear was 6.2 hours and 4.8 hours, for AFO-G and Shoe-G, respectively. Conclusion: This study confirmed that daily use of AFO is practical and effective to improve gait and balance. This could be explained by ankle stability and enhanced proprioception feedback provided by AFO. This in turn may lead to improve self-confidence during walking and thus improving gait speed over time.