Validation of an helicoidal versus standard ankle-foot orthosis for patients with unilateral drop foot

Abstract

Patients with drop foot commonly use ankle-foot orthosis (AFO) as walking aid, but the impact on gait abilities of the orthosis design is still unclear. The aim was to compare gait abilities and satisfaction of patients with drop foot wearing a helicoidal AFO (hAFO) versus a standard AFO (sAFO) or no AFO (noAFO). Twenty patients (12 females, age ranging from 29.5 to 79.4 years),with unilateral drop foot in relation with peripheral neurological deficit and myopathy ( n = 14 and n = 6, respectively; duration of disease ranging from 4 to 558 months) were included in a randomized cross-over study. Gait abilities were assessed with the 6-minute walk test (6MWT) and the Timed Up and Go (TUG) test in 3 conditions (noAFO, sAFO and hAFO) using identical shoes. The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) assessed the satisfaction while wearing sAFO and hAFO. Data were described with median ± IQR. Friedman and Wilcoxon tests were used to compare 6MWT, TUG and QUEST between conditions. There was a positive effect of wearing an AFO on the 6MWT (Chi 2 = 30.6, P < 0.001): the improvement from the noAFO condition (336.5 ± 110.3 m) was 15% with sAFO (388.5 ± 137.0 m; P = 0.079) and 32% with hAFO (443.5 ± 91.0 m; P < 0.001), with a difference of 14% ( P < 0.001) between hAFO and sAFO. The TUG was also improved by wearing an AFO (Chi 2 = 22.4, P < 0.001): the improvement from the noAFO condition (10.75 ± 3.36 s) was 7% with sAFO (10.04 ± 3.43 s; P = 0.334) and 21% with hAFO (8.48 ± 2.89 s; P < 0.001), with a difference of 15% ( P = 0.002) between hAFO and sAFO. The QUEST scores (from 0 to 5) were higher for hAFO than sAFO for device (4.63 ± 0.97 vs 3.25 ± 1.04; P < 0.001) and service (5 ± 0.25 vs 4.63 ± 1.25, P = 0.037) subscales. The use of hAFO for drop foot improves gait abilities in comparison with sAFO or noAFO, with a higher patient satisfaction.