The effect of dynamic ankle-foot orthoses on gait biomechanics, function and quality-of-life in service members with partial lower extremity paralysis

Presuto, Melanie Marie
Journal Title
Journal ISSN
Volume Title
[Honolulu] : [University of Hawaii at Manoa], [May 2013]
Lower extremity injuries account for over half of combat casualties in Operation Iraqi Freedom and Operation Enduring Freedom, and often involve nerve damage resulting in partial lower extremity paralysis. Traditional ankle foot orthoses (TAFOs) used to manage lower limb peripheral neuropathy are reportedly insufficient for the physical demands of active service members including a return to running. Recently developed dynamic ankle-foot orthoses (DAFOs) have been successful in returning service members to vigorous activity and ultimately a return to active duty. This cases series measured anthropometric, walking and running gait biomechanics, and quality-of-life changes in six service members (age 29.3±7.2 years) diagnosed with drop foot while wearing a DAFO over a six-month period, and compared gait characteristics to an age and anthropometrically matched healthy service member control group. Walking spatial-temporal, kinetic, and kinematic gait parameters at the knee and hip improved to closely resemble normative levels. Walking velocity in the DAFO exceeded controls (DAFO: 1.96 vs. Controls: 1.86 m/s) while controlling dorsiflexion velocity (No brace: 200.74°/sec; DAFO: 69.77°/sec; Control: 116.16°/sec) to increase ankle stability. Improvements in running gait were apparent with DAFO use (one-third of subjects were unable to run without the DAFO), which provided better comfort, stability and energy return during push-off and translated to continual gait improvements over the six month study period. Increases in running velocity (No Brace: 3.18 m/s vs. DAFO: 3.61 m/s) and ground reaction force, reported increased confidence during limb loading, and observed reductions in proximal kinetic chain compensations including decreased forward trunk lean and increased knee flexion moments at loading response indicated improved running capability. These improvements translated to increases in strength in all lower extremity muscle groups measured via manual muscle testing, as well as a significantly improved ability to ascend stairs measured via the SF-36 quality-of-life questionnaire. The improvements in service member quality-of-life contributed to a 'very cost-effective' rating of the DAFO despite the increase in price over traditional models. Functional outcomes from this study may be used to improve the standard of care for service members with limb salvage and provide evidence-based outcomes for the optimal cost-benefit AFO.
Ph.D. University of Hawaii at Manoa 2013.
Includes bibliographical references.
Access Rights
Email if you need this content in ADA-compliant format.