Original article
The Effect of Custom-Made Braces for the Ankle and Hindfoot on Ankle and Foot Kinematics and Ground Reaction Forces

https://doi.org/10.1016/j.apmr.2005.08.120Get rights and content

Abstract

Kitaoka HB, Crevoisier XM, Harbst K, Hansen D, Kotajarvi B, Kaufman K. The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces.

Objective

To assess the effects on gait of custom-made polypropylene orthoses: ankle-foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A).

Design

Experimental assessment.

Setting

Institutional practice, motion analysis laboratory.

Participants

Twenty asymptomatic normative subjects.

Interventions

Not applicable.

Main Outcome Measures

Three-dimensional kinematics, ground reaction force, and time-related factors in 4 conditions: shoe only, and shod with the AFO, HFO-R, and HFO-A.

Results

The AFO and HFO-R limited sagittal and coronal plane ankle-hindfoot motion. The HFO-A limited hindfoot coronal motion while allowing normal sagittal motion. At the midfoot, the AFO and HFO-A limited transverse motion, but the HFO-A also limited sagittal and coronal motion. Use of the HFO-R resulted in exaggerated midfoot sagittal and coronal motion. Braces that limited motion to a greater degree were associated with more atypical kinetic variables, indicative of less dynamic gait. The HFO-A resulted in ground reaction forces most similar to unbraced conditions.

Conclusions

Alteration in gait was affected by orthosis design. Orthoses with a rigid component crossing a joint restricted motion at that joint, but potentially compromised typical gait kinetic factors. For immobilizing the hindfoot, the HFO-A may be more comfortable and still provide more stability than the HFO-R or AFO.

Section snippets

Methods

Twenty normative subjects (10 men, 10 women) were evaluated. Mean age was 46 years (range, 27−65y) and body mass index averaged 25kg/m2 (range, 20−34kg/m2). Subjects who had previous ankle or foot pathologies, systemic rheumatic diseases, lower-extremity arthritis, joint replacement, or other disorders affecting gait were excluded.

Braces for the study were custom-made for each subject by practitioners certified in orthotic and prosthetic design. Each subject received and was tested while

Kinematics

In the sagittal plane (table 1), both the AFO and the HFO-R reduced maximal hindfoot plantarflexion and total hindfoot sagittal motion, compared with the unbraced shod and HFO-A conditions (P<.05) (fig 5). The AFO was associated with less hindfoot dorsiflexion than the HFO-A (P<.05). There were no differences between the HFO-A and the unbraced shod conditions, or between the AFO and the HFO-R conditions with respect to hindfoot maximal plantarflexion, maximal dorsiflexion, and total sagittal

Discussion

Few gait studies have focused on the effect of foot and ankle orthoses with respect to kinematic and kinetic measures. This study is important because it demonstrates that with recently developed foot-specific gait analysis techniques, it is possible to critically assess foot and ankle function while subjects are walking. To our knowledge, orthosis testing using foot specific methods, as opposed to whole body gait analysis, has not been previously reported. Our study complements information

Conclusions

The AFO and the HFO-R limited sagittal talocrural motion to a greater degree than did the HFO-A, which was forced to limit the midfoot motion. All braces limited coronal motion, with the AFO being the most restrictive of the 3. The HFO-A and the AFO limited transverse motion. However, braces that limited ROM most effectively were also associated with more atypical kinetic patterns, thereby signifying a more tentative, less dynamic gait. The HFO-A was most similar to the unbraced shod condition

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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