The Efficacy of the Floor-Reaction Ankle-Foot Orthosis in Children with Cerebral Palsy

Rogozinski, Benjamin M.; Davids, Jon R.; Davis III, Roy B.; Jameson, Gene G.; Blackhurst, Dawn W.
October 2009
Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2440
Academic Journal
Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained from the physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle. Results: Twenty-seven children had quantitative gait analyses (barefoot and with the orthoses in the same visit). The mean sagittal plane dynamic range of motion of the ankle in stance was reduced from 23° ± 9° when walking barefoot to 10° ± 3° when the orthosis was worn (p < 0.001), and the mean peak knee extension in midstance improved from 29° ± 14° of flexion to 18° ± 14° of flexion (p = 0.013). Strong negative linear correlations were found between the magnitude of knee and hip flexion contractures on physical examination and the amount of peak knee extension in midstance (r = -0.784 and r = -0.705, respectively). A strong positive correlation was found between the mean minimum sagittal knee moment in midstance and the amount of peak knee extension in midstance (r = 0.820). Our investigation did not provide evidence of a correlation between peak knee extension in midstance and any of the following parameters in the orthosis: clinical examination measurements of the thigh-foot angle (r = 0.120), the popliteal angle (r = -0.300), or the mean foot progression angle in the stance phase of gait (r = -0.188). Conclusions: The floor-reaction ankle-foot orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. The best outcomes with this orthosis, as determined by peak knee extension in midstance, were seen in the subjects with knee and hip flexion contracture of ≤10°. Knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance. Such contractures should be considered as contraindications to the prescription of this orthosis or should be addressed (surgically or otherwise) prior to the application of a floor-reaction ankle-foot orthosis in these patients. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • The Hip-Knee-Ankle Angle in Children: Reference Values Based on a Full-Length Standing Radiograph. Sabharwal, Sanjeev; Zhao, Caixia // Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2461 

    Background: It is well recognized that the alignment of the lower limb changes during early childhood. The hip-knee-ankle angle is often referred to as the mechanical femoral-tibial angle and is measured on a full-length radiograph of the lower extremity. While several authors have independently...

  • Mechanical Axis Following Staple Epiphysiodesis for Limb-Length Inequality. Gorman, Troy M.; Vanderwerff, Ryan; Pond, Michael; MacWilliams, Bruce; Santora, Stephen D. // Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2430 

    Background: Staple epiphysiodesis is an option for the treatment of limb-length discrepancies, but it is not without complications. The purpose of this study was to review the outcomes of staple epiphysiodesis, including changes in the mechanical axis. Methods: The study included patients who...

  • Factors Influencing Intra-Articular Fluid Temperature Profiles with Radiofrequency Ablation. Zoric, Bojan B.; Horn, Nils; Braun, Sepp; Milett, Peter J. // Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2448 

    Background: Radiofrequency ablation devices are being used increasingly in arthroscopic surgery. However, there are concerns that excessive temperatures may damage the articular cartilage. The purpose of this study was to investigate the temperature profiles that occur within the glenohumeral...

  • SURGERY OF VERTEBRAL BODIES COMPRESSIVE FRACTURES ACCORDING TO RESULTS OF ALGORITHM OF OSTEOPOROSIS RADIAL DIAGNOSTICS. Tomilov, A. B.; Eidlina, E. M.; Kuznetsova, N. L. // Saratov Journal of Medical Scientific Research / Saratovskii Nau;Oct-Dec2011, Vol. 7 Issue 4, p930 

    The research goal is to optimize the algorithm of radial methods of investigation of early vertebral osteoporosis and vertebral compressive fractures in case of osteoporosis, as well as surgical tactics in vertebral compressive fractures, aggravated by osteoporosis. 220 postmenopausal women have...

  • Operative treatment of patellofemoral maltracking with torsional osteotomy. Dickschas, Jörg; Harrer, Jörg; Pfefferkorn, Ronny; Strecker, Wolf // Archives of Orthopaedic & Trauma Surgery;Mar2012, Vol. 132 Issue 3, p289 

    Introduction: A femoropatellar syndrome may be caused by a deformity in the torsional axis of the femur or the tibia. The two cardinal symptoms are anterior knee pain and patellar instability. Methods: We retrospectively evaluated 32 torsional osteotomies. The aim of the study was to prove that...

  • My INSPIRATION. Rabida, Laura // Exceptional Parent;Aug2003, Vol. 33 Issue 8, p92 

    Relates the author's experience in caring for a child with cerebral palsy and brachial plexus. Inspiration derived by the author in taking care of the child; Determination of the child to live life to the fullest.

  • WEB WATCH.  // O&P News;Jul2015, Vol. 24 Issue 8, p4 

    The article lists the top stories at OandPNews.com on May 11-June 15, 2015, including "New surgical technique could reduce incidence of Charcot foot," "Study: Females with cerebral palsy require more cautious hamstring lengthening," and "Researchers identify effective, cost-effective treatments...

  • What I Make of It. Smolka, Timothy // Exceptional Parent;Aug99, Vol. 29 Issue 8, p51 

    Recounts the story of a child with cerebral palsy. Interaction among peers; Education; Club activities. INSET: A Mother's Perspective, by Maryellen Smolka.

  • My Hero Evan. Feeney, Paige // Exceptional Parent;Jul2003, Vol. 33 Issue 7, p108 

    Describes the author's brother who have cerebral palsy (CP). Author's identification of the brother as a hero; Description of the people with CP; Braveness of the brother.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics