The study
A systematic review and meta-analysis pooled 16 studies and 261 people with multiple sclerosis, looking at what ankle-foot orthoses actually change about their gait. The studies covered temporospatial measures, kinematics, energy cost, fatigue and balance, with meta-analysis where the data allowed and narrative synthesis everywhere else. One of the authors is based at the University of South Australia.
What they found
The headline outcomes most patients care about did not move. Across the pooled trials there was no significant effect on walking speed, cadence, stride length or six-minute walk distance.
What did move was ankle mechanics. Ankle range of motion improved significantly, by a mean of about 13 degrees. A subgroup signal suggested dynamic AFOs may add roughly 46 metres to six-minute walk distance compared with rigid static designs, and AFOs performed similarly to functional electrical stimulation where the two were compared. The authors flag the evidence as limited and heterogeneous.
What it means for your practice
Prescribe to a mechanical goal, not to the diagnosis. An AFO is well supported for the patient whose main problem is ankle control: a dropping foot, poor dorsiflexion clearance, an unstable stance phase. It is not well supported as a general “this will help you walk faster or further” device, and promising that sets up a disappointed patient and a device in the cupboard.
The dynamic versus static signal is worth using. If endurance over distance is the goal, a dynamic design has at least some evidence behind it over a rigid one, so it is a reasonable conversation to have at fitting rather than defaulting to the stiffest option.
Assess the gait first, fit on trial, and set the expectation out loud: we are targeting how your ankle behaves, and we will judge it on that, not on a stopwatch.
Bottom line
AFOs fix ankle mechanics in MS, not walking speed. Match the device to the deficit you actually measured.
Source
https://pubmed.ncbi.nlm.nih.gov/42080501/