SLR - February 2010 - Gina M. DiPerna
Reference:
Rogozinski, B., Davids, J.R., Davis III, R.B., Jameson, G.G., Blackhurst, D.W. (2009). The Efficacy of the Floor-Reaction Ankle-Foot Orthosis in Children with Cerebral Palsy. The Journal of Bone and Joint Surgery, 91-A, 2440-2447.
Scientific Literature Reviews
Reviewed by: Gina M. DiPerna, DPM
Residency Program: Englewood Hospital and Medical Center
Podiatric Relevance:
Cerebral palsy is a common disorder frequently seen in the podiatric clinical setting. This article discusses how to effectively manage this neurological disease and its consequences on the gait pattern of patientsvia the use of floor-reaction ankle-foot orthosis.
Methods:
Using a retrospective study design following a consecutive case series, twenty- seven juvenile patients with cerebral palsy had quantitative gait analysis based upon specific kinematic design parameters, as well as time-distance parameters. Gait kinematic parameters included measurements of ranges of motion of the foot, ankle, and/or knee during stance or midstance, and time-distance parameters including speed, stride length and cadence. Each child had comprehensive gait analysis both barefooted and braced, and the outcome was defined according to the Gross Motor Function Classification System.
Results:
When compared to the barefoot results, children using floor-reaction ankle-foot orthoses showed significant improvements in sagittal ankle and knee kinematics, as well as stride length. The orthoses effectively restricted sagittal plane ankle motion during a portion of the phase of the gait cycle thereby resulting in improvements in knee extension and the sagittal plane knee extensor moment during stance.
Conclusions:
Floor-reaction ankle-foot orthoses are best suited for a population of cerebal palsy patients who exhibit excessive ankle dorsiflexion along with associated knee flexion during the stance phase of the gait cycle. Specific degrees of knee and hip flexion contractures are considered to be contraindications to the prescription of the orthosis, and must be addressed prior to the use of such a device.