Ankle Foot Orthosis in SCI

Ankle-foot orthoses (AFOs) are widely prescribed to improve walking stability and manage foot drop in individuals with incomplete spinal cord injury (SCI), although relatively few studies have formally evaluated their effects. Available randomized trials examining the immediate impact of different AFO conditions report improvements in gait speed, step length, cadence, and walking endurance (6MWT). While these studies assessed short-term effects within a single session, clinical experience suggests that benefits are typically observed immediately, with potential for further gains through practice and adaptation. Overall, evidence supports the use of AFOs to enhance walking function in individuals with incomplete SCI who present with drop-foot.

Discussion

Because bracing devices are used widely by clinicians, and often seen as simple assistive devices for improving walking function or stability and limiting pain, there are very few studies actually researching the benefits.

Both studies we found (Kim et al. 2004; Arazpour et al. 2013) examined the immediate effects of an AFO after randomizing different brace conditions. Positive effects consisted of increased gait speed, step length, cadence and improved performance on the 6MWT. These are not typical experimental designs for an RCT, as all the conditions were assessed within one single session rather than allowing participants to adapt to different brace conditions over several weeks or sessions. However, it is generally recognized in the clinical field that effects from an AFO are attained immediately, although it is likely that practice over a few sessions may improve a person’s confidence, learning and function.

Conclusions

There is level 1 evidence (from 2 RCTs: Arazpour et al. 2013; Kim et al. 2004) that an AFO can enhance walking function in patients with incomplete SCI who have drop-foot.