April 2021

Dynamic AFO Reduces Pain, Improves Function

  • Conservative treatments should be considered before pharmaceuticals and surgery.
  • A new brace treatment was used in populations symptomatic with foot and ankle pain.
  • The bracing treatment offloaded underfoot forces during level and stair walking.
  • Pain and function scores were largely improved in most patients with brace wear.

Over 2 million Americans visit the doctor each year for foot and ankle pain stemming from a degenerative condition or injury. Ankle-foot orthoses can effectively manage symptoms, but traditional designs have limitations. This study investigated the acute impact of a novel “dynamic ankle-foot orthosis” (“orthosis”) in populations with mechanical pain (from motion or weight-bearing).

Methodology: With and without the brace, 25 participants performed standing, over-ground level walking, treadmill level walking, stair ascent, stair descent, single leg hold, squat, and sitting. Instrumented insoles captured in-shoe vertical forces and a visual analog scale was used to assess pain levels during each activity. Subsequently, the self-perceived impact of the orthosis on the patient’s symptoms and function was ranked on a scale from −10 (most worsened) to +10 (most improved).

Findings: Peak in-shoe force was reduced during level and stair walking (P < 0.05). Average perceived pain was 1.2 to 1.6 points lower in the orthosis than the unbraced control for the active tasks. The majority of participants (n = 19) reported that the brace improved their symptoms, while a smaller group (n = 5) reported that the brace did not affect their symptoms, although average function scores were improved for both groups (+2.4 to +4.5). The group of individuals with improved symptoms included cases of osteoarthritis, tendon dysfunction, chronic pain, sprains, and nerve disorders.

Takeaway: The orthosis effectively improved pain symptoms and improved the ability of impaired individuals to complete functional activities of daily living such as level walking and stair walking.

Source: Chung CL, Paquette MR, DiAngelo DJ. Impact of a dynamic ankle orthosis on acute pain and function in patients with mechanical foot and ankle pain. Clin Biomech. 2021;83:10528. https://doi.org/10.1016/j.clinbiomech.2021.105281. Used with permission.

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