November 2012

Tibial bone health asymmetries persist in stroke survivors despite use of AFOs

In the moment: O&P

By Jordana Bieze Foster

DJO Global Bone Healing - CMFTibial bone mineral density in stroke survivors who use ankle foot orthoses (AFOs) remains significantly higher in the unaffected limb than the affected limb after more than a decade, according to research from the University of Oklahoma in Oklahoma City.

Investigators analyzed nine stroke survivors (mean, 13.5 years poststroke), all of whom were ambulatory and had been using AFOs for a mean of 6.5 years. Bone characteristics were assessed using peripheral quantitative computed tomography (at sites 4%, 38%, and 66% of the length of the tibia relative to the distal end) and dual-energy x-ray absorptiometry.

Values were significantly higher on the unaffected side for total hip and trochanter bone mineral content (BMC) and areal bone mineral density (BMD); total volumetric BMD (vBMD) and BMC; trabecular BMC, vBMD, and bone strength index (BSI) at the 4% site; cortical BMC, vBMD, and thickness at the 38% and 66% sites; and cortical area and bone strength at the 66% site. The findings were e-published on October 30 by the Archives of Physical Medicine & Rehabilitation.


Sherk KA, Sherk VD, Anderson MA, et al. Differences in tibia morphology between the sound and unaffected sides in ankle foot orthosis using survivors of stroke. Arch Phys Med Rehabil 2012 Oct 30 [Epub ahead of print.]

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