Relative contribution of footwear to the efficacy of ankle-foot orthoses

Objective: To examine the relative effects of footwear and an ankle-foot orthosis (AFO) on hemiplegic gait. Design: A case series with three contrasting conditions: walking without footwear, with footwear alone, and with footwear and an AFO. Spatio-temporal parameters reflecting walking performance were analysed using an analysis of variance (ANOVA). Patients: Five patients with hemiplegia and reduced mobility following stroke. Setting: A specialist rehabilitation centre. Intervention: Wearing either footwear alone, or footwear with an AFO. Measures: Video recordings of gait were subjected to a kinematic analysis to determine spatio-temporal parameters. Results: Stride length was increased by an average of 5 cm when wearing footwear. An additional 5-cm increase was also observed when wearing an AFO. Swing velocity was also affected by the manipulation. Conclusions: The appropriate comparative baseline for assessing the efficacy of an AFO is subjects walking with existing footwear and not barefoot.