Published: 2019-11-25

Comparative study of anterior support ankle foot orthosis and posterior ankle foot orthosis in foot drop patients

Harleen Uppal, Gita Handa, U. Singh, Sanjay Wadhwa, S. L. Yadav


Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.

Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.

Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.

Conclusions: A-AFO is comparable to P-AFO in terms of energy efficiency, gait parameters and subjective preference, hence should also be prescribed.


Ankle foot orthosis, Energy consumption, Foot drop, Gait analysis, Metabolic equivalent, Orthotic devices

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Hesse S, Werner C, Matthias K, Stephen K, Berteanu M. Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke. 1999 Sep;30(9):1855-61.

Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C. Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clini Rehabil. 2003 Jun;17(4):368-72.

Tyson SF, Thornton HA. The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users’ opinions. Clin Rehabil. 2001 Feb;15(1):53-8.

Corcoran PJ. Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. Arch. Phys. Med. Rehabil. 1970;51:69-77.

Chen CL, Yeung KT, Wang CH, Chu HT, Yeh CY. Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. Archi Physical Med Rehabil. 1999 Dec 1;80(12):1587-92.

Lehmann JF, Esselman PC, Ko MJ, Smith JC, deLateur BJ, Dralle AJ. Plastic ankle-foot orthoses: evaluation of function. Archi Physical Med Rehabil. 1983 Sep;64(9):402-7.

Wang RY, Lin PY, Lee CC, Yang YR. Gait and balance performance improvements attributable to ankle–foot orthosis in subjects with hemiparesis. Am J Physical Med Rehabil. 2007 Jul 1;86(7):556-62.

Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients: standards for outcome assessment. Physical Ther. 1986 Oct 1;66(10):1530-9.

Park JH, Chun MH, Ahn JS, Yu JY, Kang SH. Comparison of gait analysis between anterior and posterior ankle foot orthosis in hemiplegic patients. Am J Physical Med Rehabil. 2009 Aug 1;88(8):630-4.

Chen CK, Hong WH, Chu NK, Lau YC, Lew HL, Tang SF. Effects of an anterior ankle–foot orthosis on postural stability in stroke patients with hemiplegia. Am J Physical Med Rehabil. 2008 Oct 1;87(10):815-20.

Wong AM, Tang FT, Wu SH, Chen CM. Clinical trial of a low-temperature plastic anterior ankle foot orthosis. Am J Physical Med Rehabil. 1992 Feb;71(1):41-3.

Chen CH, Yeung KT, Wu SH, Chiang PY. Effects of an anterior ankle-foot orthosis on hemiplegic gait. J Rehabil Med Assoc ROC. 1998;26:119-27.

Chang JJ, Su CY. A low temperature plastic anterior encased ankle foot orthosis: construction and preliminary clinical results. Kaohsiung J Medica Sci. 2000 Jan;16(1):47-52.

Pohl M, Mehrholz J. Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients. Clini Rehabil. 2006 Apr;20(4):324-30.

Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Physical Ther. 1997 Aug 1;77(8):812-9.

Duffy CM, Hill AE, Cosgrove AP, Carry IS, Graham HK. Energy consumption in children with spina bifida and cerebral palsy: a comparative study. Development Med Child Neurol. 1996 Mar;38(3):238-43.

Corry IS, Duffy CM, Cosgrave AP, Graham HK. Measurement of oxygen consumption in disabled children by the Cosmed K2 portable telemetry system. Development Med Child Neurol. 1996 Jul;38(7):585-93.

Hill KD, Goldie PA, Baker PA, Greenwood KM. Retest reliability of the temporal and distance characteristics of hemiplegic gait using a footswitch system. Archi Physical Med Rehabil. 1994 May;75(5):577-83.

Perry J. The mechanics of walking in hemiplegia. Clin Orthop Relat Res. 1969 Apr; 63:23-31.

Mojica JA, Nakamura R, Kobayashi T, Handa T, Morohashi I, Watanabe S. Effect of ankle-foot orthosis (AFO) on body sway and walking capacity of hemiparetic stroke patients. Tohoku J Experimental Med. 1988;156(4):395-401.

Dufek JS, Mercer JA, Kosta CS, Fish DJ. Metabolic Cost During Submaximal Walking with a Rigid Rotational-Control Ankle-Foot Orthosis: A Preliminary Investigation. JPO: J Prosthetics Orthotics. 1997 Oct 1;9(4):152-6.

Nielsen DH, Shurr DG, Golden JC, Meier K. Comparison of energy cost and gait efficiency during ambulation in below-knee amputees using different prosthetic feet - a preliminary report. JPO: J Prosthetics Orthotics. 1988 Oct 1;1(1):24-31.

Menotti F, Laudani L, Damiani A, Orlando P, Macaluso A. Comparison of walking energy cost between an anterior and a posterior ankle-foot orthosis in people with foot drop. J Rehabil Med. 2014 Sep 5;46(8):768-72.