The Importance of Being Earnest about Shank and Thigh Kinematics Especially When Using Ankle-Foot Orthoses

  title={The Importance of Being Earnest about Shank and Thigh Kinematics Especially When Using Ankle-Foot Orthoses},
  author={Elaine Owen},
  journal={Prosthetics and Orthotics International},
  pages={254 - 269}
  • Elaine Owen
  • Published 1 September 2010
  • Engineering
  • Prosthetics and Orthotics International
This paper reviews and summarizes the evidence for important observations of normal and pathological gait and presents an approach to rehabilitation and orthotic management, which is based on the significance of shank and thigh kinematics for standing and gait. It discusses normal gait biomechanics, challenging some traditional beliefs, the interrelationship between segment kinematics, joint kinematics and kinetics and their relationship to orthotic design, alignment and tuning. It proposes a… 
The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses.
Techniques to measure rigidity of ankle-foot orthosis: a review.
This review summarizes and classifies the current state of knowledge of AFO rigidity testing methods, and analyzed the strengths and weaknesses of the methods in order to recommend the most reliable techniques to measure AFO rigsidity.
Shank-to-Vertical Angle in Ankle-Foot Orthoses: A Comparison of Static and Dynamic Assessment in a Series of Cases
Measuring the SVA of the AFO-FC in relaxed stance is an accurate way of determining the Sva at temporal mid-stance (TMST), and seems to be the same as the measurement of the S VA in TMST.
How does a systematic tuning protocol for ankle foot orthosis-footwear combinations affect gait in children in cerebral palsy?
The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.
Using musculoskeletal modeling to evaluate the effect of ankle foot orthosis tuning on musculotendon dynamics: a case study
Musculoskeletal modeling demonstrated that the AFO-FC altered gastrocnemius operating length during post-stroke hemiplegic gait, which improved walking speed and non-paretic kinematics compared to the PLS AFO and shoes alone.
An Advanced Ground Reaction Design Ankle-Foot Orthosis to Improve Gait and Balance in Individuals With Post-Stroke Hemiparesis: A Case Series
The results of this case series suggest that this orthosis design should be considered for patients with residual hemiparesis after stroke, and further research is warranted to compare the A-GRAFO against more traditional designs.
The effects of biomechanically optimised ankle-foot orthoses-footwear combinations on the gait of children with cerebral palsy
It was concluded that biomechanically optimised AFO-FCs have the potential to improve the kinematics and kinetics of gait, energy expenditure, speed and distance covered for children with CP, and that tuning the AFO -FC should be mandatory.
Effect of Shoes on Stiffness and Energy Efficiency of Ankle-Foot Orthosis: Bench Testing Analysis.
From the results, it is recommended that shoes used with AFOs should be carefully selected not only based on their effect on alignment of the lower limb, but also their effects on overall mechanical properties of the AFO-Shoe combination.
The immediate effects of fitting and tuning solid ankle–foot orthoses in early stroke rehabilitation
In a small group of early stroke patients who were fitted with a solid ankle–foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only.


Dynamic bracing: elastics for patients with cerebral palsy, muscular dystrophy and myelodysplasia.
  • R. M. Nuzzo
  • Medicine
    Clinical orthopaedics and related research
  • 1980
A small number of children with cerebral palsy, spina bifida, and muscular dystrophy were treated with below-knee orthoses (BKO) along with elastic bracing of the remainder of the limb to augment muscle power in weakness, oppose spastic muscles, supply antagonism to unopposed muscle, and improve function.
The role of the ankle plantar flexors in normal walking.
Assessment of the significant gait variables affected by weakness of the triceps surae indicates that the disturbance of walking is profound, despite all appearances to the contrary.
Effect of a rigid ankle-foot orthosis on hamstring length in children with hemiplegia.
All participants showed an increase in maximum hamstring length when wearing an AFO, suggesting that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology.
High-performance activity with below-knee cast treatment, part I: mechanics and demonstration.
Gait mechanics is reviewed to illustrate similarities when comparing function levels achieved by cast treatment with those achieved by orthotic or prosthetic management.
Below-knee orthosis: a wrap-around design for ankle-foot control.
A new design for a custom molded plastic ankle-foot orthosis has proven superior to other designs in most applications and another advantage appears to be reflex inhibition of abnormal motor tone in may spastic patients.
Motor patterns for human gait: backward versus forward locomotion.
It is argued that conservation of kinematic templates across gait reversal at the expense of a complete reorganization of muscle synergies does not arise from biomechanical constraints but may reflect a behavioral goal achieved by the central networks involved in the control of locomotion.
The effect of four to six months use of ankle‐foot orthoses and balance training was determined for six children with cerebral palsy, and all children showed a decrease in the magnitude of the knee‐extending moment arm toward normal when barefoot.
Ankle‐Foot Orthosis Function in Low‐Level Myelomeningocele
Kinetic gait analysis permits understanding of the biomechanical effects of orthoses and small changes in the foot-shank angle of the orthosis had profound effects on knee mechanics.