Mechanical adaptations in walking using carbon fiber ankle foot orthoses for patients with peripheral artery disease.
Ryan L Mizner, Ashley A Mays, Ryan J Mays
PMID 36696821WHAT IT FOUND
Carbon fiber ankle foot orthoses immediately reduced ankle motion and push-off power during self-paced walking in PAD with calf claudication.
Walking speed and calf muscle recruitment did not change, and 12 weeks of practice did not alter these effects.
Key findings
01Walking with the carbon fiber AFO reduced peak ankle dorsiflexion by 4.3 degrees and plantar flexion at toe off by 6.3 degrees, and reduced peak ankle plantar flexor power by 1.07 W/kg.
02At 12 weeks, walking with the AFO reduced peak dorsiflexion by 3.4 degrees and plantar flexion at toe off by 5.1 degrees, and reduced peak ankle plantar flexor power by 0.942 W/kg.
03Self-selected gait speed and peak triceps surae recruitment did not significantly change with the AFO at either session, and there were no significant main effects for time or interactions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a secondary biomechanical analysis, not the main trial outcome, and it used only the AFO group, so it cannot determine whether AFOs alone caused trial benefits. Only 15 patients were enrolled and 3 dropped out before final testing, and the paper does not state the number analyzed. Gait testing was done after graded treadmill and 6-minute walk tests, so fatigue may have affected the results. Calf muscle signals were not normalized with maximal voluntary contraction testing, so the absolute magnitude of recruitment changes is unknown. AFO straps prevented using the same calf muscle in every patient, so muscle-specific responses may have been missed. Patients received walking advice and were left to gain familiarity with the AFO on their own, with no follow-up during the 12 weeks, so training or adherence effects are unclear. ABI severity and daily step counts were not examined, so predictors of response and real-world activity changes are unknown.
Declared interests
The authors reported no financial conflicts of interest. The paper is listed as NIH extramural research support.
The easy way to misread this
Do not conclude that AFOs alone improved walking capacity. Patients also received a 12-week walking program, and this paper analyzed only the AFO group, so the separate contribution of each cannot be separated.