Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions.
Benjamin C Conner, Nushka M Remec, Cassidy M Michaels and 3 others
PMID 34736095WHAT IT FOUND
Ankle strength, range of motion, and co-contraction are all significantly related to walking ability in children with CP.
AFOs improve speed and metabolic cost while worn but do not train the ankle. BTX-A shows inconsistent effects on walking.
Key findings
01Ankle strength, range of motion, co-contraction, and muscle architecture were all significantly related to walking ability in children with CP across multiple observational studies.
02AFOs consistently improved self-selected walking speed (all but one study) and metabolic cost (eight studies), but their effects are limited to when the device is worn. They function as a mobility device, not a training device.
03BTX-A injections to the calves did not produce a consistent effect on walking ability, with a nearly even split between studies showing improvement and those showing no change.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
74% of the interventional studies were Level 4 evidence, and no statistical pooling was performed, so the review cannot quantify overall effect sizes. Only 2 of 55 intervention studies (3.6%) measured physical activity levels, leaving the effect of ankle interventions on daily activity largely unknown. All AFO studies were cross-sectional (with vs. without the brace), and no study measured long-term effects of AFO use on ankle function. Surgical studies were limited to independent ankle-joint procedures, excluding the multilevel surgery that many children with CP actually receive. Many observational studies had small samples (n = 6 to 10) spanning GMFCS levels I to V, making it hard to generalise findings. No formal publication bias assessment was conducted beyond the CASP checklists.
Declared interests
The authors declare no competing interests.
The easy way to misread this
Do not read the consistent AFO speed improvements as evidence that AFOs train the ankle. Every AFO study compared walking with and without the brace, and no study measured long-term effects. The device helps while it is on and does not build function. If your goal is device-free ankle strength, the AFO evidence does not support that claim.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →