Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr, Chiemgau, Germany.
Prosthet Orthot Int. 2021 Dec 1;45(6):491-499. doi: 10.1097/PXR.0000000000000050.
Spastic drop-foot is a common problem in children with cerebral palsy that may lead to tripping and falling. To improve ankle dorsiflexion in swing phase, prefabricated carbon-composite ankle-foot orthoses are commonly prescribed; by increasing ankle stiffness, these orthoses may also improve knee extension in stance.
To compare the effect of a stiff vs. flexible prefabricated ankle-foot orthosis on sagittal plane ankle and knee kinematics and kinetics during walking.
Cross-sectional, repeated-measures, interventional study.
Twenty-seven children and adolescents with cerebral palsy who had drop-foot in swing were included. Gait analysis was conducted under four conditions: barefoot, shod, with a stiff, and with a flexible orthosis. Participants were divided into two groups including children and adolescents who have a flexed knee during stance (KF, N = 12) and without flexed knee during stance (KE, N = 15).
Ankle dorsiflexion in swing phase was significantly improved compared with the shod condition by 6.3 degrees (SD = 3.3 degrees) only in the KE group when using the flexible orthosis. For the stiff orthosis, knee extension in stance was significantly increased by 2.4 degrees (SD = 3.3 degrees) in the KE group compared with the shod condition. No significant improvements were observed for the KF group. Further analysis indicated that only seven patients in the KF group with weak ankle plantarflexors improved knee extension while using the stiff orthosis.
Our results suggested that in the KE group, the flexible orthosis was best suited for patients with drop-foot without a knee extension deficit. The stiff orthosis was not suitable in this group as it caused a hyperextended knee without improving dorsiflexion in swing phase. Therefore, stiffness should be considered when prefabricated orthoses are prescribed.
痉挛性马蹄足是脑瘫儿童常见的问题，可能导致绊倒和摔倒。为了改善摆动期的踝关节背屈，通常会开定制的碳纤维踝足矫形器；通过增加踝关节的刚度，这些矫形器也可以改善站立期的膝关节伸展。
比较刚性和柔性预制踝足矫形器对步行时矢状面踝关节和膝关节运动学及动力学的影响。
横断面、重复测量、干预研究。
共纳入 27 例有摆动期马蹄足的脑瘫儿童和青少年。在四种条件下进行步态分析：赤脚、穿鞋、穿刚性矫形器和穿柔性矫形器。参与者分为两组，一组在站立期膝关节弯曲（KF，N=12），另一组在站立期膝关节不弯曲（KE，N=15）。
仅在 KE 组中，与穿鞋条件相比，当使用柔性矫形器时，摆动期的踝关节背屈明显提高了 6.3 度（SD=3.3 度）。对于刚性矫形器，KE 组的站立期膝关节伸展比穿鞋条件增加了 2.4 度（SD=3.3 度）。在 KF 组中没有观察到显著的改善。进一步分析表明，只有 7 名 KF 组踝关节跖屈肌无力的患者在使用刚性矫形器时改善了膝关节伸展。
我们的结果表明，在 KE 组中，柔性矫形器最适合无膝关节伸展不足的马蹄足患者。刚性矫形器不适合该组患者，因为它会导致膝关节过度伸展，而不会改善摆动期的踝关节背屈。因此，在开具预制矫形器时应考虑刚度。
