The effects of ankle-foot: Orthoses on the ankle and knee in persons with myelomeningocele: An evaluation using three-dimensional gait analysis

The purpose of this study was to determine the effects of the ankle-foot or thosis (AFO) on gait patterns in patients with low-level myelomeningocele a nd to identify any abnormal gait patterns that may lead to future knee inst ability and pain. A total of 28 children (26 L4-level sides, 18 L5-level si des, and 10 S1-2-level sides) underwent a three-dimensional gait analysis w hen ambulating barefoot and with AFOs. Results show significant improvement s in sagittal plane function with reductions in excessive ankle dorsiflexio n, increases in peak plantar flexor moment, and reductions in crouch and kn ee extensor moment in the L4 and L5 groups. The only improvement in the S1- 2 group was a reduction in excessive dorsiflexion, but there was a reductio n in power generation at the ankle. The S1-2 group had normal transverse pl ane knee motion in stance during barefoot walking that increased significan tly (p < 0.01) with the AFO. Both the L5 and L4 groups showed greater than- normal transverse plane knee motion in stance during barefoot walking that also increased significantly (p < 0.01) with the AFO. The results suggest t hat excessive knee transverse plane rotation may contribute to knee instabi lity more than coronal plane abnormalities. The AFO in S1-2-level patients may be more detrimental for the knee than barefoot walking.