Do static or dynamic AFOs improve balance?

Objective: To verify if partial or total limitation of degrees of freedom at ankle joints could help patients with balance disorders in standing and walking. Design: A cross-over design was chosen. Patients with multiple sclerosis (MS) were tested in three experimental conditions: barefooted, wearing ankle foot orthoses (AFOs), and wearing AFOs that allowed plantar flexion. Setting: Neurorehabilitation unit in a rehabilitation centre. Subjects: Fourteen patients suffering from MS with mild strength problems and balance disorders that required them to use walking aids outside. Main outcome measures: Tests inferring static and dynamic skills were carried out in the three experimental conditions described above. Results: Improvements were obtained in static balance tests especially wearing dynamic AFOs; the number of patients who were able to pass tasks on balance in upright position such as 'standing with feet together, head extended' increased from three to nine. Dynamic balance was impaired especially with static AFOs; the time spent walking 10 metres with these orthoses increased by 172% with respect to barefoot; less difference (113%) has been reported wearing dynamic AFOs. Conclusion: Static and dynamic AFOs improved static balance, while dynamic balance was impaired especially by static AFOs; less negative influence on dynamic balance has been found while wearing dynamic AFOs.