Ground reaction and solid ankle–foot orthoses are equivalent for the correction of crouch gait in children with cerebral palsy

Abstract

Aim: To investigate any performance differences between the solid ankle–foot orthosis (SAFO) and ground reaction ankle–foot orthosis (GRAFO) designs for correcting crouch gait in children diagnosed with cerebral palsy (CP). Method: We retrospectively analyzed 147 individuals seen at our center who: (1) were diagnosed with diplegic CP, (2) walked with crouch gait, (3) had bilateral SAFO or GRAFO prescription, and (4) had three-dimensional gait analysis collected for both barefoot and orthosis walking conditions. Results: Overall, no performance gap was identified between the SAFO and GRAFO groups (p=0.828). A series of bootstrapped stepwise regression analyses indicated that ankle–foot orthosis (AFO) design was not predictive of crouch gait improvements. Improvements in crouch gait were instead shown to be predicted by AFO neutral angle and four patient factors: amount of dorsiflexion in stance, level of knee flexion contracture, age, and severity of crouch. Interpretation: Our results show that the SAFO and GRAFO designs are equally effective at correcting crouch gait for individuals diagnosed with CP. What this paper adds: No performance difference was detected between solid ankle–foot orthoses and ground reaction ankle–foot orthoses designs for crouch gait correction. Crouch gait improvement from ankle–foot orthoses (AFO) is influenced by AFO neutral angle. Other factors of influence include: dorsiflexion in stance, level of knee flexion contracture, age, and severity of crouch.