Symmetry of body posture among children with hemiplegic cerebral palsy using ankle foot orthoses (AFO): a case-control study

Purpose: The aim of this study was to determine how solid ankle-foot orthoses (AFO) influence the symmetrization of free standing posture in children with hemiplegic cerebral palsy (CP).

Methods: In the analysis, we examined the body posture of children (n = 43, mean age of 7 years) who did not wear any orthopedic equipment on a daily basis (Group 1). We also studied those who used unilateral (Group 2) or bilateral AFOs (Group 3). The BTS SMART D-140 6 TVC optoelectronic system was implemented in the research.

Results: There were no significant differences between the study groups in terms of obliqueness, rotation or pelvic inclination in standing position, or in hip joint angle on the (un)affected sides with and without AFOs. However, differences could be observed in obliqueness and rotation after applying AFOs (0.1 > p > 0.05). In all study groups, knee flexion angle on the affected side was greater. After putting on the orthoses (Groups 2 and 3), knee joint flexion decreased. Analysis of measurements without orthoses showed significantly less dorsiflexion and greater external rotation of the ankle joint on the affected side ( p < 0.05). After putting on the orthoses (Groups 2 and 3), the differences in dorsiflexion noted in the ankle joints of both feet did not exceed 1°. In such conditions, the rotation in these joints also became equal.

Conclusions: The results of the study made it possible to indicate that the use of AFOs in children with hemiplegic CP demonstrates a beneficial effect on the joint to which they are directly applied. They also aid other joints of the lower limbs and pelvis. The use of bilateral AFOs provides greater positive changes in standing symmetry compared to unilateral AFO implementation.