A review of the effect of a Walker ankle-foot orthosis on gait biomechanics in healthy individuals

Karol Lann Vel Lace; Michalina Błażkiewicz

doi:10.5114/areh.2021.104905

Figures & Tables

Flowchart demonstrating the selection of articles through the review process

Data extracted from reviewed articles for EMG

Study	Purpose of the study	Orthosis	Studygroup/age (years)	Results
Study	Purpose of the study	Orthosis	Test conditions/Equipment	Results
			12 healthy adults.	A significant decrease in muscle activity was found between the barefoot and boot conditions for: gastrocnemius, soleus and peroneals.
[17]	Determine if muscle activity reduction is similar using a fiberglass cast versus a prefabricated boot.	Three conditions: 1) Barefoot; 2) Fiberglass cast 3) High Walker	Subjects walked at their self-selected speed for 10 trials in each condition.	The comparison between barefoot and cast established a significant decrease in soleus and peroneal activity. The boot and cast comparison exhibited a significant decrease in the gas-trocnemius activity in the boot compared with the cast.
[17]			Force plate, EMG: left medial gastrocnemius, lateral soleus, and peroneal muscle.

[23]^{Kinem, Kinet, *}	Peak and integrated EMG in the medial gastrocnemius and soleus significantly decreased with the increasing number of wedges.

Data extracted from reviewed articles for kinematic parameters

Study	Purpose of the study	Orthosis	Studygroup/Age (years) Test conditions/Equipment	Results
[9]^Kinet	Examine characteristics of kinematic and kinetic parameters during walking in two different types of short-leg walking boots.	Sport shoe and Short Walker: 1) Gait Walker 2) Equalizer.	11 healthy adults: 27.4 ± 7.8.	1) Walking velocity: 1.24±0.18 m/s; 2) The ankle eversion ROM was smaller for the gait in Gait Walker compared to the normal walking; 3) The hip abduction ROM for the Gait Walker and Equalizer were significantly smaller than those for the shoes.
			Orthosis was worn on the right leg and the laboratory shoes on the left one. Conditions: 1) two laboratory shoes, 2) laboratory shoe and Gait Walker, 3) laboratory shoe and Equalizer.
			Motion capture system, force platform, photocells.

[19]^{Kinet, Energy}	Compare walking with fixed ankles against normal walking while controlling for added mass.	1) Pneumatic Walker 2) Ankle weights.	6 healthy adults: (22–40).	1) Walking speed: 1.25m/s; 2) The knee and hip joint angles were within the normal range.
			Oxygen consumption, gait kinematics and GRF during gait were measured in 3 conditions: 1) walking in street shoes, 2) walking with Walking boots, 3) normal gait with ankles free but weighted to match the mass of the walking boots.
			Motion capture system, force platforms.

[22]^Kinet	Explore the short-term effect of two designs of orthotic Walkers on hip and knee kinematics.	1) Walker A 2) Walker B 3) Sport shoe.	10 healthy adults: 37.1 ± 12.1.	Both walkers show significant kinematic differences compared with normal footwear. Walker A appears to produce the greatest deviation. The average walking speed for both Walkers was notably smaller than when walking in standard footwear.
			The Walker was always worn on the left lower limb. Conditions: 1) standardized footwear; 2) Walker A; 3) Walker B.
			Motion capture system, force platforms.

[8]	Compare the effects of different ankle supports used after ankle injury/surgery on temporo-spatial gait characteristics.	1) Tubigrip 2) Walker boot 3) Stirrup Ankle Brace	18 healthy adults: 42 ± 13.	Compared to Tubigrip, gait in the walker boot was slower by 0.19m/s, step length asymmetry was 10% worse, single support time asymmetry was 5% worse. Step width was 0.9 cm wider when walking in the stirrup brace and 4.1 cm wider in the walker boot.
			6 walks in total for each ankle support: 2 at slow walking speed, 2 at normal and 2 at fast walking speed.
			Electronic walkway.

[20]^Energy	Determine the immediate effects of ankle supports on gait characteristics (velocity and asymmetry) and pain during the initial period of unrestricted weight bearing 6 weeks after ankle internal fixation surgery.	1) Tubigrip 2) Short Walker boot 3) Stirrup Ankle Brace	18 adults, 6 weeks after fixation: 47 ± 14.	Single limb support time asymmetry was reduced 3% in the stirrup brace and 5% in the Walker boot compared with Tubigrip. Step width was 1.2cm wider in the Walker boot than in Tubigrip.
			Patients were wearing their normal footwear with the supports for the gait analysis.
			Electronic walkway.

[21]	Determine sagittal plane talocrural and subtalar kinematic differences between barefoot and CAM boot walking.	1) Short and tall CAM boot 2) Sport shoe.	14 healthy volunteers: 24.1 ± 3.5.	Tall CAM boot limited talocrural motion by 86.8% and subtalar motion by 37.0% compared to barefoot. Short CAM boot reduced talocrural motion by 52.1% and subtalar motion by 26.1% compared to barefoot.
			Conditions:barefoot, walking while wearing a short and tall CAM boot and sport shoe on the contra lateral foot.
			Motion capture system, force platforms, fluoroscopy images.

[24]^Kinet	Examine the bilateral spatial-temporal characteristics, kinematics, and kinetics during walking with and without an orthopedic walking boot.	1) Air Cast Walking Brace 2) Sport shoes.	40 healthy volunteers: 20.7 ± 1.8.	Walking velocity significantly decreased when wearing the boot.
			Conditions: 1) bilateral sport shoes; 2) boot on the right foot, tennis shoe on left foot; 3) boot on the right foot, bare left foot.	Significant increases in peak pelvic and thorax motions in all planes. At the hip and knee joints, there were significant differences in sagittal, frontal, and transverse plane movements in the long limb.
			Motion capture system, force platforms.

[23]^{Kinet, EMG}	To describe changes in muscle activity of the triceps surae and gait mechanics with the use of wedges in an orthopedic boot immediately and after an accommodation period.	Tall Walker with 0, 3 and 5 wedges.	12 healthy volunteers: 26 ± 11.	There were no statistically significant differences in gait speed with an increasing number of wedges.
			Walker and wedges were put on the right lower limb. Participants walked in boot with 0, 3, and 5 wedges tested in random order. They were provided a one hour accommodation period where time spent walking was collected.
			Motion capture system, force platforms, EMG.

Data extracted from reviewed articles for kinetic parameters

Study	Purpose of the study	Orthosis	Studygroup/age (years) Test conditions/Equipment	Results
[9]^{Kinem, *}	Neither walker increased the bimodal vertical GRF peaks typically observed in normal walking. Both walkers increased the demand on the knee extensors while they decreased the demand of the knee and hip abductors.

			10 healthy volunteers: 22.6 ± 1.68.
[25]	Examine how heel height differences in the walker and shoe side may influence GRFs when wearing a short walker.	Short Walkers: 1) Gait Walker 2) Equalizer 3) Sport shoe	Six conditions: lab shoes, gait walker, gait walker with heel insert on shoe side, gait walker with insert on walker side, equalizer walker, equalizer walker with heel insert on shoe side.	The application of a walker created peak vertical and AP GRF prior to the normal peaks associated with the loading response. Peak propulsive AP GRF were smaller in all walker conditions compared to shoe on walker side.
[25]		Short Walkers: 1) Gait Walker 2) Equalizer 3) Sport shoe	Force platforms, photocells.

[19]^{Kinem, Energy, *}	Compared to normal walking, ankle fixation can reduce ankle torque and work during the stance phase. Decreased ankle work in the ankles fixed condition was not compensated by greater work in other joints.

[22]^{Kinem, *}	Significant differences in peak knee extension torques were seen between all conditions with Walker A showing the highest knee extension torques followed by Walker B, and in the peak knee flexion torques between the two Walkers. Significant reductions in peak knee adduction torques were observed when walking with both Walkers compared with sport footwear. Hip extension moments showed significant differences between Walker A and both Walker B and sport footwear.

[24]^{Kinem, *}	Peak vertical GRF were significantly decreased on long limb. Peak AP GRF differed significantly across conditions and side. At the hip and knee joint, both limbs had significant differences in the all planes joint moments with the exception of the short limb frontal plane moment.

[23]^{Kinem, EMG, *}	Vertical GRF significantly decreased and peak knee extension power significantly increased with increasing number of wedges.

Data extraction from reviewed articles for energy expenditure, balance and pain assessment

Study	Purpose of the study	Orthosis	Study group/age (years) Test conditions/Equipment	Results
[19]^{Kinem, Kinet, *}	Gait in walking boots caused the total rate of energy expenditure for walking to increase significantly by 4.1% compared to normal shoes but differed by an insignificant amount (0.4%) compared to walking with equivalent ankle weight.

[26]	Determine if a walking boot increases body motion during balance tests across a range of simple to challenging conditions and if adding a heel lift to the non-involved limb would reduce body motion by correcting the leg length discrepancy.	Walking boot	12 healthy volunteers.	Walking boot significantly affected the balance in each test. When wearing the wedge, the test result in quiet stance was significantly better than when wearing the orthosis alone, but in the other tests, no differences were noticed.
			In each test, subjects were wearing sport shoes, a walking boot, or a walking boot and a heel lift in the contralateral shoe. Quiet stance test was performed during standing with both eyes open and closed, on rigid and soft surfaces.
			Functional reach test, perturbed and unperturbed walking test (90s) on a treadmill.

[20]^{Kinem, *}	Test conditions/equipment: VAS scale for pain assessment.
[20]^{Kinem, *}	The pain was significantly lower in the Walker boot and to a lesser extent in the stirrup brace compared with Tubigrip.

A review of the effect of a Walker ankle-foot orthosis on gait biomechanics in healthy individuals

Figures & Tables

Fig. 1.

Data extracted from reviewed articles for EMG

Data extracted from reviewed articles for kinematic parameters

Data extracted from reviewed articles for kinetic parameters

Data extraction from reviewed articles for energy expenditure, balance and pain assessment

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