What are the Effects of Ankle-Foot Orthoses on Walking in Adults with Calf Muscle Weakness Due to Neuromuscular Disorders? - A Cochrane Review Summary with Commentary

Abstract

Background

Calf muscle weakness due to neuromuscular disorders significantly impairs walking efficiency, increases energy expenditure, and limits mobility. Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait biomechanics and functional mobility, but their effectiveness remains uncertain.

Objective

To assess the effects of AFOs on walking performance in adults with calf muscle weakness caused by slowly progressive neuromuscular disorders.

Methods

A summary of the Cochrane Review by van Duijnhoven et al., with commentary from a rehabilitation perspective.

Results

The Cochrane review included 10 studies with 186 participants. Low-certainty evidence suggests that carbon AFOs may reduce walking energy cost, increase walking speed, and enhance user satisfaction. Leather AFOs may also contribute to improved walking speed. Polypropylene and elastic AFOs appear to provide minimal to no benefit. The effects of AFOs on perceived walking effort, balance, and long-term use remain inconclusive due to very low-certainty evidence. Although adverse events were predominantly mild, conclusions regarding safety remain limited, as most studies were conducted in laboratory settings without incorporating real-life use of AFOs.

Conclusions

The evidence supporting AFO use in adults with calf muscle weakness remains of low to very low certainty. Future research should focus on individualized AFO prescription, long-term outcomes, and safety monitoring. Additionally, further investigation is needed to clarify the impact of AFO material properties on walking, mobility, and quality of life in individuals with neuromuscular disorders.