Background: Children with cerebral palsy who are able to walk are
often managed with an ankle-foot orthosis to assist with walking. Previous
studies have shown kinematic, kinetic, and energetic benefits during gait with
the addition of an ankle-foot orthosis, although the mechanism of this gait
improvement is unknown. The ability of orthoses to correct foot malalignment
in children with cerebral palsy is not known. The current study was performed
to determine the impact of orthoses on static foot alignment in children with
Methods: A retrospective radiographic review was performed for 160
feet (102 patients). All patients had a diagnosis of cerebral palsy. Standing
anteroposterior and lateral radiographs of the foot and ankle were made with
the patient barefoot and while wearing the prescribed orthosis and were
compared with use of the technique of quantitative segmental analysis of foot
and ankle alignment.
Results: Analysis of the foot and ankle radiographs made with the
patient barefoot and while wearing the brace revealed significant changes in
all measurements of segmental alignment (p < 0.05). The magnitudes of these
differences were small (<6° or <10%) and would be considered
clinically unimportant. The coupled malalignment of equinoplanovalgus
(clinical flatfoot) showed radiographic correction of at least one segment
(hindfoot, midfoot, or forefoot) to within the normal range in 24% to 44% of
the feet. The coupled malalignment of equinocavovarus (clinical high arched
foot) showed correction of at least one segment to within the normal range in
5% to 20% of feet.
Conclusions: The present study demonstrates that the use of the
ankle-foot orthoses failed to improve the static foot alignment in the
majority of feet in children with cerebral palsy who were able to walk.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.