Background
Children with spina bifida often present with functional deficits of the lower limb associated with neurosegmental lesion
levels and require orthotic management. The most used orthosis for children with spina bifida is the ankle–foot orthosis (AFO).
The AFO improves ambulation and reduces energy cost while walking. Despite the apparent benefits of using an AFO, limited
evidence documents the influence of factors predicting the ability of an AFO to improve function and when they are indicated.
These variables include AFO design, footwear, AFO–footwear combination, and data acquisition. When these variables are not
adequately considered in clinical decision-making, there is a risk the AFO will be abandoned prematurely or the patient’s
stability, function, and safety compromised.
Purpose
The purposes of this study are to (1) describe the functional deficits based on lesion levels; (2) identify and describe variables
that influence the ability of an AFO to control deformities; and (3) describe what variables are indicated for the AFO to
control knee flexion during stance, hyperpronation, and valgus stress at the knee.
Methods
A selective literature review was undertaken searching MEDLINE and Cochrane databases using terms related to “orthosis” and
“spina bifida.”
Results
Based on previous studies and gait analysis data, suggestions can be made regarding material selection/geometric configuration,
sagittal alignment, footplate length, and trim lines of an AFO for reducing knee flexion, hyperpronation, and valgus stress
at the knee.
Conclusion
Further research is required to determine what variables allow an AFO to improve function.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.