Ankle Foot Orthosis Intervention Improves the Ground Reaction Forces During Walking in Patients with Peripheral Artery Disease (Randomized Clinical Trial)

This study investigated the impact of walking with ankle-foot-orthoses (AFOs) and without AFOs (non-AFO) on ground reaction forces (GRFs) in patients with peripheral artery disease (PAD). Additionally, this study examined the effect of AFO intervention vs. no AFO intervention on GRFs while walking with and without AFOs. Fifty patients with PAD were randomly assigned to either a three-month intervention (AFO) or a control (standard-of-care) group. After three months, subjects crossed over to the alternate group and were evaluated after three additional months. GRF data (anterior-posterior, medial-lateral, and vertical) were collected during walking with and without AFOs at baseline, three, and six months. Peak discrete GRF points, braking and propulsion impulses were compared across conditions, groups, and time points using linear mixed models. The peak brake and propulsion GRF were significantly reduced while walking with AFOs versus non-AFO (p < 0.01). Compared to non-AFO, walking with AFOs significantly reduced lateral GRF magnitude (p = 0.03) and significantly increased medial GRF (p = 0.02). The first and second maximum (p < 0.01) vertical GRF were significantly increased with AFOs versus non-AFOs. Walking with AFOs helped patients with PAD achieve greater peak propulsion and vertical GRFs compared to non-AFO, with GRF values trending toward those previously reported in healthy individuals.