Ankle-foot orthoses (AFO) are custom-made, supportive braces intended to control ankle position. They compensate for weakness and correct deformities. They are frequently used to improve walking after stroke, despite a lack of evidence regarding when to initiate the therapy. While many advocate an “earlier is better” mantra, clinical evidence has yet to substantiate this claim. Researchers from the Netherlands wanted to compare the use of an AFO immediately after stroke versus two months later.
Thirty-three patients with a stroke within the past 6 weeks were randomly assigned to an early or late group. The early group received an AFO in the first week of the study. The late group received an AFO after 8 weeks. Participants were provided with one of the three most commonly used ankle-foot orthoses: 1) flexible, 2) semi-rigid or 3) rigid. Before the orthosis, the researchers measured comfortable walking speed with a 10-meter walk test. Additionally, they performed other mobility and balance tests. The researchers repeated these measurements every other week until week 17. Final measurements took place after 26 weeks.
When is the best time to stabilize your ankle?
Both groups improved over time, with the early group showing better outcomes on the majority of functional tests through the first 11 to 13 weeks of the study. Interestingly enough, there were no differences between the two groups after 26 weeks! This outcome does not discount several advantages the early group displayed. First, they were able to walk without physical support up to 10 weeks earlier than the delayed group. They also had better balance with a decreased risk of falling and improved walking speed around the house 4 to 6 weeks earlier.
While the results were impressive, it is important to note the study included a limited number of subjects, which can limit the ability of researchers to detect differences between the two groups. In conclusion, while it appears better to start using ankle-foot braces as early as possible, a delay does not incur any long-term damage.
Lead author of the study was Dr. Nikamp from Roessingh Research and Development, Enschede, The Netherlands.