Still Looking For Documentation That AFOs Effectively Prevent Falls

Doug Richie Jr. DPM FACFAS

I am finalizing an upcoming cover story for Podiatry Today’s September issue titled, “Fall Prevention In The Elderly: Can Podiatric Physicians Have An Impact?” After searching the electronic databases, PubMed, Medline, Proquest, CINAHL and Cochrane Controlled Trials, I was astounded to see that more than 5,000 articles have been published that are relevant to the subject of fall prevention.

Companies are now marketing ankle-foot orthoses (AFOs) to podiatric physicians as part of a multifaceted program designed to prevent falls in the elderly. I am interested to read any published research showing that the use of these devices in such a program would be beneficial. So far I can find no such studies.

I want to ensure that my article is timely and accurate. I am, therefore, asking anyone to help me by providing any insight into why webinars are teaching podiatric physicians to combine bilateral AFO devices with established protocols for prevention of traumatic falls in the elderly.

While a systematic review of the literature has validated several multifaceted programs designed to prevent falls in the elderly, none of these programs involved the use of ankle bracing for elderly patients.1,2 If protocols of balance and exercise training, home hazard assessment and vitamin D therapy have already proved efficacious, what is the rationale for adding a new and unproven modality that may actually compromise balance in frail elderly patients?

If I am overlooking something, please provide me with any evidence that podiatric physicians should continue prescribing plastic shell braces for their patients at risk of falling. Otherwise, I look forward to sharing my research and insights about how podiatric physicians can make a positive impact on fall prevention using scientifically valid interventions.

References

1. Costello E, Edelstein J. Update on falls prevention for community-dwelling older adults: Review of single and multifactorial intervention programs. J Rehab Res Dev. 2008; 45(8):1135-52.
2. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Sys Rev. 2009; 2:CD007146.

Comments

It just amazes me that many of the podiatrists who endorse the Moore Balance Brace are not comfortable coming forward. That is identifying themselves on an open forum and discussing why they feel it is both appropriate and ethical to suggest bilateral AFOs to prevent a fall before it happens.

I agree with Dr.Richie as I do most of the time. After 35 yrs or so of clinical practice, I would say that without EBM clinical studies, the best way to stabilize a geriatric ambulatory patient would be with a walker.

Respectfully,
Steve Levitz, DPM

I was doing some Internet searching for AFOs for my mother who has post-polio paralysis and an arthritic knee, and is not a good surgical candidate. There are a lot of products as you mentioned but mostly anectodal evidence. There is a brace called the Moore Ankle Brace that is marketed for better balancing. Maybe there is some research behind their development ...

In response to Dr. Hoffman, I am seeking the same research findings that support the notion that the brace he mentions can actually prevent falls in the elderly. While no research has been published in a peer reviewed journal specific to the Moore Ankle Brace, claims are being made about improvements of balance and prevention of falls which must be substantiated before doctors should begin prescribing them to patients at risk of falling.

The lack of any response to this blog from those who promote bilateral AFO bracing to prevent falls indicates to me that there really isn't any credible evidence to support the use of these devices for their advertised benefits. If there is any evidence, surely the companies marketing these braces would have responded by now.

I have to agree with Steve Levitz, DPM, above. The best way to stabilize a geriatric ambulatory patient at risk of falling would be with the use of a 4-prong walker. And even better than a 4-prong walker would be a rollator. A rollator consists of 4 wheels (of which the front 2 wheels swivel). This style rollator usually comes with a padded seat, a basket, and hand brakes. A rollator is very user-friendly and can be purchased for under $150. I too would very much love to see a peer-reviewed article on the use of bilateral Moore ankle braces.

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