Keys To Prescribing AFOs For Senior Patients

Start Page: 58
68
Author(s): 
Jonathan Moore, DPM, MS

References
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2. Sudarsky L. Gait disorders: prevalence, morbidity, and etiology. Adv Neurol. 2001;87:111-117.
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4. Alexander NB. Differential diagnosis of gait disorders in older adults. Clin Geriatr Med. 1996;12(4):689-703.
5. Menz HB, Morris ME, Lord SR. Foot and ankle characteristics associated with impaired balance and functional ability in older people. J Gerontol A Biol Sci Med Sci. 2005;60(12):1546-1552.
6. Wilson RS, Schneider JA, Beckett LA, et al. Progression of gait disorder and rigidity and risk of death in older persons. Neurology. 2002;58:1815–1819.
7. Personal communication with Josh White, DPM, CPed.
8. Verghese J, LeValley A, Hall CB, et al. Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc. 2006;54(2): 255–261.
9. Menz HB, Lord SR. The contribution of foot problems to mobility impairment and falls in community-dwelling older people. J Am Geriatr Soc. 2001;49(12):1651–1656.
10. Williamson J, Stokoe I, Gray S. Old people at home: Their unreported needs. Lancet. 1964;1(7343):1117–1120.
11. Munro BJ, Steele JR. Foot-care awareness: A survey of persons aged 65 years and over. J Am Podiatr Med Assoc. 1998;88(5):242–248.
12.  Kitaoka HB, Crevoisier XM, Harbst K, et al. The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces. Phys Med Rehabil. 2006;87(1):130-5.
13. Huang YC, Harbst K, Kotajarvi B, et al. Effects of ankle-foot orthoses on ankle and foot kinematics in patient with ankle osteoarthritis. Arch Phys Med Rehabil. 2006;87(5):710-6.
14. Ramstrand N, Ramstrand S. AAOP state-of-the-science evidence report: the effect of ankle-foot orthoses on balance — a systematic review. J Prosthet Orthot. 2010;22:P4–P23.
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Doug Richie D.P.M. FACFASsays: August 2, 2012 at 11:33 am

In his zeal to promote his "Falls Prevention Brace," Dr. Moore cites literature which has no relevance to the patient population targeted in his article. The only studies that demonstrate improved balance with AFO devices were performed on patients with cerebral palsy and hemiplegia after stroke. This was clearly stipulated in the review article published by Ramstrand et al, which Dr. Moore cites.1

Furthermore, this excellent systematic review by Ramstrand et al also concluded that there is no evidence that any design of AFO can improve proprioception. The only devices thus far that have demonstrated improved proprioception are Air Cast(R) stirrup ankle braces, and these studies were performed on younger athletes with and without chronic ankle instability.

This begs the question: Can Dr. Moore provide any evidence that his device or any AFO device has demonstrated improved proprioception, balance and reduced falls in elderly patients who do not have hemiplegia or cerebral palsy?

Ramstrand N, Ramstrand S. AAOP state-of-the-science evidence report: the effect of ankle-foot orthoses on balance — a systematic review. J Prosthet Orthot. 2010;22:P4–P23.

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Doug Richie DPM FACFASsays: August 6, 2012 at 11:35 am

It is important for the readers of this article to be aware of the misrepresentation of the facts of the scientific articles quoted by Dr. Moore. For example, Dr. Moore states, "In a 2006 article, Huang and colleagues reported that a solid gauntlet style AFO is the best option (over an articulated style) for those with ankle osteoarthritis arising from ankle motion.13" Yet Huang et al., did not study any type of gauntlet braces and the device which was recommended was only a simple shell brace, not a rigid gauntlet style AFO. This simple shell brace recommended by Huang et al., barely covered any portion of the foot — only the calcaneus — and was secured on the leg by a simple velcro strap.

Moore cites the study by Rao et al., to substantiate his claim that flexible AFOs improve balance and proprioception yet scrutiny of this study reveals that the single patient wore bilateral SOLID AFO devices, which are the very devices that Moore condemns for use in patients at risk for falls.

Authors should strive to present published research in an accurate and unbiased manner. Since Dr. Moore did not disclose the nature of his relationship with Arizona AFO and Langer, readers may actually believe that leather gauntlet braces are superior to all other types of AFOs as suggested in this article. I would invite any reader to review the scientific articles cited in this piece and make their own conclusions about the presentation of facts versus promotion of specific products.

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