Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis.

The purpose of the study was to investigate the effect of firm shoes and a particular type of a frequently prescribed ankle-foot orthosis in Germany, the Valens calliper, on functional gait parameters in hemiparetic patients with marked extensor spasticity and corresponding heel-strike problems. Cycle times, vertical ground reaction forces, trajectories of the centre of pressure (gait line) under the soles and the mode of initial contact were assessed in 19 hemiparetic patients walking barefoot, with firm shoes and the orthosis. With the shoes, significant improvements (p < 0.006) were observed for: walking velocity, stride length, initial double stance duration and gait line of the non-affected foot. The pattern of the vertical force diagram improved qualitatively in six patients. With the orthosis the following variables showed an even more marked improvement (p < 0.006): walking velocity, cadence, stride length, and gait line of both the affected and non-affected foot. Fourteen patients became rear-foot strikers and the vertical force pattern further improved in six patients. It is concluded that the ankle-foot orthosis (more than the shoes) provide a useful support in the early rehabilitation of hemiparetic patients with marked spasticity.