Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations

Background: In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier's recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. Methods: Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7 (R) (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. Results: In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 +/- 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (- 0.21 +/- 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 +/- 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 +/- 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness. Conclusions: In people with calf muscle weakness, current supplier's recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes.

Automated summary

The study showed that in individuals with calf muscle weakness, the current supplier recommendations for the stiffness level of the ankle-foot orthoses are often too stiff, achieving only 80% of the energy cost reduction compared to the experimentally optimized stiffness. It is recommended to experimentally optimize the stiffness to maximize treatment outcomes.