COMPARATIVE EFFECTIVENESS OF RIGID, HINGED, AND DYNAMIC ANKLE–FOOT ORTHOSES ON GAIT AND FUNCTIONAL OUTCOMES IN CHILDREN WITH CEREBRAL PALSY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Ankle–foot orthoses (AFOs) are widely prescribed to improve gait abnormalities and walking efficiency in children with cerebral palsy (CP). However, uncertainty remains regarding the comparative effectiveness of rigid (solid), hinged (articulated), and dynamic AFO designs.

Objective: To systematically evaluate and compare the effects of different AFO types on gait parameters and energy expenditure in children with cerebral palsy.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Electronic databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL) were searched from inception to the search date. Studies involving children (≤18 years) with CP using rigid, hinged, or dynamic AFOs and reporting quantitative gait or energy expenditure outcomes were included. Random-effects meta-analyses were performed using standardized mean differences (Hedges g) with 95% confidence intervals. Subgroup analyses were conducted by AFO type, and direct head-to-head comparisons were analyzed where available.

Results: AFO use significantly improved step length (SMD 0.68, 95% CI 0.42–0.94; p < 0.001) and walking velocity (SMD 0.34, 95% CI 0.10–0.58; p = 0.006) compared with barefoot walking. AFOs were also associated with a significant reduction in energy expenditure (SMD −0.72, 95% CI −1.05 to −0.39; p < 0.001). Subgroup analysis demonstrated that dynamic AFOs produced the greatest improvement in step length, whereas rigid and hinged AFOs yielded larger reductions in oxygen cost. Direct comparisons indicated a modest advantage of hinged over solid AFOs in gait performance, while dynamic AFOs showed superiority over solid designs. Heterogeneity was moderate, and no significant publication bias was detected.

Conclusions: AFOs significantly enhance gait performance and reduce metabolic cost in children with CP. Dynamic designs may optimize forward progression, whereas rigid and hinged AFOs may better improve walking efficiency. Orthotic prescription should be individualized based on therapeutic goals and biomechanical presentation. Further high-quality randomized trials are warranted to refine evidence-based orthotic guidelines.