The use of a silicone boot orthosis on the speed and effort in walking in patients with lower motor neuron lesions.
Wright, PA (1), Morant, S.(1), Watts R.(2), Swain ID.(1),
The 10th World Congress of the International Society for Prosthetics & Orthotics, 1st-6th July 2001
(1)Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wilts SP2 8BJ
(2) Dorset Orthopaedics, Headland Park Industrial Estate, Ringwood, Hants,
Dorset Orthopaedics designed a silicone boot orthosis to maintain dorsiflexion of the foot during the swing phase of gait. These orthoses are custom made for each subject by casting the foot and ankle in a position of slight dorsiflexion. The orthosis is put on like a sock and is held in place by velcro fastening over the Achilles tendon.
Twelve subjects with lower motor neuron lesions were fitted with the orthoses walking speed and Physiological Cost Index (PCI), the effort involved in walking, measured and analysed by Wilcoxon Signed Ranks test, both initially and after six months use. In addition all subjects completed a questionnaire.
Comparison with and without the orthosis at the initial assessment showed the boot increased walking speed by 10% (p<0.01) and reduced PCI by 2%. Comparison of walking speed and PCI at the six month assessment with the orthosis compared to the initial assessment without the orthosis showed an increase in speed of 20% (p<0.02) and a reduction in PCI of 32% (p=0.02).
The questionnaire showed that the majority of subjects found the boot comfortable and all found the boot useful; five all the time, four most of the time and three sometimes. Six patients commented that they could walk further. The boot also had advantages over existing orthoses in that it could be worn without shoes and would fit into normal footwear, and its inherent flexibility ensures that it can provide support and stability without restricting active movement.