The effects of orthotics on the sensori-motor problems of the foot and ankle after stroke

The foot and ankle forms the interface between the body and ground hence stroke related changes impact on mobility but there is little research has considered the foot and ankle post-stroke. This thesis bridges these knowledge gaps to enable clinical trials to be carried out.MethodsThe initial chapters (1-3) review the knowledge about stroke-related problems in the foot and ankle and their association with mobility limitations. The following chapters (4-5) evaluate interventions targeting motor and sensory foot and ankle problems with a systematic review and clinical trial. The final chapter draws overall conclusions integrating the motor and sensory components.ResultsThere is relatively little literature concerning the foot and ankle after stroke and that available focuses on activity without examining the underlying mechanisms. Pooledanalysis of data from 251 stroke patients showed that foot sensory problems are common (37%) and significantly contribute to balance (p<0.03), mobility (p<0.01) andindependence in ADLs (p<0.001) along with muscle weakness, time since stroke, neglect and age. In all models the independent variables explained about a half of the variance in mobility measures (p<0.001).To investigate the treatment of motor impairments, a systematic review of the effect of an ankle foot orthosis (AFO) on the biomechanics of walking was undertaken. Itshowed that an AFO improved dorsiflexion at initial contact (PO.00001) and weight transfer over the affected foot (PO.001).To investigate the treatment of sensory impairments, 29 stroke survivors participated in a randomised controlled crossover trial of supplementary sensory stimulation to the foot. This stimulation improved ankle strength (P<0.03) and sensation (P<0.025), and functional balance (P