Related Experiment Video
Updated: Jun 11, 2026
Evaluating Postural Control and Lower-extremity Muscle Activation in Individuals with Chronic Ankle Instability
Published on: September 18, 2020
The Effect of Ankle-Foot Orthoses and Their Characteristics on Balance, and Postural Control in Children With
Zeinab Gasavi Nezhad1,2, Amir Reza Vafayi3, Mokhtar Arazpour2
1Student Research Committee University of Social Welfare and Rehabilitation Sciences Tehran Iran.
Background And Aims:
Cerebral palsy (CP) frequently compromises postural control and balance in children. Ankle-foot orthoses (AFOs) are routinely prescribed to improve stability, yet the influence of specific design parameters-stiffness, alignment, and individualized tuning-on balance outcomes remains inadequately characterized.
Methods:
Adhering to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251170932), this systematic review searched six databases (PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library) up to October 10, 2025. Two reviewers independently screened interventional and observational studies assessing AFO effects on balance or postural control in children with CP. Methodological quality was appraised using Joanna Briggs Institute tools, evidence certainty graded via GRADE, and findings synthesized qualitatively across AFO types, assessment methods, and outcome domains.
Results:
A total of 15 studies (n = 390) were included, predominantly involving ambulatory children with spastic diplegia (GMFCS I-III). Overall evidence certainty was very low for static and dynamic balance. Ground-reaction AFOs consistently enhanced static stability versus solid AFOs. Hinged AFOs yielded inconsistent dynamic balance effects. Individualized tuning of the AFO-footwear interface emerged as pivotal for optimizing postural control. Conversely, isolated stiffness modifications and prescribed wearing schedules showed variable or detrimental impacts.
Conclusion:
AFOs may improve balance in children with CP, but evidence is constrained by methodological heterogeneity and very low certainty. Optimal outcomes appear contingent upon individualized configuration-integrating biomechanical tuning, stiffness modulation, footwear compatibility, and context-sensitive wearing protocols. High-quality, parameter-specific trials are imperative to advance precision orthotic prescription and maximize functional stability.
