From the Research
Patients with muscular dystrophy should be prescribed Ankle-Foot Orthoses (AFOs) as the initial treatment, with the option to progress to Knee-Ankle-Foot Orthoses (KAFOs) as the disease advances, in order to prolong independent mobility and improve quality of life. The choice of orthosis depends on the stage of disease progression and the patient's functional needs. AFOs are typically used first to provide ankle stability, prevent foot drop, and maintain proper foot alignment, as seen in a study published in 2017 1. As the disease progresses to involve proximal muscles, KAFOs become necessary to provide additional knee support and prevent knee buckling during standing and walking.
Some key points to consider when prescribing orthoses for patients with muscular dystrophy include:
- The use of AFOs can prevent muscle contracture and prolong ambulation in patients with Duchenne muscular dystrophy (DMD) 2
- KAFOs can be used to slow the progression of scoliosis and pulmonary dysfunction in patients with DMD, especially when introduced early in the disease course 3
- Custom-molded plastic orthoses are generally preferred over metal designs due to their lightweight properties and better cosmetic appearance
- Orthoses should be regularly adjusted as the disease progresses, typically every 6-12 months for growing children or when functional changes occur
The primary goal of orthotic management in muscular dystrophy is to prolong independent mobility, prevent contractures, and maintain functional alignment, ultimately improving quality of life and independence. A study published in 2023 found that early introduction of a standing program using KAFOs can prolong the ambulation period and slow the progression of scoliosis and pulmonary dysfunction in patients with DMD 3. Another study published in 2011 reported a case where a combination of steroids and ischial weight-bearing KAFOs prolonged ambulation past 20 years of age in a patient with DMD 4. However, the most recent and highest quality study, published in 2023, supports the use of KAFOs in the management of muscular dystrophy 3.