Page 53 - Maximizing the efficacy of ankle foot orthoses in children with cerebral palsy

The shank-to-vertical angle
ABC
1.
2.
1.
2.
SVA
α
1’.
2’.
h HH
Figure 3.1. A) Picture of the AFO-FC of the right leg without insole wedges. B) Schematic representation of the VICTOR[17], with virtual markers 12’ and 13’ as analogue reference points of the anatomical markers at the tibial tuberosity (Figure 2, #12) and tibia (Figure 2, #13). VICTOR was used to determine the height of the insole wedges to impose a SVA of 5°, 11° and 20° during the walking trials. Wedges were added to increase the height (h) of the heel probe until the inclination angle (α) reflected the pre-defined angles of 5°, 11° and 20°. C) Picture of the AFO-FC including insole wedges (pre-defined using VICTOR (h)), resulting in the heel height (HH). The SVA during walking was calculated as the angle between the line at the anterior surface of the tibia (dashed) (i.e. the line connecting the marker at the tibial tuberosity (#12) and tibia (#13)) and the vertical (dotted) in the global sagittal plane. The SVA was expected to represent α.
Dotted, the vertical as used for SVA calculation; dashed, line at the anterior surface of the tibia, representing the long axis of the shank in the global sagittal plane; solid, estimated position of the footplate in the shoe.
on a Rail (VICTOR)[17]) (see Figure 3.1B). Using VICTOR, low (size 39: 0.6 cm; size 43: 1.3 cm), medium (size 39: 2.8 cm; size 43: 2.8 cm) and high (size 39: 4.9 cm; size 43: 5.3 cm) heel heights were specified (see Figure 3.1). These heel heights were combined with two different degrees of footplate stiffness, which could be changed by adding a stiff inlay footplate (0.89 Nm·deg-1) to the AFO’s flexible footplate (0.06 Nm·deg-1). The provided shoes (i.e. flexible sneakers) were large enough to allow for the insole wedges.
53
III