The effects of ankle-foot orthoses on the gait of people with multiple sclerosis: a systematic review and meta-analysis

Abstract

PURPOSE: To systematically review and quantify the effects of ankle-foot orthoses (AFOs) on gait in people with multiple sclerosis (PwMS). MATERIALS AND METHODS: PubMed, Scopus, and Web of Science were searched to 27 September 2025. Randomized controlled, crossover, and before-and-after clinical trials assessing AFOs on gait in PwMS were included. Outcomes comprised temporospatial, kinematic, kinetic, functional mobility, energy cost, fatigue, and balance measures. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analyses were performed where feasible; other outcomes were synthesized narratively. RESULTS: Sixteen studies (n = 261) were included. Meta-analysis found no significant effects on walking speed, cadence, stride length, or 6-min walk distance. However, ankle range of motion increased significantly (MD = 12.69 degrees ; 95 CI: 2.86 to 22.52; p < 0.001). Subgroup analysis suggested dynamic AFOs could improve 6-min walk distance compared to static AFOs (MD = 45.82 m; 95 CI: 26.93 to 64.71), while comparisons with functional electrical stimulation showed no differences. CONCLUSIONS: AFOs improve specific biomechanical deficits (e.g. ankle motion) in PwMS, and dynamic designs may enhance endurance. Effects on core gait parameters are inconsistent, and the evidence is limited and heterogeneous. Clinical prescriptions should be individualized, and larger, high-quality trials are needed to inform guidelines. Ankle-foot orthoses (AFOs) can improve ankle kinematics, but evidence for consistent gains in walking speed or endurance is limited.Preliminary evidence from a limited number of studies suggests dynamic AFOs could improve walking endurance (6-min walk distance) more than static designs.A one-size-fits-all approach is ineffective; selection should be guided by a detailed assessment of gait patterns and personal goals.Future clinical trials need adequate power, longer follow-up, standardized outcomes, safety monitoring, and user stratification.