Changes in Ankle-Foot Orthosis Effectiveness after Surgery in Cerebral Palsy: A Case Report

Introduction: Ankle-foot orthoses (AFOs) are frequently used to aid gait in children with cerebral palsy (CP), including before and after lower limb orthopedic surgery. Existing studies demonstrate the effectiveness of AFOs to improve gait in CP, considering the average effect in a group, including patients after surgery. However, there is no data examining changes in AFO effectiveness transitioning from the preoperative to postoperative period. Methods: This case report uses outcome measures (OMs) repeated at five assessment sessions from the preoperative period to the postoperative period with a total follow-up of 2 years and 5 months. OMs used were gait speed, Timed Up and Go (TUG) test, and the Edinburgh visual gait score (EVGS). The subject was a male aged 14–16 years with bilateral spastic CP and preoperative crouch gait associated with knee flexion contractures. Treatment included distal femoral extension osteotomies and AFOs. Results: Preoperatively, none of the OMs were improved with AFOs. Within the postoperative rehabilitation period, all OMs were improved with AFOs, exceeding minimal clinically important difference values. At final follow-up, TUG and EVGS remained improved with AFOs, exceeding minimal clinically important difference values. Conclusions: This case study demonstrates that AFOs can partially mitigate the negative short-term impacts of lower limb orthopedic surgery during rehabilitation, considering the 10-metre walk test and TUG as outcomes. Additionally, lower limb surgery addressing knee contractures enabled AFOs to be clinically significantly effective in some outcomes (10-metre walk test, TUG, and EVGS) in the short term, and in the TUG and EVGS in the longer term. Clinical relevance: AFO effectiveness may be improved by orthopedic surgery. Clinical gait assessment was a useful method of monitoring orthosis effects over time. ( J Prosthet Orthot. 2026;XX:XX–XX)