Modified ankle–foot orthoses in neurological rehabilitation: a systematic scoping review and evidence map

Neurological disorders can impair ankle–foot control and contribute to foot drop, altered gait mechanics, reduced balance, increased walking effort, and limitations in functional mobility. Ankle–foot orthoses (AFOs) range from conventional mechanical devices to dynamic, carbon-fiber, 3D-printed/customized, smart/sensor-based, active-assistance, and hybrid AFO-functional electrical stimulation (FES) systems. What modified-AFO technologies have been investigated in neurological rehabilitation, and what clinical, biomechanical, patient-reported, safety, and implementation outcomes are represented in the available evidence? A systematic scoping review was conducted in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, Cochrane Library, and IEEE Xplore for peer-reviewed evidence published from January 2018 through April 2026. Eligible primary and review-level sources were charted by population, AFO technology, study design, comparator, outcome domain, and implementation characteristics and synthesized narratively. Primary and review-level evidence were analyzed separately to reduce double counting. No formal risk-of-bias or certainty-of-evidence assessment was performed. Forty-four eligible evidence sources were included: 29 primary/primary-like and 15 review-level sources. Evidence was concentrated in stroke (14/44), cerebral palsy (12/44), and multiple sclerosis (5/44). The most frequently represented outcomes were gait speed (29/44), ankle kinematics (26/44), and step length or symmetry (25/44), whereas quality of life or participation (8/44), safety or adverse-event reporting (7/44), and cost or accessibility (5/44) were less frequently represented. Conventional and articulated AFOs had the broadest clinical representation, while 3D-printed/customized, smart/sensor-based, and active-assistance technologies were represented by more heterogeneous and often short-term or technology-oriented evidence. The evidence-base spans passive mechanical control to digitally customized, sensor-integrated, and actively assisted systems, but its maturity varies substantially across technologies and neurological populations. Findings support individualized interpretation of AFO characteristics rather than a universal hierarchy of device effectiveness. Future research should prioritize comparative evaluation, standardized technical reporting, longer-term real-world follow-up, and consistent assessment of patient-centered outcomes, adherence, safety, cost, and accessibility.