The Indian Journal of Pediatrics

, Volume 84, Issue 3, pp 211–215 | Cite as

Ankle-Foot Orthosis in Duchenne Muscular Dystrophy: A 4 year Experience in a Multidisciplinary Neuromuscular Disorders Clinic

  • Anupam Gupta
  • Atchayaram Nalini
  • Shanti Prakash Arya
  • Seena Vengalil
  • Meeka Khanna
  • Rashmi Krishnan
  • Arun B. Taly
Original Article



To assess Ankle-Foot-Orthosis (AFO) requirement and ambulation in Duchenne Muscular Dystrophy (DMD) patients seen over a period of 4 y at a multi-disciplinary Neuromuscular disorders clinic (NMD).


A study was conducted in university quaternary research hospital with DMD patients confirmed by MLPA (multiplex ligation – dependent probe amplification) method and were evaluated between January 2012 and December 2015. Their ambulatory status, detailed neurological and functional status were recorded. Requirement of AFOs was determined and provided.


In total 126 DMD children reported to the NMD clinic. Mean age at presentation was 7.6 y (range 2 to12 y, SD 2.1). Mean duration of illness at first evaluation was 3.4 y (range 0.5 to 10 y, SD 2.0). AFO’s were advised at a mean age of 8.5 y (range 7 to 12 y, SD 1.8). Fifty-nine patients were advised AFO as resting or walking splint. At last follow-up 113 patients were still ambulatory whereas 13 had become wheel chair bound. Out of 59 patients, 48 were still wearing AFOs and the remaining discontinued AFOs for various reasons.


Children with DMD require wearing of AFOs as resting or walking splint, mostly in first or early second decade of life. As there is some gap between onset of clinical signs and requirement of orthosis, follow-up preferably at a multidisciplinary clinic at regular intervals is desirable for timely intervention in the form of AFOs or other splints to prolong ambulatory status in these patients.


Duchenne muscular dystrophy Ankle-foot-orthosis Locomotion 


  1. 1.
    LoMauro A, D’Angelo MG, Aliverti A. Assessment and management of respiratory function in patients with Duchenne muscular dystrophy: current and emerging options. Ther Clin Risk Manag. 2015;11:1475–88.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Bushby K, Finkel R, Birnkrant DJ, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial managementl. Lancet Neurol. 2010;9:77–93.CrossRefPubMedGoogle Scholar
  3. 3.
    Emery AE. Population frequencies of inherited neuromuscular diseases—a world survey. Neuromuscul Disord. 1991;1:19–29.CrossRefPubMedGoogle Scholar
  4. 4.
    Stark AE. Determinants of the incidence of Duchenne muscular dystrophy. Ann Transl Med. 2015;3:287.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Bushby KMD, Hill A, Steele JG. Failure of early diagnosis in symptomatic Duchenne muscular dystrophy. Lancet. 1999;353:557–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Hoffman EP, Brown RH Jr, Kunkel LM. Dystrophin: the protein product of the Duchenne muscular dystrophy locus. Cell. 1987;51:919–28.Google Scholar
  7. 7.
    Sansovic´ I, Bariˇsic´ I, Dumic K. Improved detection of deletions and duplications in the DMD gene using the multiplex ligation-dependent probe amplification (MLPA) method. Biochem Genet. 2013;51:189–201.CrossRefPubMedGoogle Scholar
  8. 8.
    Aartsma-Rus A, Ginjaar LB, Bushby K. The importance of genetic diagnosis for Duchenne muscular dystrophy. J Med Genet. 2016;53:145–51.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Falzaran MS, Scotton C, Passarelli C, Ferlini A. Duchenne muscular dystrophy: from diagnosis to therapys. Molecules. 2015;20:18168–84.CrossRefGoogle Scholar
  10. 10.
    Piko´ H, Vancso´ V, Nagy B, Ba′n Z, Herczegfalvi A, Karcagi V. Dystrophin gene analysis in Hungarian Duchenne/Becker muscular dystrophy families—detection of carrier status in symptomatic and asymptomatic female relatives. Neuromuscul Disord. 2009;19:108–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Schouten JP, McElgunn CJ, Waaijer R, Zwijnenburg D, Diepvens F, Pals G. Relative quantification of 40 nucleic acid sequences by multiplex ligation-dependent probe amplification. s.l. Nucleic Acids Res. 2002;30:e57.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schwartz M, Dunø M. Improved molecular diagnosis of dystrophin gene mutations using the multiplex ligation-dependent probe amplification method. Genet Test. 2004;8:361–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Dubowitz V. Deformities in Duchenne dystrophy. Neuromuscul Disord. 2010;20:282.CrossRefPubMedGoogle Scholar
  14. 14.
    Alemdaroğlu I, Gür G, Bek N, et al. Is there any relationship between orthotic usage and functional activities in children with neuromuscular disorders? Prosthet Orthot Int. 2014;38:27–33.Google Scholar
  15. 15.
    Townsend EL, Tamhane H, Gross KD. Effects of AFO use on walking in boys with Duchenne muscular dystrophy: a pilot study. Pediatr Phys Ther. 2015;27:24–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Heckmatt JZ, Dubowitz V, Hyde SA, Florence J, Gabain AC, Thompson N. Prolongation of walking in Duchenne muscular dystrophy with lightweight orthosis: review of 57 cases. Dev Med Child Neurol. 1985;27:149–54.CrossRefPubMedGoogle Scholar
  17. 17.
    Garraldaa ME, Muntonib F, Cunniffc A, Canejad AD. Knee–ankle–foot orthosis in children with duchenne muscular dystrophy: user views and adjustment. Eur J Pediatr Neurol. 2006;10:186–91.CrossRefGoogle Scholar
  18. 18.
    Bakker JPJ, de Groot IJM, Beckerman H, de Jong BA, Lankhorst GJ. The effects of knee–ankle–foot KAFOS in the treatment of Duchenne muscular dystrophy: review of the literature. Clin Rehabil. 2000;14:343–59.CrossRefPubMedGoogle Scholar
  19. 19.
    Manzur AY, Hyde SA, Rodillo E, Heckmatt JZ, Bentley G, Dubowitz V. A randomized controlled trial of early surgery in Duchenne muscular dystrophy. Neuromuscul Disord. 1992;2:379–87.CrossRefPubMedGoogle Scholar
  20. 20.
    Sackley C, Disler PB, Turner-Stokes L, Wade DT, Brittle N, Hoppitt T. Rehabilitation interventions for foot drop in neuromuscular disease. Cochrane Database Syst Rev. 2009;(3):CD003908.Google Scholar
  21. 21.
    Rose KJ, Burns J, Wheeler DM, North KN. Interventions for increasing ankle range ofmotion in patientswith neuromuscular disease. Cochrane Database Syst Rev. 2010;(2):CD006973.Google Scholar
  22. 22.
    Moxley RT 3rd, Pandya S, Ciafaloni E, Fox DJ, Campbell K. Change in natural history of Duchenne muscular dystrophy with long-term corticosteroid treatment: implications for management. J Child Neurol. 2010;25:1116–29.Google Scholar
  23. 23.
    Kempen JC, Harlaar J, van der Kooi AJ, et al. Reliability of the walking energy cost test and the six-minute walk test in boys with Duchenne muscular dystrophy. Neuromuscul Disord. 2014;24:216–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Vill K, Ille L, Schroeder SA, Blaschek A, Müller-Felber W. Six-minutes walk test versus 2-minutes walk test in children with Duchenne muscular dystrophy: is more time more information? Eur J Paediatr Neurol. 2015;19:640–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Bello L, Kesari A, Gordish-Dressman H, et al. Genetic modifiers of ambulation in the cooperative international neuromuscular research group Duchenne natural history study. Ann Neurol. 2015;77:684–96.Google Scholar
  26. 26.
    Mehta JA, Brown C, Sargeant N. Charcot restraint orthotic walker. Foot Ankle Int. 1998;19:619–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Hyde SA, FlŁytrup I, Glent S, et al. A randomized comparative study of two methods for controlling tendo Achilles contracture in Duchenne muscular dystrophy. Neuromuscul Disord. 2000;10:257–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Scott OM, Hyde SA, Goddard C, Dubowitz V. Prevention of deformity in Duchenne muscular dystrophy. A prospective study of passive stretching and splintage. Physiotherapy. 1981;67:177–80.PubMedGoogle Scholar
  29. 29.
    Roposch A, Scher DM, Mubarak S, Kotz R. Treatment of foot deformities in patients with Duchenne muscular dystrophy. [Article in German]. Z Orthop Ihre Grenzgeb. 2003;141:54–8.Google Scholar
  30. 30.
    Main M, Mercuri E, Haliloglu G, Baker R, Kinali M, Muntoni F. Serial casting of the ankles in Duchenne muscular dystrophy: can it be an alternative to surgery? Neuromuscul Disord. 2007;17:227–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Brouwer B, Davidson LK, Olney SJ. Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy. J Pediatr Orthop. 2000;20:221–5.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2016

Authors and Affiliations

  • Anupam Gupta
    • 1
  • Atchayaram Nalini
    • 2
  • Shanti Prakash Arya
    • 1
  • Seena Vengalil
    • 2
  • Meeka Khanna
    • 1
  • Rashmi Krishnan
    • 1
  • Arun B. Taly
    • 1
    • 2
  1. 1.Department of Neurological RehabilitationNational Institute of Mental Health & Neuro Sciences (NIMHANS)BengaluruIndia
  2. 2.Department of NeurologyNational Institute of Mental Health & Neuro Sciences (NIMHANS)BengaluruIndia

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