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Passive-dynamic ankle-foot orthosis improves medium-term clinical outcomes after severe lower extremity trauma
  1. Peter Ladlow1,
  2. N Bennett1,2,
  3. R Phillip1,
  4. S Dharm-Datta1,
  5. L McMenemy3 and
  6. A N Bennett1,4
  1. 1 Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
  2. 2 Blatchford, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
  3. 3 Centre for Blast Injury Studies (CBIS), Imperial College London, London, UK
  4. 4 National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Peter Ladlow, Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey KT18 6JW, UK; peter.ladlow100{at}


Introduction Individuals with delayed below-knee amputation have previously reported superior clinical outcomes compared with lower limb reconstruction. The UK military have since introduced a passive-dynamic ankle-foot orthosis (PDAFO) into its rehabilitation care pathway to improve limb salvage outcomes. The aims were to determine if wearing a PDAFO improves medium-term clinical outcomes and what influence does multidisciplinary team (MDT) rehabilitation have after PDAFO fitting? Also, what longitudinal changes in clinical outcomes occur with MDT rehabilitation and how do these results compare with patients with previous lower extremity trauma discharged prior to PDAFO availability?

Methods We retrospectively evaluated levels of mobility, activities of daily living, anxiety, depression and pain in a heterogeneous group of 23 injured UK servicemen 34±11 months after PDAFO provision. We also retrospectively analysed 16 patients across four time points (pre-PDAFO provision, first, second and final inpatient admissions post-PDAFO provision) using identical outcome measures, plus the 6 min walk test.

Results Outcomes were compared with previous below-knee limb salvage and amputees. Before PDAFO, 74% were able to walk and 4% were able to run independently. At follow-up, this increased to 91% and 57%, respectively. Mean depression and anxiety scores remained stable over time (p>0.05). After 3 weeks, all patients could walk independently (pre-PDAFO=31%). Mean 6 min walk distance significantly increased from 440±75 m (pre-PDAFO) to 533±68 m at last admission (p=0.003). The ability to run increased from 6% to 44% after one admission.

Conclusions All functional and most psychosocial outcomes in PDAFO users were superior to previous limb salvage and comparable to previous below-knee amputees. The PDAFO facilitated favourable short-term and medium-term changes in all clinical outcome measurements.

  • rehabilitation
  • orthosis
  • outcomes
  • function
  • lower-limb
  • trauma

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  • Contributors PL, NB, RP, SDD and ANB conceived the study design. PL, NB and LM collected data. PL performed the data analysis and all authors analysed and interpreted the findings. PL wrote the draft manuscript. All authors read, critically reviewed and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NB is the developer of the orthosis and an employee of Blatchford. Blatchford supplies the orthosis to the UK Defence Medical Rehabilitation Centre (DMRC) Headley Court and has commercial interests in the product. NB’s role is to fit the orthosis at DMRC. NB has no financial interests, patent or licensing agreements. NB did not perform any data analysis as part of the study. All remaining authors certify no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, and so on) that might pose a conflict of interest in connection with the submitted article.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Due to privacy concerns, some data regarding participants are available but only to bona fide researchers working on a related project, subject to the completion of a non-disclosure agreement. Access requests for any restricted data should be sent to

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