Background: Advances in prosthetic and orthotic device design, materials, digital technologies, and clinical education have expanded what is possible. However, access to high-quality and contextually appropriate services remains uneven, particularly in low and middle-income countries where service models are fragmented, workforce development is limited, and assistive technologies are constrained by trade and regulatory barriers. Objectives: This position paper provides a state-of-the-art overview of prosthetics and orthotics service provision, with particular focus on resource-constrained settings, drawing on interdisciplinary evidence and expert insight to describe strengths, gaps, and priorities for change. Results: The paper reviews six domains: education and training, service provision, advances in technology and their global reach, international initiatives and organizations, the case for interdisciplinary collaboration, and the influence of local context, culture, and national systems. Across these domains, it highlights how inequalities arise from the interaction of clinical capacity, financing, policy, and trade. Examples from Cambodia, Sri Lanka, Ukraine, and other settings illustrate how digital tools, mixed methods research, and locally led innovation can inform more responsive services, but also how externally driven models can undermine sustainability when they are not aligned with local systems. The role of collaborative research networks in generating shared evidence and guidance is emphasized. Conclusions: The paper concludes with recommendations to strengthen prosthetics and orthotics by investing in contextual education, sustainable service models, appropriate technology pathways, regulatory and trade reforms, and support for interdisciplinary and user-engaged research. It argues that coordinated, evidence-informed, and culturally responsive action is needed if ambitions for equitable access to prosthetic and orthotic care are to be realized. Clinical Relevance Statement: This paper identifies practical priorities for improving prosthetic and orthotic services, including workforce development, sustainable service delivery, context-appropriate technology adoption, and stronger system coordination. These insights are directly relevant to clinicians, educators, and service leaders working to improve equitable access and long-term outcomes in diverse practice settings. ( J Prosthet Orthot . 2026;X:XX–XX)
Introduction: Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity affecting posture, respiratory function, and quality of life. Combining customized 3D orthoses with Schroth exercises may improve both structural and functional outcomes, yet evidence on short-term physiological adaptations remains limited. Objective: The aim was to examine the short-term effects of combined 3D spinal orthosis and Schroth exercise therapy on trunk rotation, respiratory function, dynamic balance, and quality of life in adolescents with AIS. Methods: Thirty adolescents with AIS (aged 10–18 years) participated in this study. All had a primary Cobb angle between 26° and 40°, while smaller compensatory curves were excluded. Each participant was fitted with a custom-made thoracolumbosacral orthosis designed via 3D scanning and wore it at least 18 hours daily. Schroth exercises were performed three times weekly for 4 weeks after a 3-day adaptation period. Assessments included trunk rotation (scoliometer), spirometry (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow), dynamic balance (Y Balance Test), and quality of life (Scoliosis Research Society-22 questionnaire). Data were analyzed using repeated-measures analysis of variance ( P < 0.05). Data were analyzed using repeated-measures analysis of variance with Bonferroni post hoc corrections, paired samples t tests, and effect size calculations ( P < 0.05). Results: Trunk rotation in thoracic and lumbar regions decreased significantly ( P < 0.001), exceeding the 2° measurement error threshold. Respiratory parameters improved significantly ( P < 0.05, moderate to large effect sizes). Dynamic balance scores slightly declined ( P < 0.05), indicating short-term adaptation. Scoliosis Research Society-22 questionnaire scores improved in all domains, especially pain, self-image, and satisfaction ( P < 0.05). Conclusions: Combined 3D orthosis and Schroth therapy produced meaningful short-term improvements in spinal alignment, respiratory function, and quality of life, while minor balance decline reflected transient postural adaptation. Clinical Relevance Statement: The results of this study provide evidence for the clinical application of combined 3D thoracolumbosacral orthoses and Schroth-based exercises to facilitate early gains in trunk rotation, respiratory function, and overall quality of life by informing the creation of conservative treatment plans during the early stages of adaptation to those treatments in adolescents diagnosed with idiopathic scoliosis.
Purpose: Task-specific training (TST) is an essential part of stroke patient rehabilitation, and SaeboFlex is one of the most widely used orthoses for TST. The present study attempted to evaluate the efficacy of SaeboFlex in combination with TST interventions for stroke rehabilitation based on a review of articles. Methods: A systematic search was conducted in three scientific databases: Web of Science, MEDLINE (PubMed), and Scopus. Data were extracted and checked by two independent reviewers. The methodological quality of the selected studies was assessed with the PEDro scale. Results: Six studies were identified as fulfilling the inclusion and exclusion criteria out of 105 articles. The mean PEDro score of the selected studies was 5.6, indicating fair methodological quality. Besides function, in this review, the movement range, muscle tone, and quality of life were the main aspects that were assessed. Conclusion: Based on the evidence reviewed, SaeboFlex could be an effective orthosis for TST during stroke rehabilitation, although additional high-quality research is required to confirm the level of its effectiveness. Clinical Relevance Statement: When used as an adjunct to TST after stroke, the SaeboFlex dynamic hand orthosis may help clinicians increase high-repetition, function-focused practice and achieve modest improvements in upper limb function, range of motion, muscle tone, and quality of life. Because the current evidence base is limited and of fair methodological quality, prescription and dosing should be individualized while higher quality trials are awaited.
Background: People with lower limb amputation can have multiple walking gait deviations influencing their stability and ability to generate power at toe-off. These deviations could be compounded by footwear choice influencing the footwear-prosthesis system. Objective: Conduct a scoping review to examine research quantifying the impact of footwear and footwear characteristics on standing and walking gait in people with transtibial amputation. Study Design: A systematic search of the literature was undertaken. Results: Seventy records were returned from the search and after screening for relevance, six studies met the predefined inclusion criteria. Study designs investigated small samples, laboratory settings, and only straight-line walking or bilateral standing. Footwear characteristics included in studies were shoes versus barefoot, mass, heel height, and insole hardness. Stability was a particular focus, alongside walking speed, muscle activation, lower limb kinematics, and symmetry. Conclusions: Small samples, disparate methods, and subjective interpretation limit conclusions; however, increasing heel height made users less stable, as did softer insoles. Wearing shoes versus barefoot largely influenced ankle and knee angles in early stance, but did not influence temporal-spatial parameters consistently. Altering shoe mass influenced gait symmetry, but heel height did not. Shoe mass closest to the users own footwear mass resulted in the most symmetrical gait. Consideration of footwear characteristics is essential when investigating gait in people with transtibial amputation.
Background: Multigrip myoelectric hands have been developed to improve functional and cosmetic outcomes for individuals with upper limb amputation. However, kinematic evidence comparing these devices with single-grip myoelectric hands during tasks simulating daily movements remains limited. Objective: To compare the kinematic characteristics and compensatory movements of a multigrip hand (MH) and a single-grip hand during a manual manipulation task. Study Design: Single-case comparative motion analysis study. Methods: A 32-year-old male with right transradial amputation performed a custom Box and Block Test-based task using a Michelangelo hand (MH) and a Dynamic Mode Control Plus (single-grip hand), with the MH tested in the opposition grip. Kinematic data from a motion capture system were analyzed for upper trunk and shoulder joint angles during the grasping, transferring, and releasing phases. Maximum joint angles were statistically compared, and subjective ease of use was rated using a visual analog scale. Results: The Dynamic Mode Control Plus resulted in greater shoulder flexion, internal rotation, forward tilt, and axial rotation. The Michelangelo hand showed slightly greater abduction and trunk lateral tilt. Visual analog scale scores favored the Michelangelo hand despite its greater perceived weight. Conclusions: The Michelangelo hand promoted more physiologic motion strategies and reduced compensatory movements, even in the opposition grip. These findings suggest that prosthetic design—particularly wrist and finger alignment—may influence functional performance. Clinical Relevance: This study highlights the importance of considering compensatory motion and the user experience in the context of prosthesis selection. MHs may reduce biomechanical stress during functional tasks, even in the opposition grip, thus contributing to improved long-term outcomes. ( J Prosthet Orthot . 2026;X:XX–XX)
Background: Becoming accustomed to a new prosthesis or orthosis is potentially a lengthy process that may be influenced by a variety of patient- and device-specific factors. This makes it difficult in clinical practice and research to purposefully allocate accommodation times that are neither too short nor too long. The goal of this work was to determine the average duration, in time and step count, until a lower-limb prosthesis user is acclimated to a new prosthetic foot. Methods: Participants’ prostheses were modified by replacing the original foot with a different type. Step counts, measures of gait symmetry, and self-reported ratings of accommodation were recorded in prescribed increments over a total period of 30 days. The resulting time series were approximated as a power function and analyzed to extract the average period after which the accommodation level had reached 90% of the eventual value. Results: A total of 18 participants were enrolled, of whom 14 generated enough data to be included in the analysis. On average, they reached 90% of accommodation after using the new foot for 37 minutes and walking 365 steps. Discussion: Recommendations for accommodation periods, based on this methodology, are shorter than frequently assumed. These differences are likely attributable to divergent definitions of the construct of “full accommodation.” Our findings may be adopted to inform the design of efficient protocols in prosthetics and orthotics research and to enhance the clinical practice of prescribing and fitting prostheses or orthoses for individual patients. Clinical Relevance: Allowing too much or not enough accommodation time after changes to a prosthesis is problematic, as it can lead to flawed clinical decisions, undue burdens for the patient, or both. Determining a reasonable accommodation period and applying it consistently can help mitigate these issues.
Introduction: Cranial remolding orthosis (CRO) is theorized to establish holding and nonholding areas within the orthosis that either inhibit or promote targeted cranial growth. There is no clinically published data on the magnitude and change in pressures between the head and orthosis during cranial remolding therapy with a CRO. This study quantifies the CRO holding and nonholding pressures on head-mimics of infant patients undergoing cranial remolding treatment. Materials and Methods: Pressure distribution data were collected for six patients throughout their treatment for up to 17 weeks using surrogate head forms. Tekscan I-Scan sensors and software were used to quantify pressures within the head-CRO interface. Results: Holding quadrants experienced an average pressure of 2.37 (±1.10) kPa initially and 4.37 (±0.89) kPa at final measurements. Nonholding quadrants observed 1.27 (±0.92) kPa initially and 1.99 (±1.32) kPa at final treatment. There was a statistically significant difference in average pressures between holding and nonholding quadrants at both initial and final. Between initial and final treatments, a significant increase in average pressure was seen in holding quadrants. For holding quadrants, the peak pressure was 8.54 (±3.79) kPa at initial and 20.54 (±8.18) kPa at final measurements. For nonholding quadrants, the peak pressure was 5.28 (±2.97) kPa at the initial fitting and 9.84 (±4.51) kPa at the final treatment. There was a significant difference in peak pressures between holding and nonholding quadrants at the final measurement and a significant increase in peak pressures between initial and final treatments in holding quadrants. Conclusions: This study presented a novel pressure mapping procedure for data collection during infant cranial remolding treatment. The results provide a base understanding of pressures present at the head–CRO interface and will provide a better understanding of the mechanical basis for plagiocephaly correction, CRO treatment, and influence best-fit practices for clinicians. Clinical Relevance: There is currently no published data on pressures felt at the head–CRO interface. Providing clinicians with this quantitative benchmark pressure would allow for optimized remolding therapy, increasing the quality of patient care.
Purpose: The methodological expectations for evidence synthesis have evolved and become more rigorous; this tutorial will build readers’ understanding of the new and emerging types of evidence synthesis as well as provide information on the updated and rigorous standards utilized in many of the health sciences and medical fields. Method: Guidance on how to find and apply current best standards and methods for evidence synthesis is provided, including appropriate methodology for systematic reviews, scoping reviews, rapid reviews, and other types of evidence synthesis to ensure reproducible and replicable evidence synthesis projects. Systematized reviews are highlighted as the best approach for students and also for professionals who have limited time and who might not have a team to work with. Results: The expectations and benefits of the different types of methodology are introduced, as well as information concerning ways to improve the quality of the reviews through collaboration with professional experts from other fields. The differences between methodology and reporting guidelines are highlighted, as well as examples of structured research questions that should guide the production of evidence synthesis. Conclusion: Although systematic reviews are highly recognized by most medical professions, there is a lack of publication of other types of evidence synthesis. Understanding the different types of evidence synthesis methodologies and the recognized international standards for Systematic Reviews will enable professionals in the prosthetics and orthotics field to produce higher-quality research and knowledge translation into clinical practice. Clinical Relevance Statement: This paper introduces readers to core concepts of evidence synthesis with guidance and resources for clinician and researcher teams to create high-quality research papers by better understanding and following best practices in evidence synthesis.
Background:Deterioration of bone mineral density (BMD) in the residual femur after a transfemoral amputation (TFA) has been reported over the past five decades, with various potential explanations described in the literature. BMD loss is a critical risk factor of fracture and hence an important clinical concern for prosthesis users. Objectives:This scoping review audited in vivo imaging studies that focused on BMD in individuals with TFA, with the aim to synthesize the status of knowledge on this topic, report on the mechanisms related to BMD status as hypothesized in the reviewed literature, and review BMD outcomes separately for prosthetic socket and bone-anchored suspension. Methods:Three databases (Scopus, PubMed, and Web of Science) were searched on December 1, 2024. Search keywords covered terms that reference bone mineralization (BMD, osteopenia, and osteoporosis) and TFA. Data were extracted for analysis and grouped according to reported prosthesis suspension for analysis. Results:In total, 244 articles were screened, with 20 ultimately reviewed. Articles were published between 1969 and 2024. Fourteen articles reported the use of socket prosthesis and six used bone-anchored devices. The former group consistently reported BMD loss, while the latter presented maintenance or improvements. The socket prosthesis cohort was younger in age compared to bone anchored (range 24-73 vs. 47-58 years). Proposed reasons for BMD loss included disuse atrophy, bedrest post-surgery, gait asymmetry, and prosthesis influence. Conclusions:Articles reporting BMD status using socket prosthesis consistently reported demineralization despite interventions, with no consensus on the mechanical cause of BMD loss. Further, the bone-anchored group tended to demonstrate improvements in limb loading symmetry during ambulation and higher levels of bone loading compared to prosthetic socket use. Clinical relevance:The residual femur in persons with TFA has demonstrated bone demineralization, which appears to be less prevalent in bone-anchored devices compared to socket use. These findings warrant further analysis of the effects of prosthetic socket use on bone demineralization in persons with TFA.
Background: Through-knee amputation (TKA) is often overlooked in favor of transfemoral amputations (TFAs) despite potential benefits. Evidence is limited regarding functional outcomes. This study aimed to evaluate functional, clinical, and patient-reported outcomes in patients undergoing TKA at a single UK center over 10 years. Methods: A retrospective service evaluation was conducted in a tertiary Vascular Surgery unit in the UK. Adults undergoing a TKA between 2015 and 2025 with ≥6 months follow-up were included. Demographic and perioperative data, including comorbidities, indication, and complications, were extracted from electronic records. Long-term outcomes, including survival, mobility, quality of life, and prosthesis use and patient feedback, were obtained through follow-up questionnaires. Results: Twenty-seven patients underwent TKA during the study period. The mean age was 65 years, and the median follow-up was 29 months. Ulcers and infection were the commonest indications. Complications included surgical site infections in five patients (19%) and six (22%) required revision to TFA. At follow-up, 80% of patients were living at home, 60% required a carer, and 30% reported regular prosthesis use. Special Interest Group in Amputee Medicine grades ranged from A to Db, indicating limited prosthetic mobility. The mean EuroQol 5 domain questionnaire overall health score was 54, reflecting a moderate level of perceived health. Conclusion: This service evaluation highlights the need to select patients likely to walk on a prosthesis and who would be able to tolerate a reintervention if TKA failed. Future work should explore patient’s perceptions of these risks and their priorities when choosing TKA over TFA to better guide shared decision-making.
Introduction: Excessive foot motion during the stance phase of gait is the result of foot hyper-deformability, which is often treated with a foot orthosis. The effectiveness of a foot orthosis in reducing excessive foot motion by reducing the deformability of the foot during the stance phase of gait can be influenced by footwear. A foot orthosis designed to reduce excessive foot motion may not effectively reduce the stance-phase deformability of the shod foot. It is thus important to assess the influence of different footwear on the effectiveness of a foot orthosis in reducing excessive foot motion. A method to assess the effectiveness of a foot orthosis in reducing the stance-phase deformability of the shod foot has not been reported in the literature. Materials and Methods: This technical note addresses a novel procedure using digital platform-based pedobarography for evaluating the stance-phase deformability of the shod foot to assess foot orthotic effectiveness. The method involves first standardizing the acquisition of the plantar pressure profile of the shod foot by attaching a smooth and homogeneous removable outsole to the shoe, and then analyzing the deformation of the plantar pressure profile by fitting an ellipse to the profile and measuring the change in the ellipticity (axial ratio) of the best-fit ellipse. Because the ellipticity of the plantar pressure profile changes during the stance phase of gait, the true (logarithmic) strain in the axial ratio of the best-fit ellipse represents the correct relative measure of deformation of the profile. The stance-phase deformability of the shod foot is quantified as the total deformation of the plantar pressure profile throughout the stance phase of gait. An example of the method is provided with a single-subject assessment of foot orthotic effectiveness that has useful applications in clinical biomechanics. Results: The same foot orthosis designed to reduce excessive foot motion for a single subject was inserted into two different shoes: a dress shoe and an athletic shoe. Whereas the foot orthosis in the athletic shoe effectively reduced the stance-phase deformability of the shod foot, the foot orthosis in the dress shoe did not reduce excessive foot motion. Conclusions: Evaluating the stance-phase deformability of the shod foot is important for assessing the effectiveness of foot orthoses in reducing excessive foot motion in different footwear. The method is easy to implement in a clinical setting, and may promote successful clinical outcomes when dispensing foot orthoses to treat excessive foot motion. Clinical Relevance: This technical note describes a clinically accessible approach to evaluate the stance-phase deformability of the shod foot for assessing the effectiveness of foot orthoses in reducing the deformability of the hyper-deformable foot. The method has clinical implications for potentially improving functional outcomes in the orthotic treatment of foot pathomechanical disorders.
Background: Immediate in-brace Cobb angle correction is an early indicator of brace effectiveness in adolescent idiopathic scoliosis (AIS). However, data describing the real-world performance of Boston and Chêneau braces in routine clinical practice are limited. Objectives: To audit the immediate in-brace correction achieved with Chêneau and Boston braces in adolescents with AIS and to describe brace application patterns in routine clinical practice. Study Design: Retrospective Institutional Audit. Methods: This retrospective review included adolescents with AIS treated between 2021 and 2023 who had complete prebrace and immediate in-brace radiographs. Brace selection was nonrandomized, resulting in differences in baseline curve severity. Immediate correction was calculated from standardized radiographs. Group comparisons used nonparametric and Chi-square testing. Analysis of covariance adjusted for baseline Cobb angle. Exploratory subgroup analyses were conducted for single- and double-curve patterns. Results: A total of 186 adolescents were included (Boston n = 149; Chêneau n = 37). Baseline Cobb angles were higher in the Chêneau group (41.7° ± 10.2°) than in the Boston group (37.0° ± 9.1°). Unadjusted percent correction did not differ significantly (43.8% vs. 36.1%; P = 0.078). After adjusting for baseline severity, the Chêneau brace achieved greater immediate correction (adjusted mean difference ≈ 4°; P = 0.007). Exploratory analyses indicated greater correction for single curves with the Chêneau brace ( P = 0.047). Conclusions: Both brace designs provided meaningful immediate in-brace correction. After accounting for baseline severity, the Chêneau brace showed a modest statistical advantage, although clinical relevance is uncertain owing to nonrandomized allocation. Immediate in-brace correction is a surrogate marker only; without longitudinal data on curve progression, adherence, and patient-reported outcomes, the translation of this finding to long-term clinical benefit cannot be assumed. Clinical Relevance Statement: Both Boston and Chêneau braces provide effective immediate in-brace correction for AIS in routine practice. While Chêneau braces demonstrate a modest statistical advantage when adjusting for baseline severity, clinicians can expect meaningful, real-world performance from either orthotic design. ( J Prosthet Orthot. 2026;X:XX–XX).
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.
Background: Individuals with lower-limb amputations tend to have asymmetrical gait characteristics, which can result in decreased stability and increased sound joint loading. These asymmetries have been associated with poor physical function and prosthetic socket fit. Objectives: This study aimed to characterize the influence of socket design on dynamic gait stability and joint loading in individuals with transfemoral amputations (TFA). Study Design/Methods: Individuals with unilateral TFA participated in this study. Participants walked overground in one standard of care socket and five interventional sockets, which varied in volume, brim height, geometry, and pliability. Bilateral minimum mediolateral margin of stability and sound hip and knee joint reaction forces and moments were measured. Changes in dynamic stability and joint loading between the standard of care and interventional sockets were determined using generalized estimation equations. Results: Socket design had a significant main effect on both dynamic gait stability and joint loading. Reduction in socket volume resulted in an increase in minimum prosthetic limb mediolateral margin of stability. The undersized, ischial containment, and low-brim socket design modifications significantly influenced sound joint loading. Conclusions: Reduced socket volume appears to result in poorer stability during gait in individuals with TFA. Additionally, reduced brim height caused the greatest increase in sound joint moments. Clinical Relevance: Clinicians may use these findings to guide socket design to minimize the patient’s risk of developing secondary conditions or falling. ( J Prosthet Orthot . 2026;X:XX–XX)
Introduction: Large language models have transformed how individuals access and utilize information, demonstrating remarkable potential to influence patient care and clinical decisions. Osseointegration (OI) for limb reconstruction has garnered extensive attention due to its advantages over traditional socket-type prostheses. However, as a novel technique, high-quality publicly accessible patient information is limited. This study aimed to assess and compare the quality of responses from two common chatbots regarding frequently asked questions on Osseo-integrated prostheses for limb reconstruction. Materials and Methods: Ten comprehensive questions on OI spanning five categories (i.e., basic information, contraindications, OI procedure and implant, perioperative care and physical therapy, and complications and outcomes) were developed. These questions were entered into ChatGPT and Gemini in separate sessions, and responses were recorded. Twelve experts, including orthopedic surgeons, prosthetist, physiatrists, and physical therapists, rated the responses. Readability was evaluated using the Flesch-Kincaid Reading Ease Score and Grade Level scoring system. Results: Both chatbots provided satisfactory responses requiring minimal clarification (ChatGPT, 2.1 ± 0.37; Gemini, 2.3 ± 0.24; P = 0.05). Experts preferred ChatGPT responses for 70% of the questions over Gemini responses. There was no difference in ratings based on expert occupation for both ChatGPT and Gemini responses ( P = 0.16 vs. 0.57). Both chatbots produced responses with “very difficult” readability (ChatGPT, 20.54 ± 8.40; Gemini, 20.53 ± 7.24) and a college graduate reading level (ChatGPT, 15.42 ± 1.72; Gemini, 14.75 ± 1.35). Conclusions: Online chatbots can provide accurate responses to questions regarding OI for limb reconstruction, but they have limited readability. However, the complexity of their language underscores the need for healthcare providers to interpret and communicate this information to patients clearly. Clinical Relevance: ChatGPT and Gemini can provide satisfactory information regarding the topic of osseointegration; however, the high reading difficulty emphasizes the importance of clinicians in translating and conveying this information effectively to patients.
Background: Infantile tibia vara (ITV) is a progressive developmental disorder of the proximal tibial physis leading to varus deformity and mechanical malalignment of the lower limbs. Early conservative management can prevent progression and reduce the need for surgery. Objective: To evaluate the effectiveness of combining custom-fabricated static knee-ankle-foot orthoses (KAFOs) with structured physiotherapy in correcting tibiofemoral (TF) and metaphyseal–diaphyseal angles (MDAs) and tibial torsion in children with early-stage ITV. Study Design: Descriptive observational study. Methods: Sixteen children aged 3–6 years with ITV (Langenskiöld stages I–III) received night-time custom-fabricated static KAFOs and a 12-month physiotherapy program focusing on strengthening, mobility, balance, and gait training. Radiographic and clinical assessments (MDA, TF angle, tibial torsion) were performed at baseline, 1, 3, 6, and 12-months. Data were analyzed using Friedman’s test for repeated measures and paired comparisons, with P < 0.05 considered statistically significant. Results: Significant improvements were observed across all parameters. Mean MDA decreased from 15.6° (standard deviation [SD] = 3.71) to 7.88° (SD = 1.82), TF angle improved from 17.44° (SD = 2.39) to 9.50° (SD = 2.30), and tibial torsion decreased from 17.9° (SD = 5.15) to 12.06° (SD = 3.04) ( P < 0.05). The greatest improvement occurred in children aged 3–4 years and at Langenskiöld stages I–II. Conclusions: The combined use of night-time KAFOs and structured physiotherapy resulted in significant correction of varus deformity and improved lower-limb alignment in early-stage ITV. This conservative, cost-effective approach provides a viable alternative to surgery when initiated early.
Background: Ankle–foot orthoses (AFOs) are commonly prescribed to support lower limb function in individuals with neuromuscular or musculoskeletal impairments. While traditionally fabricated custom AFOs remain the standard of care, the adoption of 3D printing has emerged as a promising alternative manufacturing process, offering potential benefits in design flexibility, process efficiency, and patient-centered customization. However, clinical evidence evaluating patient satisfaction with 3D-printed AFOs remains limited. Objectives: The primary objective of this study was to evaluate and compare patient satisfaction with 3D-printed versus traditionally fabricated custom AFOs using a standardized satisfaction questionnaire. A secondary objective was to assess patients' preference of their device after a 3-month wear period. Study Design: A single-group crossover study was conducted as a program evaluation within a private orthotic clinic. Methods: Fifty-six patients were recruited, with 29 completing the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) surveys. Participants received both traditionally fabricated and 3D-printed AFOs. Each device was worn for a period of 2 weeks. QUEST 2.0 satisfaction data were collected after each 2-week wear period for both devices. At the 3-month mark, participants were asked to indicate their preferred device. Statistical comparisons were performed using a Wilcoxon signed rank test. Participant comments were analyzed using a hybrid content and thematic analysis approach. Results: Mean patient satisfaction scores for both device types were high (traditional: 4.41 ± 0.30; 3D printed: 4.47 ± 0.23) out of a possible 5 points. No statistically significant differences were found in overall satisfaction for the original and extended QUEST surveys ( P = 0.472 and P = 0.222); however, individual items showed statistically significant differences in favor of the 3D-printed AFOs for weight ( P = 0.001) and in favor of the traditionally fabricated AFOs for durability ( P = 0.039). At the 3-month follow-up, 61% of participants preferred their 3D-printed device, 22% preferred the traditional AFO, and 17% had no preference. Conclusions: This study demonstrates that 3D-printed AFOs are a clinically viable alternative to traditional fabrication with comparable overall patient satisfaction. These findings support the broader integration of digital workflows in orthotic and prosthetic care, while highlighting the importance of continued research into long-term outcomes. Clinical Relevance Statement: The field of orthotics and prosthetics is undergoing a significant technological shift toward digital workflows and 3D printing, yet patient satisfaction with these emerging fabrication methods has remained largely unexamined. This study provides foundational evidence that 3D-printed AFOs are well-received by patients, offering critical insight to guide the future of integrating 3D printing into clinical orthotic practice.
Introduction:Sit-to-stand (STS) movement is one of the most demanding tasks for individuals with unilateral transfemoral amputation (uTFA). Despite the potential of a powered prosthetic knee (PPK) to improve loading asymmetry during STS tasks, empirical evidence supporting its effectiveness remains relatively limited. The aim of this study was to investigate vertical ground reaction force (vGRF) loading during the STS task and its asymmetry in individuals with uTFA using a recently developed PPK.Materials and Methods:This study used a single-group, prospective, repeated-measures observational study using an A-B design. Eight individuals with uTFA performed the STS task using their daily-use prostheses immediately followed by the same task with the PPK. We extracted the peak vGRF during the ascending phase of the STS task in both the prosthetic and intact limbs and then calculated the degree of asymmetry.Results:The peak vGRF of the prosthetic limb significantly increased when participants used the PPK. However, no significant differences were observed in the peak force in the intact limb between two prosthesis cases. Consequently, degree of asymmetry was significantly improved with the PPK (40.1%) compared to that with the daily-use prosthesis (52.8%).Conclusions:These findings suggest that PPK technology can help individuals with above-knee amputation distribute their weight more evenly when standing, even immediately after switching from their usual prosthesis.Clinical Relevance:The immediate improvement in loading symmetry during sit-to-stand tasks suggests that PPKs may enhance functional performance in individuals with transfemoral amputation. This technology has the potential to support more balanced rehabilitation strategies and reduce compensatory strain on the intact limb. (J Prosthet Orthot. 2026;38:e103-e107)
