Comparison of two design principles of unpowered ankle-foot orthoses for supporting push-off: a case study

Ankle propulsion is essential for efficient human walking. In recent years, several working principles have been investigated and applied to ankle-foot orthoses (AFOs) to enhance the work of the plantarflexor muscles and achieve proper propulsion during gait. Comparing the performance and effectiveness of different designs is difficult because researchers do not have a standardized set of criteria and procedures to follow. This leads to a wide range of tests being conducted, with variations in important factors such as walking speed and assistance provided, which greatly affect users' kinematics and kinetics. In this work, we investigate the possibilities and potential benefits of two of the most important design principles for supporting ankle propulsion with unpowered AFOs. To this end, we present and evaluate two AFO prototypes with springs parallel to the Achilles tendon based on: (i) a linear compression spring, and (ii) a customized leaf spring-cam transmission with a non-linear ankle torque-angle curve. The effects of both AFOs are reported for a case study with one healthy participant using both prototypes at two walking speeds under the same experimental conditions. Large reductions in muscular activity were found when the user received assistance, and ankle kinematics were influenced by the different assistance approaches. This case study was intended as a first step to provide insights on how two promising principles can passively support push-off during gait.