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1150 - Use of Orthotics and Other Treatment Modalities in Duchenne Muscular Dystrophy to Prevent Contractures and their Subsequent Impact on Ambulation: A Systematic Review

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

VM

Vanessa D. Molina, BS

Medical Student
Sam Houston State University College of Osteopathic Medicine
Houston, Texas, United States

Co-Author(s)

AK

Abrar Khazi, BS

Medical Student
Paul L. Foster School of Medicine - Texas Tech University Health Sciences Center El Paso
El Paso, Texas, United States

Corresponding Author(s)

SB

Savitha Bonthala, DO

DO
Sam Houston State University College of Osteopathic Medicine
Houston, Texas, United States

Objectives: Duchenne Muscular Dystrophy (DMD) is an X-linked degenerative disorder characterized by progressive muscle weakness, contracture development, and eventual loss of ambulation. Onset of symptoms typically occurs between ages 2 to 5, with loss of ambulation occurring between ages 9 and 13. Current treatments prioritize slowing disease progression, delaying loss of ambulation, and enhancing quality of life. This review aims to investigate the use of orthotics in conjunction with other interventions to prevent contractures and prolong ambulation in patients with DMD.

Design: A systematic search of PubMed and Google Scholar search engines was performed for publications from 2018-2024 using the keywords “Duchenne Muscular Dystrophy”, “Gait”, and “Orthotics”.

Results: The use of ankle-foot orthoses (AFOs) in DMD primarily aims to prevent contractures. Several studies have shown that use of AFOs during gait eliminates compensatory plantar flexion used to ambulate, leading to increased fall risk. Given this, AFOs are typically prescribed for nighttime use despite some sources reporting improved ambulation with AFO use in those with minimal ankle dorsiflexion. There is more debate regarding whether the use of AFOs truly contributes to decreased joint contractures and whether this subsequently leads to delayed loss of ambulation. One 2024 study found a positive correlation between early use of nighttime AFOs and delayed onset of contractures and loss of gait. However, a 2018 study found that there was no significant difference in the appearance of joint contractures between patients who stretched and patients who did not. Other treatment modalities for contractures include corticosteroid injections and surgical release in conjunction with physical therapy.

Conclusions: Given the multiple interventions to prolong gait and their differing effects on patients, an individualized approach to treatment and rehabilitation is crucial to the maximization of ambulation.