OBJECTIVE: To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. DATA SOURCES: Five databases were searched (PubMed, PsycINFO, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. REVIEW METHODS: Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDro score >= 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. RESULTS: Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD 0.88, p < 0.001) and gait speed (SMD 0.28, p < 0.001), and decreased cadence (SMD -0.72, p < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD 0.30, p = 0.004), E (SMD 0.28, p = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD 0.57, p < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD 1.65, p < 0.001) and during swing (SMD 1.34, p < 0.001), and decreased ankle power generation in stance (SMD -0.72, p < 0.001) in children with equinus gait. CONCLUSION: In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.

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