Impact of a Shoe with Orthosis on Gait Parameters.

Observe the immediate effects of adding a shoe and orthosis on the gait parameters of a patient with right hemiparesis following a stroke.

Comparison of Two Conditions

1. Barefoot Walking

Observed characteristics:

• Three-step gait, with a pause in double support to move the cane
• Relatively symmetrical gait
• Low step amplitude (heel-to-heel distance of about 20 cm)
• Reduced cadence

2. Walking with Orthosis and Shoe

Observed characteristics:

• Transition to a two-step gait
• Maintenance of gait symmetry
• Increase in step amplitude
• Faster cadence

Overall result:
Significantly increased walking speed with the orthosis and shoe.

Clinical Analysis

In this patient, the right foot varus (without equinus, due to an active anterior tibialis) is particularly pronounced in case of pain (e.g., claw toes) or imbalance.

The shoe alone, although providing partial support, is not sufficient to correct the varus or ensure a secure plantar support.

Therapeutic Benefits of Orthoses

Orthoses, like mobility aids, play a key role in helping patients walk:

• With safety
• With more comfort
• And with more autonomy

Recommendations for this Patient

Given the observed persistent varus:

• Equip with an orthosis and adapted shoe
• Referral to a Physical Medicine and Rehabilitation (PMR) physician for management of claw toes:
  • Botulinum toxin injection?
  • Neurotomy?
  • Tenotomy?

Conclusion

This clinical demonstration illustrates the importance of:

• A dynamic gait assessment
• An adapted orthopedic equipment
• A multidisciplinary approach (physiotherapist, PMR, orthotist)

These elements are essential to improve gait fluidity, safety, and quality of life for post-stroke patients.

When the walking situation does not allow for the use of an orthosis and shoe (for example, when going to the shower), using a more stable walking aid helps compensate for this loss of foot stability. For hemiplegic patients, the one-handed walker Wheeleo® is particularly suitable.