Breaking out of the mould-recent developments in 3D-printed ankle-foot orthoses and strategies to improve clinical practicality: a systematic review.

INTRODUCTION

Conventional ankle-foot orthoses (C-AFOs) are commonly used to improve patient mobility. The traditional handmade process offers limited design flexibility and personalisation. In the last decade, 3D-printed AFOs (3D-AFOs) have emerged as a promising alternative. While numerous biomechanical benefits over C-AFOs have been suggested, their clinical application and real-world feasibility remain underexplored. This study aims to evaluate recent developments in 3D-AFOs and identify strategies to improve their clinical relevance and integration.

METHODS

A systematic review was conducted on 3 October 2024. Five electronic databases (PubMed, Cochrane, Scopus, CINAHL and EMBASE) were searched for studies published between 2022 and 2024. The inclusion criteria focused on physically tested 3D-AFOs modelled from leg scans or commercial templates. Data were categorised into design, mechanical properties, walking ability and participant satisfaction.

RESULTS

Of the 69 studies identified, 11 met the eligibility criteria and 36 participants were included. 3D-AFOs were designed with reduced weight and demonstrated improved gait symmetry and ankle range of motion. The modifiable material composition of 3D-AFOs influenced stiffness and durability. 3D-AFOs also demonstrated improved walking speed and muscle efficiency, although performance varied across terrains. Although superior in comfort, support and effectiveness, 3D-AFOs were comparable or inferior in social participation, perceived weight and convenience of use.

CONCLUSION

While 3D-AFOs demonstrate strong biomechanical promise, current research falls short of translating these benefits into clinically meaningful outcomes. Future studies can consider targeting patients with relevant comorbidities, extend follow-up duration, and incorporate compliance and usability metrics to promote further integration of 3D-AFOs into routine clinical practice.