An orthosis is a brace or splint, such as an insole, ankle or knee brace, which can help manage walking difficulties.
Orthotic shorts are a type of fabric orthosis designed to support the hips and pelvis. Orthotic shorts may also improve posture and sensory awareness of position and movement of legs. They have been found to improve walking in other conditions, such as after a stroke, but there has been very little research to support their use in MS.
This small feasibility study aimed to test whether orthotic shorts could improve walking and whether people would be willing to wear them in daily life.
Fifteen participants who considered they had walking difficulties were recruited. They were given two pairs of shorts – one pair were tailor-made orthotic shorts and the other were looser fitting. Each pair was worn at home for two weeks and participants kept a diary of wear times and experiences. Walking ability was assessed formally in the clinic and through interviews and questionnaires to assess the participants’ opinions about wearing the shorts and the effect on their walking and balance.
Orthotic shorts were acceptable to most users. Where shorts were less acceptable, this was due to restricted bending at the hip, particularly when going up stairs, or appearance, with beige and pastel colours being least acceptable. When wearing the orthotic shorts, participants felt more confident walking, felt they had better control over their leg direction, could walk further and faster and felt more stable with better balance, smoother walking and less wobble. These perceived improvements were supported by modest improvements in clinical measures of walking, particularly for measures that reflect side-to-side stability.
The results of the study suggest that orthotic shorts could improve walking for people with MS, particularly those who have balance problems and find it hard to control leg direction when they walk but may not suit people who struggle to lift their legs for stairs or kerbs.
Background
Walking can be difficult for many people with MS. For some this might be weakness in the leg, for others foot drop and stumbling. An orthosis is a brace or splint, such as an insole, ankle or knee brace, which can help manage walking difficulties and allow people to remain mobile and keep doing activities they enjoy the most.
Orthotic shorts are a type of fabric orthosis designed to support the hips and pelvis. Pelvic movement in walking is known to be particularly variable in people with MS, and this lack of stability around the hips and pelvis can affect balance and walking. Orthotic shorts may also improve posture and sensory awareness of position and movement of legs. They have been found to improve walking in other conditions, such as after a stroke, but there has been very little research to support their use in MS.
This small feasibility study had two aims. Firstly, would orthotic shorts improve walking and, if they do, how best to measure this. Secondly, would people with MS choose to wear them or are tight shorts impractical in daily life?
How this study was carried out
UK researchers recruited 15 participants who considered they had difficulty walking and felt unsteady around the hips or lower trunk, could walk for at least 2 minutes and had no skin or circulatory problems that might prevent them wearing tight clothing.
Each participant tested two pairs of shorts. The orthotic pair were constructed from a tight-fitting base layer, with added panelling which provided compression around the pelvis and improved hip movements. The second pair of shorts consisted of the base layer fabric only and were a looser fit. Participants could choose the colour of their shorts and the fit of the orthotic shorts was customised for individuals’ needs following a clinical assessment of their walking style or gait.
One pair of shorts was worn at home for two weeks, followed by a two week break and then the second pair of shorts were worn for a second two week period. Participants were asked to increase the time they wore their shorts each day up to 14 hours and kept a diary of wear times and experiences. Walking ability was assessed formally in the clinic and through interviews and questionnaires to assess the participants’ opinions about wearing the shorts and the effect on their walking and balance.
What was found?
Orthotic shorts were acceptable to most users; participants wore them for 86% of the recommended time and 75% chose to keep their orthotic shorts. Some participants particularly liked the hidden nature of the shorts in comparison to other walking aids such as a walking stick or rollator. Where shorts were less acceptable, this was due to restricted bending at the hip, particularly when going up stairs, or appearance, with beige and pastel colours being least acceptable. Some participants found the shorts difficult to put on and take off, though most found they got used to them.
When wearing the orthotic shorts, participants felt more confident walking, felt they had better control over their leg direction, could walk further and faster and felt more stable with better balance, smoother walking and less wobble. These perceived improvements were supported by modest improvements in clinical measures of walking ability, speed and gait, particularly for measures that reflect side to side stability. The looser shorts were intended to be an inactive control, or placebo, but some improvements in clinical measures were also seen with these looser shorts. This may have been due to the skin contact of the shorts making people more aware of the position and movement of their legs and giving them better control of their walking.
What does it mean?
The results of the study suggest that orthotic shorts could improve walking for people with MS, particularly those who have balance problems and find it hard to control leg direction when they walk but may not suit people who struggle to lift their legs for stairs or kerbs.
The study involved just 15 participants so further, larger studies would be needed to confirm the benefits and whether people would be willing to wear the shorts for longer periods.
Custom-made orthotic shorts can be expensive for an individual to buy privately. Generating evidence for the benefits of orthotic shorts will make it more likely for garments like these to be provided on the NHS.
Snowdon N, et al.
Orthotic shorts for improving gait and walking in multiple sclerosis: a feasibility study.
Disability and Rehabilitation 2022 Aug 24:1-12
Summary
Full article
Many people with MS have some difficulties with walking but walking problems vary considerably from one person with MS to another. Common difficulties include: unsteadiness on walking or turning, tripping, stumbling, weakness of the leg when weight is on it and difficulty placing the foot on the ground. Other MS symptoms can also make walking more difficult, such as vision problems, balance problems and pain. Having trouble walking can mean people with MS are more vulnerable to tripping and falling. It can also use up more energy, making fatigue worse, and people may alter how they walk to try and compensate for the difficulty they are having. This alteration in walking can result in bad posture which can lead to pain and strains.
In this article, orthotist Emma Davidson explains how orthotic devices - such as braces and splints - can help manage walking difficulties, enabling people to maintain their mobility and keep doing the activities they enjoy the most.
If you are experiencing walking difficulties, you can speak to your MS nurse or GP who may refer you to physiotherapy services. The best way forward depends on what is causing the difficulties. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity or pain.
