Durable Medical Equipment

In the absence of conclusive evidence, durable medical equipment (DME), including ankle-foot orthoses (AFOs), bracing, canes and walkers, and shoe modifications, should be considered as part of a comprehensive, individualized management plan for patients with symptomatic ankle osteoarthritis (OA). These devices may provide symptom relief, improve stability, and support functional mobility, particularly for patients with pain, instability, or gait deviations. Clinicians should recognize the current evidence is insufficient to determine effects on structural disease progression or future need for invasive interventions, and decisions should be guided by patient-specific factors, clinical judgment, and patient preferences.

Benefits & Harms: 

Benefits 

• Symptom relief/reduced pain 
• Improved gait mechanics 
• Reduced falls risk 
• Improved stability and ability to perform ADLs 

Harms 

• Skin breakdown 
• Device discomfort 
• Patient adherence and use 
• Out of pocket costs 

Outcome Importance: 

Pain reduction, physical function (walking, transfers), balance and fall prevention, patient-reported quality of life, ability to participate in daily activities, and adverse events (skin issues, falls) are outcomes that may be favorably affected through the use of appropriate DME.

 Cost Effectiveness/Resource Utilization: 

• Custom vs off the shelf items
• Low cost compared to surgical interventions
• Should consider payer coverage, patient ability to pay, and potential future savings from reduced falls or delayed surgical interventions

Acceptability: 

Generally acceptable to patients and clinicians when devices are used as part of a tailored plan and fit/comfort is optimized.

Feasibility: 

• Widely used and available in most clinical settings
• Custom orthoses and specialist fitting require access to orthotists and may be limited by geographic location, insurance, or cost
• Requires clinician assessment, prescription, fitting, and follow-up for adjustments and support to improve adherence

Future Research: 

• RTC’s comparing specific DME types 
• Studies of adherence, patient preferences, and strategies to improve comfort 
• Longitudinal studies to determine device on progression and need for invasive interventions