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

Abstract 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.