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The Gait Normal Gait CMT Gait Foot Drop In CMT AFOs in CMT Our Solution The Device CMT Foot Without Device CMT Foot WIth The Device Examples Of Shoes Suitable For Modification Pictures From Video Tape

The Gait in Charcot-Marie-Tooth Disease (CMT) In mild cases, the tibialis anterior and the peroneal muscles are not too weak and with the help of the more preserved long extensors, will ensure sufficient dorsiflexion of the feet. In these cases, there might be tripping after prolonged walking, due to fatigue. There also may be ankle sprains, due to both altered proprioception and impaired muscular response, on uneven ground. High sport shoes, with an air chamber in the heel, are recommended for daily use because they are light, prevent ankle sprains and absorb shocks caused by the heavy gait. Foot orthoses with supports on the lateral side are helpful to reduce turning of the feet. In moderate and severe cases of CMT,the gait is characterized by footdrop, which alters phases 2 and 3 of the gait and causes increased lifting of the knee, as shown in figure n.1, where it is compared with normal gait. Normal Gait Phase 1 Phase 2 Phase 3 Phase 4 Phase 1 CMT Gait Phase 1 Phase 2 Phase 3 Phase 4 Phase 1 This altered gait is tiring, makes tripping easier, and increases the risk of falls. Up until now footdrop could be corrected only by AFOs, which keep the ankle at 90° during phases 2 and early 3, and enable some plantarflexion (which is very important if there is weakness of the quadriceps muscle) just after the heel is placed on the ground. Click on the IMAGE for a larger view and use the back button on your browser to return here Although AFOs are effective in correcting footdrop, there is poor acceptance of this kind of orthoses, expecially among young people and people who are conscious of their appearance with others.(eg: people who wish to wear shorts in summer, or females who prefer dresses and skirts.) A recent survey reveals that about 40% of people with CMT do not wear the prescribed AFOs and often fall or have to reduce mobility, i.e. do not walk on uneven ground or get easily tired (as they have to lift the thigh more than normal, to compensate for the inability to dorsiflex the foot). If asked, they justify their refusal with the discomfort caused by AFOs on the skin, especially in summer, when there is sweating. But the real problem of AFOs is their lack of esthetics,as they stick out of the shoes and reach the middle of the calf or the proximal part of the legs. AFOs and psychological problems for everybody with CMT, especially to adolescents, as they alter their physical self-image and reinforce the sensation of disease and disability. There are people who undergo long and painful surgical treatment, risking worsening of their CMT due to prolonged immobilization, in order to avoid AFOs, and be able to wear normal shoes. To conclude, we can say that giving the patients with CMT a totally in-shoe device to correct footdrop can help to manage their disability in a better way. Pages:1    2

"The Problem of Acceptance of AFO's in CMT" © 1998 by Paolo Vinci M.D. and Sandra Linet Perelli M.D. is on this website at the author's request. All Rights Reserved This Website was created and is maintained by Dorothy B. Gosling (Retired R.N.) All rights reserved © Copyright 1997-2005 The Views & Opinions of Contributors To This Website are not necessarily shared by the Webmaster Disclaimer and Privacy Policy

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