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.
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.
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 cause 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.
OUR SOLUTION:A MODIFIED SHOE which fixes the ankle at 90� in phase 2 of gait and allows some plantarflexion after the heel touches the ground.
SHOES suitable for our modification are 6.5 inch high boots(or higher) , in stiff leather, like the ones shown in the following photographs, and are trendy in Italy now.
Fixation of the ankle is obtained by putting a properly shaped strip of very thin polypropylene between the lining and the vamp in the back of the boot, as shown in the next photos.
Plantarflexion with Insert in Boot
The FOAM RUBBER PAD, which is attached to the upper part of the back of the boot, on the inside, is very important as it accomplishes the following functions:
- It fills the space between the lower third of the leg (which is generally thin in CMT) and the boot: allowing the 90� position to be held during phase 2 and early 3 of gait
- It allows the angle between the leg and foot to become more than 90� after the heel is placed on the floor, so the sole can easily touch the floor and the knee can be fully extended: this is very important, when the quadriceps muscle is weak, as rigid fixation of the ankle can cause knee flexion and falls.
- It gives protection to the Achilles tendon and prevents skin irritation.
sketch showing CMT foot with shoe modification inserted
Images showing the CMT foot in shoes without the device:
CMT foot in a leather boot without the device
The following images are shown with the device inserted in a shoe chosen by the patient:
These are examples of shoes, which correct footdrop, thanks to this device.
high top athletic shoe with device
These are more examples of shoes, which correct footdrop, thanks to this device.
The following images are taken from a vidoetape showing ambulation in shoes with the device inserted:
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Changes last made on:Tuesday January 11, 2005 8:11:25 AM