Background
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy and is associated with foot deformity, gait abnormalities and functional impairment. Orthoses are often prescribed for children with CMT, yet the indication and type of prescription is usually based on clinical judgement due to the lack of high quality research in this field. Therefore, the aims of this paper were to review the indications of commonly prescribed foot and ankle orthoses, and formulate a clinical algorithm for the optimal prescription of foot and ankle orthoses for children with CMT.
Materials and methods
We searched MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982), AMED (from January 1985), Cochrane Neuromuscular Disease Group Specialized Register, and reference lists of articles.
Results
Table 1 shows a clinical algorithm for prescribing foot and ankle orthoses for children with CMT. In general, in-shoe orthoses are indicated for affected children with pes cavus deformity, foot pain and/or mild balance impairments. Ankle-foot orthoses are indicated for children with pes cavus, foot drop, foot and ankle muscle weakness and/or ankle equinus, and moderate-severe balance impairments and/or difficulty walking (self-reported clumsy gait, frequent trips/falls) and gait abnormalities (slower speed, shorter step length, wider base of support).
Table 1
Clinical algorithm for prescribing foot and ankle orthoses for children with CMT
Impairments and activity limitations | Orthoses |
|---|---|
Pes cavus and foot pain | Foot orthoses |
Pes cavus and poor balance | UCBL* orthoses |
Pes cavus and poorer balance (not corrected by UCBL* orthoses) | Supramalleolar orthoses |
Pes cavus and poorer balance (not corrected by supramalleolar AFOs†) | Hinged AFOs† |
Foot drop and poor walking | Posterior leaf spring AFOs† |
Foot drop, poor walking, pes cavus, and poor balance | Hinged AFOs† with PF‡ stops |
Global weakness of foot/ankle muscles and poor walking and/or balance (with/without pes cavus and/or foot drop) | Hemispiral AFOs† |
Global weakness of foot/ankle muscles and poorer walking and/or balance (not corrected by hemispiral AFOs†, with/without pes cavus and/or foot drop) | Solid AFOs† |
Pes cavus and/or ankle equinus (≥ 0°, not corrected by hinged AFOs† with/without PF‡ stops) | Solid AFOs† |
Conclusions
A clinical algorithm is proposed to guide the prescription of orthoses for children with CMT. Further research is required to determine the efficacy of different foot and ankle orthoses, and the predictive ability of the proposed clinical algorithm to improve foot deformity, gait abnormalities and disability in childhood CMT.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
