Poor compliance with AFOs in CMT

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Eur J Phys Rehabil Med. 2008 Jun;44(2):27-31.

Poor compliance with ankle-foot-orthoses in Charcot-Marie-Tooth

disease.

Vinci P, Gargiulo P.

Italian Charcot-Marie-Tooth, Association Rehabilitation Service,

Rome, Italy

AIM: The aim of this study is to evaluate the compliance with ankle-

foot orthoses (AFOs) in patients previously prescribed and affected

with Charcot-Marie-Tooth disease (CMT).

METHODS: Twenty-five Italian patients (8 males 17 females; mean age:

41.6 years, range 16-54) with severe bilateral footdrop (leg-sole

angle alfa >105 degrees ) alone or associated with other problems

(rotation, plantarflexor failure, knee flexor failure) were examined

by a physiatrist (with measurement of the leg-sole angle a' with

their footwear) and interviewed by a psychologist.

RESULTS: Only 5 patients (20%) used AFOs (3 prefabricated

polypropylene AFOs, 2 custom-made short AFOs incorporated in high-top

boots) with satisfactory functional results (a' <=94 degrees ;

reported increased mobility and no more falls). The interview

revealed that all patients had a bad relationship with their own

body. The 3 subjects using prefabricated AFOs said that they hated

them and one of them complained of pain. Patients not using AFOs

justified their decision with statements such as: ''I am not yet

ready to accept them'' (n=3) or ''I can still manage without them for

a while'' (n=2) or both (n=15). Four patients had experienced pain

during the trial, 2 had not found proper shoes to accommodate them

and 12 were absolutely not interested in AFOs and, therefore, had not

gone to an or- thotist.

CONCLUSION: Compliance with AFOs is poor. Patients with CMT discard

AFOs because they highlight their disability, are not essential for

their limited daily walking and are uncomfortable. We suggest that

prescription of AFOs be accompanied with psychological support and

that research of more comfortable and cosmetically acceptable

solutions for the problem of footdrop be stimulated.