Gait analysis in a patient with severe CMT: a case study with neww orthotic devi

[Guest guest]

Eur J Phys Rehabil Med. 2010 May 6

Gait analysis in a patient with severe Charcot-Marie-Tooth disease: a case study

with a new orthotic device for footdrop.

Vinci P, Paoloni M, Ioppolo F, Gargiulo P, Santilli V.

Rehabilitation Service, Italian Charcot-Marie-Tooth Association, Rome, Italy

Abstract

Management of footdrop in severe Charcot-Marie-Tooth (CMT) patients is a

challenge owing to the combination of quadriceps muscle weakness, distal

muscular atrophy, sensory impairment and poor soft tissue resistance to the

placement of an orthotic device.

We present a case study of a patient who gradually became unable to use his

ankle-foot orthoses because they hampered the compensative movements required to

stabilize his knees passively and caused pain.

The aim of this report is to describe orthotic management in such a severe CMT

case and to present a new orthotic device that we devised for the footdrop in

this patient.

We provided him with 3 different footdrop devices, each of which was highly

elastic to allow knee hyperextension, and left him free to decide which one to

use:

1) the silicone-ankle-foot orthoses were rapidly discarded because of pain;

2) the Codivilla support was not used because of discomfort and poor aesthetic

appearance;

3) a new device, called the " Soft Footdrop Insert " (SFI), consisting of a sheet

of Veolform, a reticulated polyolephinic foam, stuck to the counter of midcalf

boots, was found to be effective, comfortable, pain-free and aesthetically

acceptable, and was consequently used the vast majority of the time.

At a 3-year follow-up, an instrumental gait analysis, in which ordinary shoes

were compared with the Codivilla support and the SFI, revealed that both the

Codivilla support and the SFI controlled footdrop more effectively than ordinary

shoes and increased swing and mean velocity; in addition, the SFI yielded the

best gait performances.

We think that a soft, invisible device, such as the SFI, may satisfy the needs

of CMT patients and improve compliance with orthoses-wearing for footdrop.

[Guest guest]

thank you --

" soft foot drop inserts " ? I googled but could not find them --- are they

commercially available? I will be in Europe and would be interested even if

only available there.

Thanks so much -- and thanks for all your work, Gretchen and team, in keeping

this group so dynamic.

Sam

>

> Eur J Phys Rehabil Med. 2010 May 6

>

>

> Gait analysis in a patient with severe Charcot-Marie-Tooth disease: a case

study with a new orthotic device for footdrop.

>

> Vinci P, Paoloni M, Ioppolo F, Gargiulo P, Santilli V.

>

> Rehabilitation Service, Italian Charcot-Marie-Tooth Association, Rome, Italy

>

> Abstract

> Management of footdrop in severe Charcot-Marie-Tooth (CMT) patients is a

challenge owing to the combination of quadriceps muscle weakness, distal

muscular atrophy, sensory impairment and poor soft tissue resistance to the

placement of an orthotic device.

>

> We present a case study of a patient who gradually became unable to use his

ankle-foot orthoses because they hampered the compensative movements required to

stabilize his knees passively and caused pain.

>

> The aim of this report is to describe orthotic management in such a severe CMT

case and to present a new orthotic device that we devised for the footdrop in

this patient.

>

> We provided him with 3 different footdrop devices, each of which was highly

elastic to allow knee hyperextension, and left him free to decide which one to

use:

>

> 1) the silicone-ankle-foot orthoses were rapidly discarded because of pain;

>

> 2) the Codivilla support was not used because of discomfort and poor aesthetic

appearance;

>

> 3) a new device, called the " Soft Footdrop Insert " (SFI), consisting of a

sheet of Veolform, a reticulated polyolephinic foam, stuck to the counter of

midcalf boots, was found to be effective, comfortable, pain-free and

aesthetically acceptable, and was consequently used the vast majority of the

time.

>

> At a 3-year follow-up, an instrumental gait analysis, in which ordinary shoes

were compared with the Codivilla support and the SFI, revealed that both the

Codivilla support and the SFI controlled footdrop more effectively than ordinary

shoes and increased swing and mean velocity; in addition, the SFI yielded the

best gait performances.

>

> We think that a soft, invisible device, such as the SFI, may satisfy the needs

of CMT patients and improve compliance with orthoses-wearing for footdrop.

>