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

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Eur J Phys Rehabil Med. 2010 Sep;46(3):355-6

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.