Indicators for the prescription of foot and ankle orthoses for children with Charcot-Marie-Tooth disease
© Scheffers et al; licensee BioMed Central Ltd. 2012
Published: 10 April 2012
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.
Clinical algorithm for prescribing foot and ankle orthoses for children with CMT
Impairments and activity limitations
Pes cavus and foot pain
Pes cavus and poor balance
Pes cavus and poorer balance (not corrected by UCBL* orthoses)
Pes cavus and poorer balance (not corrected by supramalleolar 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)
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)
Pes cavus and/or ankle equinus (≥ 0°, not corrected by hinged AFOs† with/without PF‡ stops)
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.
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