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Orthotic Management of Charcot Marie Tooth

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    Orthotic Management of Charcot Marie Tooth Orthotic Management of Charcot Marie Tooth Presentation Transcript

    • Mr Simon B Dickinson MSc (Hons) MBAPO SRpros/orth Orthotic Clinical Lead & Clinical Specialist-Nottingham University Hospitals Professional Affairs Chairman- British Association Of Prosthetists and Orthotists (BAPO)
    •  Orthotists are registered healthcare professionals who specialise in the assessment of the whole body for biomechanical problems and if appropriate may prescribe, measure, fit, or review, an orthosis.
    •  An orthosis is an externally applied device.  It may also be called a „brace‟, „splint‟ or „orthotic‟.  The purpose and design of an orthosis may change over time along with the changing needs of the patient.  An orthosis can: improve function, reduce pain, prevent deformity.
    •  Centre of Excellence  In-house service  On site manufacturing  3 sites  3rd Largest Orthotics department in England The Team  7 Orthotists  6 Administrators  4 Technicians
    •  Neurologist  Orthopaedic Surgeon  Orthotist  Physiotherapist  Podiatrist?
    •  Named in 1886  Common inherited Neurological disorder  Affects 1:2500 people  Affects peripheral sensory and motor nerves  Mainly affects feet and hands  Slowly Progressive
    •  Impaired Balance  Recurrent Ankle Sprains/fractures  Changing foot shape (high arch, flat foot  Drop-Foot  Reduced hand function
    •  Motor nerve degeneration  Typically weakening Peroneal muscles (ankle evertors) causing muscle imbalance  Repeated sprains weaken lateral ankle structures
    •  Weakness in Peroneal Muscles  Initially ankle feels unstable  Made worse on uneven ground  Frequency of sprains increases
    •  Weakness of pre-tibial muscles  Initially causes increased tripping  Foot Slap  Compensation by bending knee and hip excessively to help swing leg through
    • Patient History/Diagnosis Biomechanical Assessment Gait/Pressure/Force Analysis Establish Biomechanical Deficit/Objective Design Orthosis Measurement/Casting Manufacture Fitting Stage Is Biomechanical Objective Being Achieved? Yes No Follow Up Return To Beginning Review
    • This must include: Weight Bearing and Non-Weight Bearing Exam Static and Dynamic Assessment Proprioception Physical Examination
    • For every patient and EVERY Joint  Ask about discomfort/pain in segment  R.O.M (Range of Motion)  Muscle Strength  Limitations/compensations  Soft tissue
    • “Neutral” Supination Pronation
    •  Protect against excessive ankle inversion  Function is to evert ankle and forefoot
    • M m d D For Rotation Equilibrium to occur the net turning moment must be zero M x d= m x D
    • MF 2D D GRF GRF x 2D = MF x
    •  Improve Balance  Improve Stability  Improve Walking Pattern  Prevent deformity  Reduce Pain  Supplement function of weakened muscles  Reduce need for Surgery
    •  Every patient is different  Every Patient should be thoroughly assessed  Orthosis designed in conjunction with patient and clinical team  Orthosis should be designed to meet patients needs  Orthosis should be as comfortable and cosmetic as possible
    •  Insoles (foot orthoses)  Ankle Braces  Supra Malleolar Orthoses (SMO‟s)  Ankle Foot Orthoses (AFO‟s)  Silicon Ankle Foot Orthoses (SAFO‟s)  Footwear and footwear adaptions  Conventional calipers  Surgery?
    •  Orthopaedic footwear controls foot deformities  Insoles (foot orthoses) correct feet to neutral and make them work normally  All AFO‟s should be at 90 degrees  The hindfoot and forefoot should be held neutral in an AFO
    •  Aim to improve stability and reduce pain  Rarely pre-made  “Gold standard” is custom made  Wedges added to improve alignment and stability
    • DESIGN ESSENTIALS  Should conform to shape of foot  Fairly rigid  Durable materials  Wedges to replace function of weakened peroneal muscles-lateral forefoot wedges  Accommodate fixed deformities  Should be comfortable
    • FUNCTION  Reduce heel inversion  Improve ankle stability  Can assist very mild drop foot Caution  Ankle braces can improve stability but can make ankles weaker Push Aequi. when brace removed
    •  Correct drop foot  Increase ankle stability  Improve balance  Prevent contractures  Can be bulky and cause problems with footwear  Should be comfortable  Strong durable devices
    •  Should conform to shape of leg and foot  Should correct poor foot alignment  Accommodate fixed deformities  Wedges to replace function of weakened peroneal muscles-lateral forefoot wedges  Ankle straps to control ankle position
    •  Highly cosmetic  Appropriate for very mild instability and easily correctable drop foot  Difficult to apply/remove  Tolerance?  Unsuitable for moderate to severe ankle instability  Unsuitable for any patient with reduced ankle movements
    •  Required to accomodate fixed deformities  Must have custom made insole inside boot/shoe  Can be reinforced for increased support  Footwear adaption: Heel raises, wedges, floats/flares
    •  Used to provide increased forces  Must be used in conjunction with appropriate footwear  Must be used in conjunction with foot orthosis
    •  Orthotic treatment for patients must be designed to meet their individual needs  Orthoses must be appropriately designed and made  All patients must be regularly reviewed  More investment must be made to improve orthotic treatment options to meet the needs of patients