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Orthotic Treatments for Charcot Marie Tooth (CMT) disease
The document provides a comprehensive overview of orthotic treatments for patients with Charcot-Marie-Tooth (CMT) disease, highlighting the impact of the condition on both lower and upper limbs. It discusses various goals of orthotic intervention, including stability and balance improvement, as well as different types of orthotic devices for foot drop and upper extremity support. Additionally, it addresses the need for personalized treatment based on individual patient assessments.
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Orthotic Treatments for Charcot Marie Tooth (CMT) disease
- 1. A Comprehensive Lookat Orthotic Treatments Available to CMT Patients Jim Amesbury, BSc, CO(c) Melanie Chan, BASc, CO(c) Ronda Badger, BSc, CO(c)
- 2. • How arelimbs affected by CMT • Goals of orthotic treatment • Orthotic treatment for lower limbs • Orthotic treatment for upper limbs • Case study Overview
- 3. • Peripheral nervedamage can lead to: • High arches, claw toes, callouses • Foot drop, foot slap, high steppage gait • Numbness in feet and legs • Balance difficulties How are lower limbs affected?
- 4. Goals of OrthoticIntervention • Support, prevent, correct • Improve stability • Improve balance • Energy conservation • Treat the person not the disorder
- 5. Lower Extremity • Gaitconsiderations: • Supination, inversion of heel www.equusmedical.com/information/michaudreview.htm • Foot Drop
- 6. Supination, Inversion ofHeel • Foot Orthoses • Support arches of foot • Relieve pressure areas, callouses • Improve alignment of foot • Shoe modifications • Lateral buttress addition • Improve stability of ankle joint • Widen base of support http://reviews.jbjs.org/content/3/12/e 5.figures-only
- 7. Supination, Inversion ofHeel • Ankle Braces • Increase ankle stability • some designs provide foot clearance through strapping system • Supramalleolar Orthosis (SMO) • Increase ankle stability • Support arches of the foot • Improve alignment Inversion Photo courtesy of DJ Ortho
- 8. • Ankle FootOrthosis (AFO) • Control range of motion at ankle • Improve foot clearance • Improve knee stability • Increase stability of ankle joint Foot Drop http://www.oandp.org/jpo/library/images/2002_04_150/ 1404150f5.jpg
- 9. • Which AFOto use? • Current issues • Other medical • Muscle strengths and range of motion • Activities • Gait analysis • Design specific to the patient Foot Drop
- 10. Prefabricated AFOs: • CarbonFibre AFOs • Improve foot clearance • Lightweight • Foot orthosis is recommended • Silicone AFOs (SAFO) • Improve foot clearance • Improve ankle stability AFOs Photo courtesy of Dorset Orthopaedic Photo courtesy of Ottobock Photo courtesy of OrtoPed
- 11. Custom AFOs • Customthermoplastic AFOs • Flexible, semi-rigid, hinged
- 12. Custom AFOs • Customflexible AFO • Controls foot drop • Foot clearance • Custom foot plate to accommodate pressure points •Custom Semi-Rigid AFOs • Controls foot drop • Increased ankle stability • Increased knee stability
- 13. Custom AFOs • CustomHinged AFOs • Controls foot drop • Increased ankle stability • Increased knee hyperextension stability
- 14. • Energy Storingand Return (ESR) AFOs • Posterior leaf spring • Controls ankle joint motion • Springs back when pushing off • Beneficial for weak plantar flexors Energy Storing AFOs Photo courtesy of OrtoPed
- 15. • Gait considerations: •Knee hyperextension Lower Extremity Photos courtesy of Ottobock Photo courtesy of Trulife
- 16. • Peripheral nervedamage can lead to: • Muscle weakness, reduced strength • Claw like hands, tightness • Reduced range of motion • Numbness in hands How are upper limbs affected?
- 17. • Muscles ofthe hand • Control fine motor activities • Function reduced • Tightness develops Upper Extremity Extend Flex http://clinicalgate.com/polyneuropathies/
- 18. • Finger splints •Custom sterling silver ring splints or custom-molded plastic • Lumbrical Bar • Reduces claw hands Upper Extremity Photo courtesy of Digisplint
- 19. • Wrist-Hand Orthosis •Help with wrist position • Increase function • Wrist-Hand-Finger Orthosis • Resting splint • Help with finger and wrist position Upper Extremity
- 20.