http://www.orthotist.co.uk Orthotic Management of Charcot Marie Tooth

1. 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)

2.  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.

3.  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.

4.  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

5.  Neurologist
 Orthopaedic Surgeon
 Orthotist
 Physiotherapist
 Podiatrist?

6.  Named in 1886
 Common inherited
Neurological disorder
 Affects 1:2500 people
 Affects peripheral
sensory and motor
nerves
 Mainly affects feet
and hands
 Slowly Progressive

7.  Impaired Balance
 Recurrent Ankle
Sprains/fractures
 Changing foot shape
(high arch, flat foot
 Drop-Foot
 Reduced hand
function

8.  Motor nerve
degeneration
 Typically weakening
Peroneal muscles
(ankle evertors)
causing muscle
imbalance
 Repeated sprains
weaken lateral ankle
structures

9.  Weakness in Peroneal
Muscles
 Initially ankle feels
unstable
 Made worse on
uneven ground
 Frequency of sprains
increases

10.  Weakness of pre-tibial
muscles
 Initially causes
increased tripping
 Foot Slap
 Compensation by
bending knee and hip
excessively to help
swing leg through

11. 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

12. This must include:
Weight Bearing and Non-Weight Bearing Exam
Static and Dynamic Assessment
Proprioception
Physical Examination

13. For every patient and EVERY Joint
 Ask about discomfort/pain in segment
 R.O.M (Range of Motion)
 Muscle Strength
 Limitations/compensations
 Soft tissue

15. “Neutral”
Supination Pronation

16.  Protect against
excessive ankle
inversion
 Function is to
evert ankle and
forefoot

23. M
m
d D
For Rotation Equilibrium to occur the net turning moment must
be zero
M x d= m x D

24. MF
2D D
GRF
GRF x 2D = MF x

25.  Improve Balance
 Improve Stability
 Improve Walking
Pattern
 Prevent deformity
 Reduce Pain
 Supplement function
of weakened muscles
 Reduce need for
Surgery

26.  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

27.  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?

28.  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

29.  Aim to improve
stability and reduce
pain
 Rarely pre-made
 “Gold standard” is
custom made
 Wedges added to
improve alignment
and stability

30. 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

31. 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

32.  Correct drop foot
 Increase ankle
stability
 Improve balance
 Prevent contractures
 Can be bulky and
cause problems with
footwear
 Should be comfortable
 Strong durable
devices

33.  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

34.  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

35.  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

36.  Used to provide
increased forces
 Must be used in
conjunction with
appropriate
footwear
 Must be used in
conjunction with
foot orthosis

38.  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