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As a new grad, its a bit scary when you have those "what on earth am i going to do here!!" moments. Had one the other day...

Can anyone give me advice RE improving ankle stability in CMT patients. What kind of ankle bracing, AFOs, etc have people found useful/ no good.

There's a mountain of products out there, i'm just wondering what people have had most, and least, sucess with.

Thanks.

 

Phil - you could try the SAFO by Dorset Orthopaedics http://www.dorset-ortho.co.uk/index.php?page=1000042 . My experience over the past three years with this product has been extremely positive. Contact Matthew Hughes or Bob Watts for further info. +44 (0) 1425 480065

Mark Russell

 

Mark

Have contacted the SAFO group re a polio patient of mine who happened to be going to the UK last year. They (SAFO) were concerned about how the patient would tolerate the device in the heat and humidity of Queensland, also the cost around $2000 for one foot was of concern. With that said I think it looks like a fantastic device.

Phil I suppose the big questions are how far has it progressed and what is the patient willing to do eg. shoes, exercises and braces. Have any xrays been taken and has the option of surgery been discussed?

Cheers

 

Dear Phil,
Perhaps you can supply some more details about your CMT patient:
1. CMT Type? (there are 53 types!)
2. Foot deformity - typical pes cavus or pes planus or 'normal'
3. Foot drop?
4. Symptoms besides 'ankle instability'? e.g. pain, functional limitation, etc.
5. Demographics - age, gender, occupation, etc.

I have done some work on the assessment and treatment of patients with CMT and would be happy to help,
Kind regards

Joshua Burns PhD, B App Sc (Pod) Hons
NHMRC Australian Clinical Research Fellow
Institute for Neuromuscular Research, The Children's Hospital at Westmead
Conjoint Senior Lecturer, Discipline of Paediatrics and Child Health
Faculty of Medicine, The University of Sydney, Australia

Email: joshuab2@chw.edu.au

 

It is important to look at the direction of instibility. If there is muscle weakness is one group more effected than others. In addition, you have to look at STJ axis location. If the patient has weak peronals, it is much more of a problem if they have a laterally deivated STJ axis than if they have a medially deviated STJ axis, because the ground is much more likely to cause a supination moment in the laterally deviated STJ axis foot. So, if it is a supination related problem then you need to add pronation moments in your treatment. (Valgus forefoot and rearfoot wedges) An ankle stirup lilke an aircast can be helpful for both inversion and eversion instablilty. You can go up from there to AFO's Ritchie Braces which have ankle hinges to allow ankle motion, but will prevent inversion.

I've seen CMT patients with weak peronals with pronation related problems. So, you should look at the foot and not just think CMT = Lateral instability.

Eric