Assessment of Appropriate Ankle-Foot Orthoses Models for Patients with Charcot-Marie-Tooth Disease

Guillebastre B, Calmels P, Rougier PR: Assessment of appropriate ankle-foot orthoses models for patients with Charcot-Marie-Tooth disease. Am J Phys Med Rehabil 2011;90:619-627. Objective: The purpose of this study was to demonstrate to what extent ankle-foot orthoses improve posture and gait control in patients with Charcot-Marie-Tooth disease and to identify the most appropriate characteristics of ankle-foot orthoses for patients regarding their clinical characteristics. Design: Twenty-six Charcot-Marie-Tooth patients were recruited. Clinical data (such as levels of sensory and muscular deficits) and posture and gait capacities were collected in three randomized experimental conditions (wearing ordinary shoes or with plastic and elastic orthoses). Several subgroups of patients, constituted using predictive value analysis, were associated using the probabilities of enhancing posture and gait control while wearing the various models of orthoses. Results: Compared with ordinary shoes alone, adding plastic ankle-foot orthoses partially improved both gait and posture control, whereas wearing elastic orthoses only partially affected the more dynamic gait control. Furthermore, the choice between the two models can be clarified by taking into account distal lower limb muscle capacity. Conclusions: Ankle-foot orthosis prescription appears relevant for improving balance and gait performance in Charcot-Marie-Tooth patients, particularly when the model adequately compensates for specific muscle deficits. This study also provides objective arguments for making adequate bracing.