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http://www.orthotist.co.ukOrthotic Management of Charcot Marie Tooth
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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
Fitting Stage
Is Biomechanical Objective Being Achieved?
Yes No
Follow Up Return To Beginning
Review
Manufacture
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
Mm
d D
For Rotation Equilibrium to occur the net turning moment must be zero
M x d= m x D
GRF
MF
2D D
GRF x 2D = MF x D
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 when brace removed
Push Aequi.
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