CMT foot Replies

CMT foot Replies

shraddha rasal

3/9/2013

Hello List,

Thanks to all for their time and opinion. These are the replies;

High arch, met pads and lateral forefoot arch on a fairly rigid base of
let's say copoly with a puff or trilam cover. The lateral forefoot post is
critical because the CMT foot as it becomes cavus, tends to invert and
supinate. Good challenge!

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Total contact is the only rule. Total contact iinsole, encompassed into a
well moulded AFO, with the needed rubber rocker will be the best you can
offer. If you refer to CROW Walker, you will get good idea. Fabrication
is also available as you tube video.

They usually have a very cavus arch. I like to mold with intention of
posting lateral and dropping the
1st met head severely to neutralize mid and fore foot inversion and even
reducing some of the heel varus.
Material selection is usually multi density with firm posting materials for
lateral heel/forefoot. Orthopedic extra depth shoes
are a must for this type of fitting.


The more you understand CMT, the more complex the issues of the CMT foot
will be realized and solutions to solve them. One must understand the
progressive nature of the type of CMT the person has and which of the two
mechanical profiles they will most likely follow. 70% of CMTers will
develop a Pes Cavus profile of the foot, but globally, they will develop an
external rotary pathway (ERP) with deformity. 30% will follow the Pes
Planus with joint laxities and up the chain will have an internal rotary
pattern (IRP). They soon develop a steppage gait due to the neurological
issues of CMT. Foot orthoses may only be beneficial in the very early
stages of progression. CMTers have triplanar mechanical issues that are
hard to control with a single plane device. An FO can influence the three
dimensions only in the early detection phase of deformities.

The ERP foot often becomes rigid and more difficult to manage. The weight
line shifts laterally and the lateral aspect of the foot receives the
majority of the weight and increased pressures. The metatarsal heads and
the base of the fifth are often sore from pressure and need relief.
 Walking balance is greatly reduced. They become more unstable laterally
and will start widening their base of support as a compensation for
security. The IRP foot bares most of the weight medially which slowly
breaks down the mid foot. In my practice, I only use corrective forces to
stop the progressive nature of the deformities in all three dimensions, 26
bones of the foot times 3D, is required to reestablish the normal levers.
 I often reduce and remodel deformities which enables better weight
distribution, improves balance, and mobility. This is only touching on a
small aspect of CMT orthotic treatment.

Thanks to all


Shraddha

Clinical Orthotist & Prosthetist


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