Abstract
Ankle-foot orthoses are commonly prescribed in Charcot-Marie-Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop. This study aimed at assessing the effect of an anterior ankle-foot orthosis on walking economy in a group of Charcot-Marie-Tooth type 1A patients. Within-group comparisons. 7 Charcot-Marie-Tooth type 1A patients (four women and three men; 37 ± 11 years; age range = 22-53 years) were asked to walk on a circuit at their self-selected speeds ('slow', 'comfortable' and 'fast') in two walking conditions: (1) with shoes only and (2) with Taloelast(®) anterior elastic ankle-foot orthoses. Speed of walking and metabolic cost of walking energy cost per unit of distance were assessed at the three self-selected speeds of walking for both walking conditions. Speed of walking at the three self-selected speeds did not differ between shoes only and anterior elastic ankle-foot orthoses, whereas walking energy cost per unit of distance at comfortable speed was lower in patients using anterior elastic ankle-foot orthoses with respect to shoes only (2.39 ± 0.22 vs 2.70 ± 0.19 J kg(-1) m(-1); P < 0.05). In Charcot-Marie-Tooth type 1A patients, the use of anterior elastic ankle-foot orthoses improved walking economy by reducing the energy cost of walking per unit of distance, thus reflecting a lower level of metabolic effort and improved mechanical efficiency in comparison with shoes only. From a practical perspective, Charcot-Marie-Tooth type 1A patients with anterior elastic ankle-foot orthoses can walk for a longer duration with a lower level of physical effort. Improvements in walking economy due to ankle-foot orthoses are likely a consequence of the reduction in steppage gait.
Highlights
Ankle-foot orthoses are commonly prescribed in Charcot–Marie–Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop
The post hoc analysis showed that the walking energy cost per unit of time (WECt) was lower in shoes only with respect to A-Ankle-foot orthoses (AFOs) at comfortable speed (P < 0.05), whereas WECt was higher in shoes only with respect to anterior elastic AFOs (A-AFOs) at fast speed (P < 0.05)
The post hoc analysis showed that walking energy cost per unit of distance (WECd) (Figure 3) was lower in shoes only with respect to A-AFO at comfortable speed (P < 0.05), whereas WECt was higher in shoes only with respect to A-AFO at fast speed (P < 0.05)
Summary
Ankle-foot orthoses are commonly prescribed in Charcot–Marie–Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop. Conclusions: In Charcot–Marie–Tooth type 1A patients, the use of anterior elastic ankle-foot orthoses improved walking economy by reducing the energy cost of walking per unit of distance, reflecting a lower level of metabolic effort and improved mechanical efficiency in comparison with shoes only. Patterns of walking in CMT patients have been extensively described by means of motion analysis These studies highlighted that the main limits of CMT walking are instability of the ankle in the sagittal plane,[13] increase in plantarflexion during the initial contact,[14] higher dorsiflexion during the stance phase,[14,15] loss of active push off,[13] higher knee and hip flexion,[14] the asymmetric hip movement in medio-lateral plane,[16] hip elevation[14,16] and decrease in hip adduction.[14,16] the altered patterns of walking result in an increased energy cost of walking, which has been assessed by measuring both the mechanical displacement of the body centre of mass[14] and oxygen consumption.[17]
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