Wegener Caleb, Wegener Katrin, Smith Richard, Schott Karl-Heinz, Burns Joshua
The University of Sydney, Sydney, NSW, Australia
Shoe Tech Pty Ltd, Sydney, NSW, Australia.
Prosthet Orthot Int. 2016 Aug;40(4):436-46. doi: 10.1177/0309364615579318. Epub 2015 May 1.
Charcot-Marie-Tooth disease is an inherited neuropathy causing progressive weakness, foot deformity and difficulty walking. Clinical anecdotes suggest orthoses designed on the 'sensorimotor' paradigm are beneficial for improving gait in Charcot-Marie-Tooth disease.
Investigate the effect of sensorimotor orthoses on in-shoe and lower limb biomechanics in adults with Charcot-Marie-Tooth disease.
Randomised, repeated-measures, exploratory study.
Eight males and two females with Charcot-Marie-Tooth disease aged 31-68 years fitted with pedorthic shoes and custom-made sensorimotor orthoses were randomly tested at baseline and after 4 weeks of adaptation. In-shoe three-dimensional multi-segment foot and lower limb kinematics and kinetics were collected as were plantar pressures, electromyography and self-reported comfort, stability, cushioning and preference.
Compared to the shoe only condition, sensorimotor orthoses increased midfoot eversion and plantarflexion, increased ankle eversion and produced small but significant changes at the knee and hip indicating increased internal rotation. The orthoses increased medial ground reaction forces and increased pressure at the heel, midfoot and toes. There were minimal effects on electromyography. The sensorimotor orthoses were rated higher for comfort, cushioning, stability and preference.
Sensorimotor orthoses produced changes in kinematic, kinetic and pressure variables in adults with Charcot-Marie-Tooth disease and were regarded as more comfortable, cushioned and stable during walking.
In this study, the walking ability of patients with Charcot-Marie-Tooth disease improved with the use of foot orthoses designed according to the sensorimotor paradigm. However, the mechanism of action appears to be primarily mechanical in origin. Randomised controlled trials are necessary to evaluate the long-term patient-reported outcomes of sensorimotor orthoses.
夏科-马里-图思病是一种遗传性神经病变，会导致进行性肌无力、足部畸形和行走困难。临床实例表明，基于“感觉运动”模式设计的矫形器有助于改善夏科-马里-图思病患者的步态。
研究感觉运动矫形器对成年夏科-马里-图思病患者鞋内及下肢生物力学的影响。
随机、重复测量、探索性研究。
8名男性和2名女性夏科-马里-图思病患者，年龄在31至68岁之间，穿着足部矫形鞋并佩戴定制的感觉运动矫形器，在基线期和适应4周后进行随机测试。收集鞋内三维多节段足部和下肢的运动学和动力学数据，以及足底压力、肌电图和自我报告的舒适度、稳定性、缓冲性和偏好。
与仅穿鞋子的情况相比，感觉运动矫形器增加了足中部外翻和跖屈，增加了踝关节外翻，并在膝关节和髋关节处产生了虽小但显著的变化，表明内旋增加。矫形器增加了内侧地面反作用力，并增加了足跟、足中部和脚趾处的压力。对肌电图的影响极小。感觉运动矫形器在舒适度、缓冲性、稳定性和偏好方面的评分更高。
感觉运动矫形器使成年夏科-马里-图思病患者的运动学、动力学和压力变量发生了变化，并且在行走过程中被认为更舒适、更具缓冲性和更稳定。
在本研究中，夏科-马里-图思病患者使用根据感觉运动模式设计的足部矫形器后，行走能力得到改善。然而，其作用机制似乎主要源于机械因素。有必要进行随机对照试验，以评估感觉运动矫形器长期的患者报告结局。
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