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A Walk in the Park-
Orthotics and Braces Make Life Easier for CMT Patients.  The simple task of walking is not so simple for many CMT patients. If you have CMT, you know that the disease can make getting around a major challenge.
We consulted with our resident orthotics expert, Mitchell Warner, CPO, of Ortho Rehab Designs in Las Vegas, to provide you with a primer on "putting your best foot forward." Here are some of the steps to take for receiving the proper treatment and orthotics to make walking easier and more productive. The first step is to find a board certified orthotics specialist who works frequently with CMT patients. Warner feels that this is essential. A good orthotist will work with your physician or physical therapist in order to ascertain muscle strengths and physical condition that will help in the design of your orthosis. Search for an orthotist who asks questions and listens to your very personal problems with CMT. With so many types of CMT, from mild to severe, you want a practitioner who approaches each case individually. He or she should also be willing -- and able -- to design an orthotic device for your specific needs and physical mechanical profile. Says Warner, "When I established Ortho Rehab Designs in 1991, my goal was a focus on hard-to-fit patients that required stability and prevention of further deformity. My primary goals have always been to increase function and endurance for my patients." Goals for the CMT Patient:
1. To prevent any further deformity.
2. To correct of any deformity already present.
3. To improve limb function. The primary goal of any orthosis is to prevent any further deformity. Once this is achieved, new alignment can be put in place, and better balance develops. If you achieve all three goals, you will experience improved alignment, which equals enhanced balance and usually results in an increased walking speed. Orthotics & Braces
Born with a foot deformity and defects in the skeletal structure of his right foot, Warner has worn orthotics since he could walk at age one. "Throughout my professional life I have always sought out more ways to control my foot structurally and maintain as much function as possible." He has found that orthotics with carbon graphite and silicone combine to create maximum correction and comfort. Warner's severe foot deformity led him to develop bracing systems that can prevent further joint deterioration and maintain function. He says, "Like all CMT patients, I do not want to have joints and muscles that deteriorate with age. The goal is to maintain as much of what you have throughout your entire life". One way to make sure your symptoms do not slide rapidly downhill is to seek out braces for your condition. Below, Warner describes the revolutionary technology now available in bracing systems. Ortho Rehab Designs recently invented the Helios™, which incorporates an extremely high modulus carbon-graphite composite that creates a very high level of energy loading and dynamic release. It also incorporates a footplate using a custom-designed silicone padding system. "You can tolerate greater loads and feel more comfortable throughout the day using silicone. I have used silicone on my own foot and this is what led me to realize its value, and to incorporate it into my bracing system". How do braces help people restore balance? By correcting and stabilizing the deviations in joint alignment. How is stability achieved in bracing? The broader the supporting area, the greater the stability. Greater stability equals greater balance. Through careful mechanical design of the orthosis, stability is achieved by 1) the alignment of the orthosis, 2) the mechanical design of the footplate (the aspect that you bear weight on). Designing the orthosis with stability brings your center of gravity to a more normal standing position. This directly translates to better balance while standing and walking. Through proper brace design and reduction of gait deviations, better balance and stability is attainable.
Correction vs. Overcorrection
With CMT, orthotists want to correct your foot as much as possible, but not beyond what your body can tolerate. Your orthotics should be comfortable and provide maximal correction. To this end, appropriate alignment allows greater tolerance to correction and greater comfort. The Right Fit
After your initial evaluation at Ortho Rehab Designs, you lower limbs will be custom molded. Next, a plaster mold is made of your limbs, and then mold rectifications takes place. This brings us to the diagnostic stage of your visit. Once the mold is properly rectified with specific measurements and data from your videotape, a diagnostic orthosis is then made. The diagnostic orthosis serves as a fitting tool. From this we get back important information on how to make your final carbon graphite orthosis. The diagnostic orthosis helps us determine:
1. Your fit.
2. The proper structural alignment of your limb and joints.
3. Your comfort. We will work with you in the diagnostic orthosis for approximately one day. Once we have determined that the fit, alignment, and comfort are all in check, we will then go to final fabrication of your carbon graphite Dynamic Response Orthosis. The diagnostic serves as a prototype to ensure a proper fitting final device. Creating Corrective Energy
If your joints are misaligned, especially when wearing an orthosis, the whole body is fatigued, depleting your oxygen. Thus, you are losing energy with every step. This is the worst possible thing that could happen to a brace wearer, as losing energy creates greater fatigue and, in addition, can cause further muscular weaknesses as the body tries to compensate. For example, when a foot has been derotated, and the knee is taken out of hyperextension, we get corrected alignment. This corrected alignment, linked with a proper stabilizing fit that uses corrective three-point pressure systems, will allow you to maintain proper alignment and have a much improved gait. You will be less fatigued and have greater endurance while walking in your orthotics; with the addition of a dynamic release brace, you will get more energy from the entire process. When a brace user is not in proper alignment, does not have a proper fit, or proper three-point pressure corrective systems, that person will lose energy as they walk. Your goal is to produce energy, energy that corrects and gives back to the wearer. This energy also increases velocity, which in turn produces better balance and stability. Common Questions about Braces & Orthotics As you research bracing for CMT, you will have many questions. Mitchell Warner addresses the most common ones here. We urge you to e-mail us with any questions or concerns you may have. Question:
I have a high stepped gait. Will this disappear with braces?
Answer:
Yes, but only if you are braced in proper alignment. Question:
I feel off balance in my current AFOs. Why is this?
Answer:
It can be due to a poor fit, or poor fit in conjunction with poor alignment. Question:
I feel extremely tired after walking a long distance, is this related to my braces? Answer:
This is a strong indicator that you are not getting the benefits from an energy return system. Or you might be walking with gait compensations that are causing early fatigue. Question:
With my current brace I am getting severe pain in my foot from the footplate. Why is this?
Answer:
Generally, this is due to poor mold rectifications. It might be over corrected, or there simply might not be any correction at all. This is something that needs to be checked. Question:
What are floor reaction forces?
Answer:
The reaction from the floor as an object, such as a ball or a foot, or a braced limb strikes it. Question:
With my current braces I try to get to a faster walking speed and I have trouble sometimes, as there is a hesitation when my foot tries to rollover. Why is this?
Answer:
It can be because: 1) There is not enough energy loading, and consequently not enough energy released by your brace. 2) If your brace has a full-length footplate and you have strong quadriceps muscles, you will not be able to bend your metatarsals enough. In addition, a full-length footplate with a person who has good quadriceps, causes a tremendous amount of floor reaction. Floor reaction used in bracing systems is generally done for the purpose of creating an extension force at the knee, and preventing the knee from buckling. This is not a desirable force system to use with a person who has good quadriceps. Question:
How fast should I be walking?
Answer:
The average of human walking speed is 3.0 miles per hour. Related links:
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