Prescription of foot and ankle orthoses for children with Charcot-Marie-Tooth disease: a review of the evidence

Background: Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy and is associated with debilitating lower limb impairments and activity limitations. These impairments and activity limitations are potentially amendable to the prescription of orthoses, yet there is no universal, literature-based consensus to inform the decision making process of whether or not orthoses are indicated for a particular child with CMT, and if so, what type of device. Objectives: The aims of this paper were to: (1) review the lower limb impairments and activity limitations of children with CMT; (2) review the indications of commonly prescribed foot and ankle orthoses; and (3) formulate a clinical algorithm for the optimal prescription of foot and ankle orthoses for children with CMT. Major findings: We conducted a comprehensive search of the major databases and reference lists of relevant articles and books. In general, in-shoe orthoses are indicated for children with CMT and pes cavus and foot pain and/or mild balance impairments, whilst ankle-foot orthoses are indicated for children with CMT and pes cavus, foot drop, global foot and ankle muscle weakness and/or ankle equinus, and moderate-severe balance impairments and/or difficulty walking. Conclusions: A clinical algorithm is proposed to guide the prescription of foot and ankle orthoses for children with CMT. Further research is required to determine the efficacy of different foot and ankle orthoses, and the predictive ability of the proposed clinical algorithm, to improve the lower limb impairments and activity limitations of children with CMT.