April 2018

Supportive footwear for children with CMT

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The effect of footwear on gait and balance of children and adolescents with Charcot-Marie-Tooth (CMT) disease is of interest to parents and clinicians. Children with CMT, which causes progressive damage to peripheral nerves, particularly the feet and ankles, often have gait difficulties due to muscle weakness, including problems with balance, resulting in falls.

Researchers from Australia evaluated different styles of footwear and their relation to specific gait and balance parameters. Subjects included 30 children and adolescents with CMT and 30 healthy volunteers, ranging in age from 4 to 17 years. The CMT group included children and adolescents with different genetic defects. Inclusion criteria were the ability to walk >75m without gait aids (orthoses permitted). Exclusion criteria included developmental disorders, neuromuscular/musculoskeletal disorders that could affect gait, and lower limb injury or surgery in the preceding 6 months. Assessments of anthropometry, gait, footwear, and disease severity were conducted at a single study visit.

The 2 groups wore similar shoes including several types of optimal footwear, such as athletic-type runners, high-top leather or canvas boots, leather school shoes, and canvas shoes with laces; and suboptimal footwear, such as flip-flops, slip-on footwear, sandals, and slippers. Seven participants with CMT wore foot orthoses.

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For both groups, the optimal footwear was found to improve gait compared to suboptimal footwear and walking barefoot, and was found to significantly improve gait speed, promote longer steps, and decreased cadence. The base of support was found to be wider in both types of footwear compared with barefoot, which may be a compensatory response to the reduced sensory feedback in footwear and subsequent reduced balance, researchers noted. Also, the degree of difference was almost double in suboptimal footwear compared with optimal footwear.

Although the researchers found no interaction effect, they demonstrated that walking in suboptimal footwear resulted in worse gait performance in both groups of children, but that the finding may have greater clinical implications for children with CMT as they may be less able to successfully compensate for such changes brought about by loose or unfastened footwear. Additional studies are needed to further understand the effect of suboptimal footwear on CMT children and the potentially adverse effects it has on gait, such as falls.

Source:
Kennedy RA, McGinley JL, Paterson KL, et al. Gait and footwear in children and adolescents with Charcot-Marie-Tooth disease: A cross-sectional, case-controlled study. Gait Posture. 2018;19;262-267.

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