1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-39
BIOMECHANICS OF GAIT IN CHARCOT-MARIE-TOOTH DISEASE
Õunpuu, Sylvia, MSc, Westwell, Melany, PT, Bell, Kathy, MS,
Brian Smith, MD and DeLuca, Peter, MD
Connecticut Children's Medical Center, Hartford, Connecticut, USA
Summary/conclusions
Motion data indicate that there are distinctively different types of gait patterns in children and
youth with CMT. The primary deformity seen in most cases was late peak ankle dorsiflexion
in stance (ST); the secondary deformity was excessive peak ankle dorsiflexion in ST.
Excessive equinus in swing or drop foot was much less common. The variation in gait patterns
would suggest the need for different treatment strategies spcific to the individual and
depending on gait presentation.
Introduction
Charcot-Marie Tooth (CMT) is characterized by distal muscle weakness and imbalance with
associated gait implications which progress at varying rates. The textbook gait description
includes: foot drop in swing phase, steppage (hyper-flexion of knee and hip in swing),
circumduction and pelvic hiking. However, clinical observation would suggest that gait
patterns in persons with CMT do not match a single set of parameters. It is possible that there
are a variety of patterns of gait in CMT that could be defined more accurately with the use of
computerized motion analysis. Therefore, the purpose of this study was to document
objectively the characteristic gait patterns in children with CMT.
Statement of clinical significance
Identification of gait patterns in CMT would improve our understanding of the pathomechanics
of gait in persons with CMT. This would also provide a stronger basis for determining the
prognosis for future ambulatory function, treatment decisions and ultimately improve treatment
outcomes.
Methods
Nineteen patients (9 male/10 female) with a mean age of 13±3 (range 6 to 19) years and a
diagnosis of CMT where included in this study. All patients were independent ambulators with
no previous lower extremity surgeries. All had ankle/foot deformity for which surgical
intervention was being considered. Each patient underwent a three-dimensional motion
analysis using standard techniques 1 . A comprehensive clinical examination including passive
joint range of motion and muscle strength measures was also completed. All gait data were
compared to normal reference data collected in the same laboratory 2 . A Students t-test was
used for comparisons with normal reference data (p