ORLANDO, Fla. — Both orthotic and surgical options can be indicated for ideal treatment of patients with Charcot-Marie-Tooth (CMT) Disease, according to a symposium on the topic presented at the 2011 Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists.
Patients with CMT ultimately benefit from the use of a multidisciplinary team, because of the separate and specific roles that orthotists and orthopedic surgeons play in their treatment. Stephen F. Conti, MD, director of the division of foot and ankle surgery at Allegheny General Hospital in Pennsylvania and associate professor of orthopedic surgery at Temple University College of Medicine, said that he appreciates working with orthotists for that reason.
“The reality is in the orthopedic community, I think there are a lot of people who take care of lower extremity, but not a lot of people unfortunately who really understand lower extremity mechanics like [orthotists] do,” he said.
Michael E. Shy, MD, neurology specialist at Harper University Hospital in Detroit and professor of neurology at Wayne State University School of Medicine, provided some background on the disorder. He noted that there are 40 genes that can cause inherited neuropathies, and studies show that up to 10% of the population has a peripheral neuropathy. The most common type of inherited peripheral neuropathy, CMT has an estimated prevalence of 1 in 2,500 and it can be traced directly to its source in many instances.
Given this information, Shy said that patients and their families want to know who else in their family is at risk.
“It matters to families, knowing the [likelihood of] inheritance for CMT,” he said.
|Michael E. Shy|
Sean McKale, CO, LO, practice manager of Midwest Orthotic and Technology Center in Chicago and Merrillville, Ind., touted the role of the neurologist in the treatment team as someone who expands “the understanding of how the disease is likely to progress and effect the individual,” he said. “Knowing the specific type of CMT helps to clarify what those expectations may be.”
Responding to audience questions, Conti added that, as orthotists, the patient’s medical diagnosis often is irrelevant to the treatment.
“You don’t need the medical diagnosis,” he said. “You need diagnose the biomechanic issues and provide treatment.”
McKale agreed, saying, “The diagnosis is almost unimportant.”
He urged orthotists not to get caught up in that aspect of treatment and, instead, provide the patient with the best device and care possible.
“We need to be concerned with the overall picture of the person and what we’re seeing when we’re treating these patients, because ultimately the decisions we are making as orthotists affect the outcome,” he said. “If we’re not making the proper decisions then that outcome is not going to be what the patient wants and the brace is going to get thrown on the shelf.”
Making the decision for surgical options also affects the use of orthoses. Treating a patient at the level of early supple deformity might indicate trying orthotic intervention as the best option; however, a patient at the same level also might be the best candidate for tendon transfer surgery to rebalance foot, Conti said.
Another benefit of surgery, he said, is that it might not completely eliminate the need for an orthosis, but downgrade the level of orthosis necessary for treatment.
For many CMT patients, McKale said, surgery is not a guarantee that orthotic devices will not be needed. For most patients, it is more a question of how long they will wear them.
“Ultimately, this is a lifelong disease that will continue to progress, and patients will have to have realistic expectations about what that means,” he said.