Improving foot posture, balance in CMT may aid ankle stability

Early care advised for FAI prevention.

Functional ankle instability (FAI) is a common problem in children and adolescents with Charcot-Marie-Tooth disease (CMT), according to Australian research that advises further study of interventions that target balance and normalize foot structure to evaluate whether they can help improve ankle stability in this population.

“…ankle sprains in children with CMT are not prevented adequately as the neurological condition is not often diagnosed in childhood, unless present in another family member. He noted that the child may be seen as clumsy until CMT is diagnosed in adulthood.” David Misener CPO MBA.

foot-orthotics-for-childrenBy Katie Bell, Lower Extremity Review February 2016

Lead author Kristy Rose PhD, a lecturer in pediatrics at the University of Sydney, said, “One of the reasons we decided to do this study was because our pediatric patients with CMT report a high incidence of ankle instability that includes ankle sprain during their daily activities. We know that FAI has the potential to cause significant pain and disability, which could be a big problem for these children who already have underlying pathology resulting from their peripheral neuropathy.”

The study’s aim was to investigate the relationship between FAI and other functional, structural, anthropometric, and demographic characteristics in children and adolescents with CMT.

Investigators from the Institute for Neuroscience and Muscle Research at The Children’s Hospital at Westmead in Sydney recruited 30 children (16 girls) with CMT aged 7 to 18 years. An assessor trained to administer the Cumberland Ankle Instability Tool asked children and their parents questions about their perceptions of ankle instability in both the left and right ankle.


SureStep photo.

Of the participants, all but one (29) reported moderate to severe bilateral FAI. Girls reported greater ankle instability than boys. FAI was associated with cavus foot structure, which was evident in 13 participants, with a more severe cavus foot posture associated with greater ankle instability.

The researchers noted the majority of studies on CMT that have identified pes cavus as a common feature have been in adults and that foot structure may progress to a more cavus posture later in life, especially during musculoskeletal growth. FAI was also associated with female gender and impaired toe-to-heel balance.

The findings were published in the Journal of Foot and Ankle Research in November 2015.

Commenting on the link between FAI and female gender, Rose noted, “One of the reasons was perhaps girls were better reporters of FAI, were more mature than males of the same age, and had a better understanding of their bodies. The other thing could be flexibility and hypermobility. We didn’t assess hypermobility, one of our regrets, but hypermobility is more commonly seen in females than males. Perhaps our female participants had greater joint laxity that made them more susceptible to FAI.”

Continue reading in Lower Extremity Review

Correlates of functional ankle instability in children and adolescents with Charcot-Marie-Tooth disease, Rose KJ, Hiller CE, Mandarakas M, Raymond J, Refshauge K, Burns J. J Foot Ankle Res. 2015 Nov 5;8:61. doi: 10.1186/s13047-015-0118-1. eCollection 2015.

Also see
Ankle instability treatment focuses on postural control in Lower Extremity Review
The Pitter-Patter of Little Feet: Kids and the ‘Pedal Foundation’ in Foot Levelers

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