Background: Ankle foot orthoses (AFOs) are commonly prescribed to individuals with Charcot-Marie-Tooth disease (CMT). The aim of this study was to evaluate patient reported satisfaction with orthotic devices and services in individuals with CMT to provide preliminary data for advancing AFO development and improving clinical care. Methods: The Orthotics and Prosthetics Users Survey was distributed via e-mail through the Inherited Neuropathy Consortium (INC) Contact Registry and includes 11 device-specific questions and 10 service-related questions. Participants were also asked open-ended questions about their experiences with AFOs. Results: Three hundred and fourteen individuals completed the survey. Over one-third of participants provided negative responses, including dislike of AFO appearance, discomfort, abrasions or irritations, and pain. Ratings of orthotic services were generally positive. Conclusions: Lower scores related to discomfort, abrasions and pain identified areas for AFO improvement. Continued research in these areas will be beneficial to informing and advancing AFO development and improving clinical care.

Ankle foot orthoses (AFOs) control the position and motion of the ankle, compensate for weakness, and correct deformities. AFOs can be classified as passive or powered. Powered AFOs overcome the limitations of passive AFOs by adapting their performance to meet a variety of requirements. However, the actuators currently used to power AFOs are typically heavy, bulky, expensive, or limited to laboratory settings. Thus, there is a strong need for lightweight, inexpensive, and flexible actuators for powering AFOs. In this technical brief, Carbon Fiber/Silicone Rubber (CF/SR) Twisted and Coiled Artificial Muscles (TCAMs) are proposed as novel actuators for powered AFOs. CF/SR TCAMs can lift up to 12,600 times their weight with an input power of only 0.025 W cm-1 and are fabricated from inexpensive materials through a low-cost manufacturing process. Additionally, they can provide a specific work of 758 J kg-1 when an input voltage of 1.64 V cm-1 is applied. A mechanical characterization of CF/SR TCAMs in terms of length/tension, tension/velocity, and active-passive length/tension is presented, and results are compared with the performance of skeletal muscles. A gait analysis demonstrates that CF/SR TCAMs can provide the performance required to supplement lower limb musculature and replicate the gait cycle of a healthy subject. Therefore, the preliminary results provided in this brief are a stepping stone for a dynamic AFO powered by CF/SR TCAMs.

Objective Partial foot amputation (PFA) is often associated with decreased mobility and function. Recent advances in custom carbon-fiber dynamic ankle-foot orthoses (CDO) have improved gait, pain, and function following musculoskeletal trauma and may benefit individuals with PFA. However, limited information is available related to CDO use outside the military. The purpose of this case report is to describe the course of care and outcomes of a civilian provided CDOs after bilateral transmetatarsal amputation. Methods (Case Description) A 72-year-old man had a blood-borne bacterial infection (septicemia) of unknown origin at 68 years of age, developed limb threatening necrosis of the hands and feet, and received bilateral transmetatarsal amputations with skin grafting. The patient initially used foam toe fillers and cushioned shoes but was functionally limited and experienced recurrent ulceration. He was fit with bilateral CDOs 39 months after amputation and completed device-specific training with a physical therapist. Results After 1 week with the CDOs, ankle ROM during gait was reduced, but greater than 40% increases were observed in bilateral ankle plantar-flexor moments and ankle plantar-flexion push-off power compared with the toe fillers. With additional therapist-directed training focused on gait and activity performance, ankle plantar-flexor moments and plantar-flexion push-off power further increased when compared with results after 1 week of CDO use. The patient reported marked improvement in quality of life with the CDOs due to improved walking ability on level and uneven terrain, marked improvement in confidence, and reduced pain. Conclusion This case reflects the lessons learned and outcomes of a civilian using bilateral CDOs after bilateral transmetatarsal amputation and with poor skin quality. The results from this case study suggest that carbon fiber CDOs and focused training by a physical therapist can result in improved gait biomechanics, mobility and quality of life.

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Background:Shoes play an important role in ankle foot orthosis (AFO) function and alignment. Despite this, shoe mechanical testing systems are rarely colocated with gait analysis systems, limiting their availability and use during AFO-related studies.Objective:The purpose of this study was to evaluate a novel mechanical testing system used to measure shoe heel stiffness and change in height with loading using equipment available in most gait analysis laboratories. The novel testing system will allow for shoe assessment during AFO studies at little additional cost.Study design:Shoes were tested to determine initial stiffness, terminal stiffness, and total stiffness, and whether these measures changed with repeated compressions (early vs. late).Technique:The novel testing system consists of a baseplate for counterweights, uprights that support a low-friction hinge, and a lever arm with a heel-shaped indenter to apply force to the shoe. Minimal detectable change values were calculated using the standard error of measurement. Intraclass correlation coefficients were calculated in SPSS using a (2, k) model.Results:No significant differences in mean values, or interactions, were observed between rounds of testing and early and late compressions (P > .05). Intraclass correlation coefficient values were greater than 0.98, and minimal detectable change values were less than 20% of the average for each measure.Conclusions:The novel mechanical testing system, combined with pre-existing gait analysis equipment, can be used to reliably assess shoe stiffness and change in height.