Guideline-based provision of ankle-foot orthoses improves walking ability in individuals with Charcot-Marie-Tooth disease.

Abstract

Ankle-foot orthoses (AFOs) are commonly prescribed to individuals with Charcot-Marie-Tooth (CMT) disease, despite limited evidence for their effectiveness in improving walking ability. This study evaluated the effectiveness of AFOs provided according to the Dutch orthotic guideline in individuals with CMT. Individuals with CMT receiving their first guideline-based AFO between 2012 and 2024 were included. Baseline measurements (with shoes or standard-care AFOs) were compared with follow-up measurements after three months of guideline-based AFO use. Outcomes included walking speed, energy cost of walking, gait biomechanics, and perceived functioning. Data were analyzed for the whole group and for subgroups with and without baseline AFO use. Forty-eight participants were included; follow-up data were available for 24 (13 without AFO at baseline). Guideline-based AFOs significantly improved walking speed, energy cost of walking, gait biomechanics, and 6/7 perceived walking ability items (all <i>p</i> ≤ 0.033). Participants without AFO at baseline showed similar improvements (all <i>p</i> ≤ 0.040). Participants with AFO at baseline showed significant improvements on walking speed, ankle biomechanics, and 3/7 perceived walking ability items (all <i>p</i> ≤ 0.046). Guideline-based AFO provision improved objective and perceived walking ability in individuals with CMT, including those already using a standard-care AFO. These results support further implementation of the guideline.