Questions about bracing

When to brace
(October 1993)
Q: "I am interested in the wearing of splints or orthotic devices. I'd like to know whether it is better to wait as long as possible before using such aids or if I should have my children looked at and find out if they need orthotics now."

Dr. Kamal Ibrahim, Chief, Section of Pediatric Orthopaedics and Scoliosis, Loyola University Medical Center, and Clinical Professor of Orthopaedics, Loyola University, Chicago, replies:
"I believe that braces have an important role in the management of foot problems with CMT but also, if they are overly used, it can lead to disuse weakness and atrophy for the muscles; therefore, I believe braces are indicated in the following situations:
1. Patients who have drop foot gait, i.e., they are dragging their feet or they are touching the floor with their toes before their heel.

These patients would benefit a lot from ankle/foot orthoses which will splint the ankle and give them a much better gait and stability on the ground.
2. Children who start to show some feet deformities can benefit from physical therapy and night splinting which might delay the development of the deformity by maintaining supple feet between the sessions of therapy.
3. Children who had correction for their deformities with surgery but, due to the significant muscle weakness, they feel unstable on walking might benefit from ankle/foot orthoses just to add stability for the gait.

Besides this major indication for bracing, I feel that indiscriminate bracing might lead to excessive muscle weakness. I always support the early surgical intervention to correct the cavus and/or varus deformity to avoid any further deterioration, rigidity and/or the need for triple arthrodesis."

How long can I wear my AFOs (June 2001)

Q. I read somewhere that AFOs should not be worn for more than eight hours at a time and I am concerned.

Dr. Robert Sampson, who has CMT, answers: I am not aware of an eight-hour limit on orthotics. I wear mine 16 hours a day and would be lost without them for the second eight hours. Possibly he misinterpreted what was said. For instance, early on one needs to get used to orthotics and we often advise limited use, with a progression to wearing them, as tolerated, for a full day. Another possible explanation, some people who need braces will get weaker when they wear them and so I try to minimize the time in the brace, if that is possible. One good way to really get atrophy of a weak muscle is brace it. Other than these two ideas I am not sure why he was told that there was an eight hour limit.