Mr Victor
I met Victor while he was on holiday
as i took the photographs you see here,
a short while later i got a chance to talk
to him at length about his feet, he informed that the deformitity of his
feet was a result of Charcot-Mane-Tooth-Atrophy a disease named after
a Mr Charcot, Mr Mane and Mr Tooth, who first regognised the inherant
genetic condition which also has a variant condition, Charcot-Saunders-Atrophy.
We spoke at length and Victor said that he
would email me some details along with some early photographs of his feet
before and after surgery, the rest of this page is a transcript from his
email;
Victor is a 63-year-old farmer. He is
very active and farms more than 60 hours per week. Victor has been diagnosed
with Charcot-Mane-Tooth disease and has profound weakness in his lower
extremities. He was unable to stand without support and actually has crawled
on his knees to work on his farm equipment.
He previously was fitted with articulated
AFOs in hospital, but they were of little benefit because of the free ankle
design.
His gait pattern without orthoses was one
of exaggerated hip flexion with foot slap upon heelstrike and a knee hyperextension
moment during the heel-off portion of stance phase. Victor has poor knee
extensors and fair knee flexors with absent ankle plantarflexors and poor
grade dorsiflexors resulting in his tendons pulling his feet inward and
under. Victor was fitted with custom solid-ankle AFOs which enabled him
to walk, he wore them for many years prior to surgery. After surgery the
position of the feet in the orthoses was 5 degrees of plantarfiexion to
ensure floor reaction control for knee extensor stability.
The heel height of his left boot / shoe
had to be raised 2 inches to maintain sagittal knee alignment. Victor stood
without support for the first time and ambulated with long stride lengths
and good balance.
Victor also had significant lower-leg atrophy,
acquiring the "stork legs" appearance.
After three subsequent operations he said his
life was "almost normal," and he was able to work more effectively on his
farm. On Victor's last visit to hospital in 1979 the forefoot adduction
deformity was reduced to neutral, and new orthapeadic footwear was fabricated
to accommodate correction of the foot.
