ABSTRACT
BACKGROUND: The dynamic plantar pressure patterns of children and adolescents with Charcot-Marie-Tooth (CMT) disease and its relationship to musculoskeletal alterations may help to understand the natural history of the disease and improve therapeutic interventions. RESEARCH QUESTION: The study compared dynamic plantar pressure patterns in children and adolescents with and without CMT. It also tested the associations between isometric muscle strength (IMS), passive range of motion (ROM), foot posture and dynamic plantar pressure patterns in CMT. METHODS: This cross-sectional study compared children and adolescents (aged 8-18 years) with CMT (nâ¯=â¯40) with a typical group (nâ¯=â¯40). The plantar pressure distribution during gait was recorded, and the contact area (CA), peak pressure (PP), contact time (CT) and pressure-time integral (PTI) in five foot regions (rearfoot, midfoot lateral, midfoot medial, lateral forefoot and medial forefoot) were analysed. The IMS of the dorsiflexors and plantar flexors, passive ROM, and foot posture were also recorded. RESULTS: PP (medial midfoot and medial forefoot) and PTI (rearfoot, lateral midfoot and medial forefoot) were higher in children with CMT compared with the typical group. The adolescents with CMT presented a less CA (whole foot) and a higher CT (medial midfoot) when compared with typical group. For CMT, in the medial midfoot, plantar flexor IMS associated with PP (ß=-11.54, pâ¯=â¯0.01) and PTI (ß=-3.38, pâ¯=â¯0.04); supinated foot posture associated with PP (ßâ¯=â¯33.89, pâ¯=â¯0.03) and PTI (ßâ¯=â¯12.01, pâ¯=â¯0.03). SIGNIFICANCE: Children with CMT showed clear changes in most of the dynamic plantar pressure variables, while adolescents with CMT showed changes mostly in CA and CT. This information together with the associations established between supinated foot, dorsiflexion ROM and plantar flexions IMS can be useful for guiding rehabilitation professionals in their therapies.
Subject(s)
Charcot-Marie-Tooth Disease/physiopathology , Foot/physiology , Gait/physiology , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Male , PressureABSTRACT
This study aimed to verify whether there are differences in foot type, physical function, and performance between children and adolescents with Charcot-Marie-Tooth disease (CMT) and their healthy counterparts, and whether an interval of 6 months, from the initial assessment, reveals any significant changes on physical performance and other specific physical measures of the lower limbs. Subjects and Methods: Participants between 6 and 17 years of age, with CMT (CMT group n = 40), were compared to healthy participants (Control group, n = 49). Twenty participants with CMT completed the follow-up. We collected anthropometric, goniometric (ankle and knee), and dynamometric (inversion, eversion, plantar flexors, dorsiflexors, knee, hip extensors) measures, agonist/antagonist ratios, feet alignment (Foot Posture Index - FPI), muscle power (Long Jump), Pediatric Balance Scale (PBS), and 10-meter walk test (10MWT). Results: Compared to Control, CMT showed reduced passive range of motion (ROM), weakness in all evaluated muscles, increased agonist/antagonist ratios, predominance of varus and lower performance (PBS and Long Jump). After 6 months, CMT measures did not change. Conclusion: The cross-sectional analysis showed reduced ROM, strength, power, and distal muscle imbalance, as well as secondary limitations (PBS and 10MWT) in children and adolescents with CMT. These biomechanical and functional alterations did not change at the 6-month follow-up.
Subject(s)
Ankle Joint/physiopathology , Charcot-Marie-Tooth Disease/physiopathology , Muscle Strength/physiology , Physical Functional Performance , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Male , Range of Motion, Articular/physiology , Walk TestABSTRACT
BACKGROUND: Histomorphometric studies of unmyelinated fibers of the rat fibular nerves are uncommon, and side-to-end neurorrhaphy studies using the fibular nerve investigate primarily motor fibers. We investigated side-to-end tubulization (SET) technique, in which occurs collateral sprouting from the intact donor nerve fibers to the distal stump of receptor nerve, with muscle reinnervation and functional rehabilitation, to assess whether there is a successful growth of unmyelinated fibers in this model. METHODS: Adult Wistar rats fibular nerves were sectioned to create a 5-mm gap. A 6-mm silicone tube was attached between a side of the intact tibial nerve and the sectioned fibular nerve distal stump (SET group), with the left fibular nerve as normal (sham group). Seventy days postsurgery, unmyelinated fibers from the distal segment of the fibular nerve were quantified using light and transmission electron microscopy and their diameters were measured. RESULTS: The number of unmyelinated fibers was similar between sham (1,882 ± 270.9) and SET (2,012 ± 1,060.8), but axons density was significantly greater in the SET (18,733.3 ± 5,668.6) than sham (13,935.0 ± 1,875.8). Additionally, the axonal diameters differed significantly between groups with mean measures in sham (0.968 ± 0.10) > SET (0.648 ± 0.08). CONCLUSIONS: Unmyelinated fiber growth occurred even with a 5-mm distance between the donor and receptor nerves, reaching similar axonal number to the normal nerve, demonstrating that the SET is a reliable technique that can promote a remarkable plasticity of unmyelinated axons.
