A Charcot foot is very much like a Dropfoot from a biomechanical standpoint. There is always significant equinus and there is weakness of the anterior tibial musculature from motor neuropathy. In addition, there are foot deformities that mimic the changes seen in Posterior Tibial Tendon Dysfunction. Therefore, the Richie Brace, with certain design modifications has and can be used for some types of Charcot Foot types.
There are some concerns with this pathology which should be considered. First, the Richie Brace is semi-rigid plastic brace. Patients with severe sensory neuropathy should not be wearing this type of appliance. Secondly, the primary deforming force in Charcot feet is in the sagittal plane exerted by the tight Achilles causing rocker bottom effect to the midfoot. A traditional fixed AFO is better designed to resist this deforming force in severe cases. Thus when using the Richie Brace for Charcot, we recommend a fixed ankle pivot to resist sagittal plane force exerted by the heel cord. Secondly, we recommend the Diabetic top cover (Plastizote/Poron laminate) full length on the Richie Brace orthotic footplate. Finally, we recommend that the patient have only mild to moderate sensory neuropathy.
Via, Dr. Doug Richie
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