Custom Orthotics to Mitigate Effects of Chemotherapy-induced Peripheral Neuropathy

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a complication commonly involving extremities characterized by dysthesias. Given the predilection towards diminished proprioceptive feedback, balance and gait deficits often result, leading to an increase in falls risk. To date there is no published evidence to support the use of orthotics in the treatment of balance dysfunction secondary to CIPN. Purpose: This report describes custom foot orthotics with a closed cell foam overlay to improve postural stability and mobility in CIPN. Case Description: An individual experiencing progressive balance dysfunction was provided orthotics when standard interventions were not effective. Expectations were that improved joint contact via midfoot compression and improved bony alignment would alter proprioceptive feedback throughout the kinetic chain and result in greater postural stability. Finding a cosmetically appealing shoe to provide sufficient tactile cues and support, without undue pressure challenged clinical decision making. Outcome Measures: Computerized dynamic posturography and accelerometry were used to measure postural sway. Three conditions (barefoot, shoes only, and shoe plus orthotics) were tested to differentiate effects of orthotics and shoes. With orthotic use measures of sway velocity and area improved as did his ability to stand unassisted. Timed Up and Go and gait speed measures also improved.