Charcot Marie Tooth Disease
Pedorthic Management of Charcot Marie Tooth Disease
Written By Mike Lukowsky, Certified Pedorthist
Charcot Marie Tooth (CMT) disease is a hereditary disorder with progressive peripheral motor neuropathy. This et leads to progressive distal and anterior especially in the feet and ankles. Predominantly, the distal leg muscles, peroneal and anterior tibial muscles are affected causing progressive weakness with gait disturbances (clumsiness, frequent falls, and tripping over feet). As CMT progresses, the deformity of pes cavus worsens and eventually foot drop will occur.
In the early stages, patients begin to have difficulty finding footwear because of the lack of dorsiflexion, due to the atrophy of the anterior tibial compartment. Women have difficulty because of societal pressures to wear dress shoes, which are typically slip-on styles. They are unable to hold this type of footwear on the dorsum of the foot. Today there are many choices of footwear that have straps or ties that are acceptable as dress shoes.
As the feet of the patients with CMT become more pes cavus, the soft tissue of the plantar surface become abnormally short. The metatarsal heads are lower in relation to the hind foot at the tarsometatarsal joints. This foot deformity becomes rigid and lacks the ability to absorb shock. Unfortunately, due to the lack of knowledge of CMT, patients tend to seek out and are guided toward very cushioned and flexible footwear. This type of footwear actually causes more instability to a cavus foot. These patients, in fact, need footwear that has strong rear foot control with lateral stability. Cushioned orthoses provide the needed shock absorption and support for the pes cavus foot. Intrinsic metatarsal support will unload the metatarsal heads. the combination of cushioned orthoses and stable footwear will give the patient optimum support and comfort.
Due to the high medial longitudinal arch, the extensor tendons and ligaments are shortened causing dorsiflexion of the distal phalanges (i.e. claw and hammer toes). There fore these patients need shoes with deep toe boxes. In today’s pedorthic facilities, there are many choices of footwear with these features.
As peroneal and anterior tibial muscles atrophy, a drop foot develops. Shoes with mild rocker soles are very helpful in reducing toe drag. For a more severe foot drop, thicker, more rigid rocker shoes can be attached to the majority of footwear today. In cases where a rocker shoe still does not provide enough dorsiflexion for zero toe drag, slick leather toe tips added to the soles in front reduce the chance of tripping. Most patients are receptive to trying footwear modifications and foot orthoses before having to wear an Ankle Foot Orthoses (AFO). In severe cases of drop foot an AFO is required, but performance of an AFO can be enhanced with the proper footwear, and rocker soles may still be required. New products like Springlites (thin carbon fiber foot plates) alter the flexion of shoes and improve ambulation and energy return, especially when incorporated into foot orthoses and AFO’s.
With awareness of CMT increasing, many physicians are discovering that Pedorthic modalities can truly enhance their patients’ lives by improving the simple task of walking that most of take for granted.
Sole Control orthotics and shoes to help those with Charcot Marie Tooth Disease in St. Louis, MO.
9120 Watson Road
Suite 200
Crestwood, MO 63126
636-536-9800
