BLOG - CHARCOT MARIE TOOTH DISEASE AND PODIATRY 

People living with Charcot Marie Tooth (CMT) will know that it is a multifaceted disorder that damages the peripheral nerves, and this causes motor and sensory problems in the arms, hands, legs and feet.  
 
There are several variations of CMT and each individual will know their own disease intimately. 
The repeated demyelination and remyelination of the nerves affect the signals sent from your brain to your feet and visa-versa causing lower limb problems such as: 
 
• Weakness in your legs, ankles and feet 
• Loss of muscle bulk in your legs and feet 
• High arched or very flat feet 
• Hammertoes 
• Decreased ability to run 
• Footdrop 
• Awkward gait 
• Frequent tripping or falling 
• Neuropathy in your legs and feet 
 
There is no cure for CMT, treatment takes a multidisciplinary approach of which Podiatry is one. Podiatric intervention can help relieve symptoms, aid mobility, and increase independence and quality of life for people living with CMT. 
 
Annual neurological assessments can help monitor the progress of the disease in your lower limb so that you can be aware of any problems as they arise and there is no down time in looking for treatment. 
 
Progressive changes within the feet can vary from a highly arched foot (pes cavus) with tight soft tissue and retracted toes due to muscle spasming and shortening to a very low arch (pes planus) associated with low muscle tone. Both foot types can be unilateral or bilateral and can be treated conservatively using bespoke orthoses that stabilise the foot, assist with shock absorption and control the anatomical deterioration of the foot. 
 
The correct orthoses would aim to address other lower limb issues such as tripping by enhancing the rearfoot to forefoot rocker and the contact from a bespoke device can assist with proprioception – the messages your foot sends to your brain regarding the slope and firmness of the ground you are walking on. 
 
If the disease progresses to foot drop in either one or both feet cast ankle foot orthoses (AFO’s) such as the Richie brace can produce life changing results. Its dynamic assist AFO hinges at the ankle joint to swing the foot up to allow ground clearance creating a smooth step. 
 
Trips to a podiatrist on a regular basis for general foot care is important as peripheral neuropathy can mean that you are not aware of ingrowing toenails, blisters, corns, ulcers and fungal infections. Not receiving the pain signals that alert us to these issues mean that they can quickly develop into infections. 
 
Just as CMT is a very individual disease managing it is individual too. Developing a good relationship with your podiatrist can help you avoid day to day hazards and keep you mobile in the long term. 
 
For more information on CMT go to www.CMT.org.uk 
 
ALWAYS check your podiatrist is HCPC registered www.hcpc-uk.org/check-the-register/ 
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