Charcot Marie Tooth Foot Surgery

Charcot Marie Tooth Foot Surgery

Charcot Marie Tooth Foot Surgery

Charcot Marie Tooth Foot Surgery

What is Charcot Marie Tooth Disease?

Charcot-Marie-Tooth (CMT) disease is a group of genetic disorders that affect the peripheral nerves, causing progressive weakness and wasting of the muscles in the feet and hands, as well as sensory loss. The disease is named after the three physicians who first described it in 1886, Jean-Martin Charcot, Pierre Marie, and Howard Henry Tooth.

CMT affects an estimated 1 in 2,500 people worldwide and is one of the most common inherited neurological disorders.

CMT disease is caused by mutations in genes that produce proteins involved in the structure or function of the peripheral nerves. These mutations result in the degeneration and loss of myelin, a fatty substance that insulates the nerve fibres and allows them to conduct electrical signals quickly and efficiently. As a result, the nerves cannot transmit signals properly, leading to weakness, muscle wasting, and loss of sensation.

How does Charcot Marie Tooth Disease affect the feet?

Most of the people I meet who have CMT describe their symptoms beginning in their adolescence, or early adulthood.

CMT symptoms include:

  • Gradually worsening weakness and muscle imbalance of the feet and lower legs, leading to difficulty walking or running

  • High arched feet and inverted heels (heels that turn inwards), which can cause instability, pain due to over loading of the outer (lateral) side of the foot and difficulty fitting into shoes

  • Hammer toes or claw toes, (the toes curl downward or upward, respectively) and pain in the ball of the foot

  • Numbness, tingling, or pain in the feet or lower legs

  • Recurrent ankle sprains

  • Peroneal and Achilles tendon pain

  • Heel pain (plantar fasciitis)

  • Painful foot joints (because of secondary wear and tear)

Over time, as the disease progresses, a person’s muscle wasting can become more pronounced, and they may begin to experience foot drop.

Foot and Ankle Surgery for Charcot Marie Tooth Disease and other neuromuscular conditions

Although neuromuscular conditions can’t be cured, the good news is that most patients with long-term foot problems can be helped with conservative measures like orthotics and custom-made footwear. For some patients however surgery might become necessary. Surgery can lower a very high foot arch, and if the problem is ankle instability or foot drop, I can help with reconstruction of ligaments, and tendon transfers.

Correcting a high arch

Ankle sprains are common in people who have CMT, and this is because their high arched feet and a turned in (varus) heel creates a foot that’s difficult to balance on.

The aim of surgery is to realign the heel under the leg, flatten the arch, and correct any ankle ligament instability. This may involve surgery to cut and realign the heel bone and the first metatarsal bone (joint preserving surgery), and ligament reconstruction may be required for an ankle that gives way.

Tendon transfer surgery

Every patient is different and presents at a different stage in their CMT journey. This kind of surgery may be considered after very detailed assessment.

Options that can be considered include peroneus longus to peroneus brevis tendon transfer, and tibialis posterior tendon transfer.

Fusion surgery may be required especially if the joints were arthritic and painful. I may recommend to a patient a combination of these surgical procedures to get the best outcome for them.

The surgery is usually carried out under a general anaesthetic (or with a spinal anaesthesia), and there is usually an overnight stay in hospital.