Charcot-Marie-Tooth Disease Podiatry | Richmond & Kensington

Overview

What Is Charcot-Marie-Tooth Disease?

Charcot-Marie-Tooth disease (CMT) — named after the three physicians who first described it in 1886 — is the most common inherited peripheral neuropathy, affecting approximately 1 in 2,500 people. It is a genetic disorder that causes progressive damage to the peripheral nerves responsible for transmitting signals between the brain and spinal cord and the muscles of the feet, legs, hands and arms.

CMT primarily affects the motor nerves — producing progressive muscle weakness and wasting — and the sensory nerves, causing reduced sensation, proprioception and pain perception in the lower limbs. The feet and ankles are typically the first and most significantly affected area, producing a characteristic pattern of high-arched feet (pes cavus), claw toes, foot drop and lateral ankle instability.

Although CMT is a lifelong progressive condition with no current cure, its impact on mobility and quality of life can be substantially reduced with expert podiatric management. Early intervention — before deformities become fixed — makes a significant difference to long-term outcomes.

A note on our approach: CMT is a complex, progressive neurological condition that requires coordinated management across multiple specialities. Our role as podiatrists is to maximise foot and ankle function, prevent or delay deformity, and support mobility. We work closely with neurologists, physiotherapists, orthotists and orthopaedic surgeons to ensure our patients receive joined-up care.

Classification

Types of CMT Disease

CMT is caused by mutations in over 100 different genes and is classified by the nerve component primarily affected. The type influences the rate of progression and some aspects of management.

Most common · ~50% of cases

CMT1 — Demyelinating

Affects the myelin sheath surrounding the nerve. Caused most commonly by PMP22 duplication (CMT1A). Slower progression. Nerve conduction velocity significantly reduced.

Axonal

CMT2 — Axonal

Affects the nerve axon itself rather than the myelin sheath. Normal or near-normal nerve conduction velocity. Often presents later and can be more variable in severity.

Intermediate

CMT3 (Dejerine-Sottas)

Severe demyelinating form presenting in infancy or early childhood. Significant disability, often requiring AFOs or wheelchair use by adulthood.

X-linked

CMTX

Caused by mutations in the GJB1 gene (connexin 32). X-linked dominant inheritance — typically more severe in males. Second most common form overall.

Clinical features

How CMT Affects the Feet & Ankles

Common Foot & Ankle Presentations

High-arched foot (pes cavus) — the hallmark deformity Claw toes — fixed or flexible flexion deformities Foot drop — weakness of the tibialis anterior Steppage gait — high-stepping to clear the dropped foot Lateral ankle instability and recurrent sprains Reduced sensation — pressure sores and callus formation Hammer toes and metatarsalgia Difficulty fitting standard footwear Progressive loss of balance and proprioception

Why the Pes Cavus Pattern Develops

The characteristic high-arched foot of CMT develops because the intrinsic foot muscles and peroneal muscles weaken before the posterior tibial muscle, creating a muscle imbalance that pulls the foot into an inverted, plantarflexed position. The plantar fascia and soft tissue structures then adaptively shorten over time, progressing from a flexible to a rigid deformity.

This cavus foot creates excessive lateral loading, reduces the foot's shock-absorbing capacity, and concentrates pressure under the metatarsal heads and heel — contributing to pain, callus, pressure injury and further instability.

Early podiatric intervention, while the deformities are still flexible and correctable, significantly improves the long-term outcome compared with waiting until deformities become fixed.

Progression

How CMT Typically Progresses

Early

Subtle gait changes

Mild high arch, reduced ankle dorsiflexion, early ankle instability. Frequent ankle sprains. Fatigues easily when walking. Footwear may begin to feel uncomfortable.

Mid

Established deformity

Fixed or semi-fixed pes cavus, claw toes developing, foot drop emerging, steppage gait. Callus and pressure areas under metatarsal heads. AFOs typically indicated at this stage.

Advanced

Significant disability

Fixed rigid deformities, marked foot drop, loss of ankle stability, pressure sores, significant difficulty walking. Surgical intervention may be considered. Walking aids often needed.

Upper limb

Hand involvement

Progressive weakness in the hands and forearms develops in many patients, affecting grip and fine motor tasks. This does not typically affect podiatric management but is important in the broader MDT picture.

Management

Our Podiatric Approach to CMT

Podiatric management of CMT focuses on four goals: maintaining mobility, preventing or delaying fixed deformity, protecting insensate or vulnerable skin, and supporting safe, efficient gait for as long as possible. Management is staged to the individual's current level of function and deformity, and reviewed regularly as the condition evolves.

Comprehensive Gait & Foot Assessment

A thorough baseline assessment including foot posture and deformity classification, ankle range of motion, muscle strength testing (particularly tibialis anterior, peroneal and intrinsic muscles), sensory testing, pressure mapping under the foot, and video gait analysis with Onform joint tracking. This establishes a baseline against which progression can be monitored and management adjusted over time. We assess footwear and any existing devices at the same appointment.

Custom Ankle-Foot Orthoses (AFOs)

AFOs are one of the most important interventions in CMT management. A well-designed AFO controls foot drop, stabilises the ankle, compensates for tibialis anterior weakness, reduces the risk of ankle sprains, and significantly improves walking efficiency and safety. The type of AFO — from a simple posterior leaf spring to a more rigid carbon fibre device — is matched to the individual's degree of weakness and functional requirements. We assess, prescribe and coordinate AFO provision, working with specialist orthotists where appropriate.

Custom Orthotics

Custom foot orthotics with lateral wedging, metatarsal offloading and arch support address the pes cavus mechanics, redistribute plantar pressure away from high-load areas, and reduce the risk of painful pressure lesions. For patients in the earlier stages of CMT whose deformities are still flexible, orthotics can significantly slow the progression of cavus deformity by counteracting the muscle imbalance driving it. Prescribed following pressure mapping and gait analysis.

Footwear Assessment & Guidance

Standard off-the-shelf footwear is frequently incompatible with the CMT foot — particularly the high arch, claw toes and wide forefoot that develop with progressive deformity. We provide detailed guidance on appropriate footwear characteristics and, where standard shoes cannot accommodate the foot and any devices prescribed, we can refer to specialist footwear services. Footwear that fits correctly and accommodates AFOs or orthotics is essential to the overall management plan.

Routine Foot Care & Skin Management

Reduced sensation in CMT means that pressure injuries, callus buildup and skin breakdown may go unnoticed until they become clinically significant. Regular podiatric foot care — including callus and corn management, nail care, and pressure area monitoring — is an important protective intervention for patients with CMT. We also educate patients on daily foot inspection and the importance of identifying skin changes early.

Stretching & Strengthening Programme

A targeted exercise programme focusing on maintaining flexibility in the calf, Achilles and plantar fascia — to slow the progression of cavus deformity — alongside strengthening of the remaining functional muscle groups. Balance and proprioception training is important to reduce fall risk as sensory loss progresses. We prescribe specific programmes and coordinate with physiotherapy for patients whose rehabilitation needs extend beyond the podiatric scope.

Pressure Offloading

For patients with established pressure lesions, painful callus or areas of skin breakdown, targeted offloading using felt padding, silicone toe devices, orthotic modifications or — in more significant cases — walking boots or total contact casting allows healing to occur while protection is maintained. We also prescribe silicone toe sleeves and inter-digital devices to manage claw toe pressure points.

Multidisciplinary Coordination & Surgical Referral

CMT management at its best is multidisciplinary. We work alongside neurology (for disease monitoring and genetic counselling), physiotherapy (for exercise and balance rehabilitation), orthotics (for AFO provision) and orthopaedic surgery where surgical intervention — such as Achilles tendon lengthening, plantar fascia release, tendon transfer or claw toe correction — is being considered. We coordinate referral and contribute to the pre- and post-operative podiatric care plan.

Why us

Why Patients with CMT Choose The Functional Podiatrist

✓

AFO assessment & prescriptionWe assess, prescribe and coordinate ankle-foot orthoses matched to your current level of function and foot drop severity.

✓

Pressure mapping & gait analysisObjective baseline assessment with Onform joint tracking — allowing us to monitor progression and adjust management at each review.

✓

Custom orthotics for cavus feetPrecision orthotic prescription to redistribute plantar load, support the lateral column and slow deformity progression while flexibility remains.

✓

Routine specialist foot careRegular monitoring and management of skin, callus and nail pathology in patients with reduced sensation — an important protective intervention.

✓

Multidisciplinary referral networkCoordinated care with neurology, physiotherapy, orthotics and orthopaedic surgery — we don't work in isolation.

✓

HCPC-registered podiatristsRichmond (TW9) and Kensington (W8) — no GP referral needed for an initial assessment.

FAQs

Common Questions About CMT & Podiatry

Can podiatry slow the progression of CMT?

Podiatry cannot slow the neurological progression of CMT — that is determined by the underlying genetic mutation. However, expert podiatric management can significantly delay the progression of the secondary foot and ankle deformities that result from the progressive muscle imbalance. By addressing the biomechanical consequences of CMT early — with orthotics, AFOs, stretching and footwear — we can keep patients mobile and functional for considerably longer than without intervention.

When should I start seeing a podiatrist with CMT?

As early as possible — ideally at diagnosis or at the first sign of foot or ankle changes. The window during which deformities are still flexible and correctable is the most valuable time for podiatric intervention. Patients who are seen early can often avoid or significantly delay the need for more invasive interventions such as surgery. Even if you have had CMT for years and have established deformities, podiatric management can still improve comfort, reduce pain and protect the skin.

Do I need an AFO?

This depends on your current level of foot drop, ankle stability and walking pattern. Not all CMT patients require an AFO — particularly in the early stages. We assess this at your gait assessment appointment. If an AFO is indicated, we work with you to identify the most appropriate type for your lifestyle and level of weakness — from a lightweight carbon fibre leaf spring for mild foot drop to a more supportive device for advanced weakness. The goal is always to maintain walking efficiency and safety with the least restrictive device possible.

Can I have surgery for my CMT feet?

Yes — surgical options exist for specific deformities associated with CMT, including Achilles tendon lengthening, plantar fascia release, tendon transfers (particularly tibialis posterior transfer to address foot drop), metatarsal osteotomies and claw toe corrections. Surgery is typically considered when conservative management has been optimised and deformities are causing significant functional difficulty or pain that cannot otherwise be managed. We can coordinate referral to an orthopaedic or podiatric surgeon with experience in CMT.

My child has been diagnosed with CMT — should they see a podiatrist?

Yes — early assessment in childhood is particularly valuable as deformities are at their most flexible and responsive to intervention. A baseline gait assessment, advice on footwear, and early orthotic prescription where appropriate can make a significant difference to the trajectory of foot deformity through the growth years. We have experience assessing and managing children with CMT and will tailor our approach to their age and level of understanding.

Is podiatric treatment for CMT covered by health insurance?

Yes — podiatry consultations are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. Custom orthotics and AFOs may also be claimable depending on your policy. See our insurance page for full details, and we recommend checking your policy terms before booking.

Related conditions & services