Charcot-Marie-Tooth disease (CMT) is named after the three doctors who first described the disease in 1886: Jean-Martin Charcot (shar-coh), Pierre Marie, and Howard Henry Tooth. Today, CMT refers to any peripheral neuropathy with a genetic cause, whether or not the specific genetic mutation is known.
CMT is a rare multisystem, multiorgan disease that causes lifelong, progressive symptoms, including muscle weakness and atrophy in the arms and legs, sensory loss, and other complications. These symptoms often lead to challenges with balance, walking, and other daily activities due to progressive foot and ankle deformities. Corrective foot and ankle surgery can improve mobility, alleviate pain, and improve the quality of life for many individuals with CMT.
When to Consider Foot and Ankle Surgery
Foot and ankle deformities caused by CMT vary widely but often include cavovarus foot (high arches), pes planus (flat feet), and toe deformities such as hammertoes. These issues can lead to chronic pain, difficulty walking, frequent falls, and increased risk of joint damage.
Surgery may be an appropriate option when:
- Conservative treatments, such as orthotics or physical therapy, no longer manage symptoms effectively.
- Pain significantly impacts daily activities.
- Progressive deformities threaten long-term mobility or joint health.
- Balance and stability are severely compromised.
The decision to pursue surgery should involve a comprehensive evaluation by an experienced CMT orthopedic surgeon.
Understanding Surgical Correction
Correcting CMT-related foot and ankle deformities often involves combining several procedures to address structural abnormalities and muscle imbalances contributing to instability and deformities.
Common Procedures:
- Tendon Transfers: Tendons are surgically repositioned to restore balance between opposing muscles, improving function and reducing deforming forces.
- Osteotomies: Bones are reshaped or realigned to correct structural deformities such as high arches or flat feet.
- Soft Tissue Release: Tight ligaments or tendons are surgically lengthened to improve flexibility and reduce tension.
- Joint Fusion (Arthrodesis): Fusing unstable joints can improve stability and reduce pain, but it is reserved for severe cases.
Goals of Surgery:
- Restore balance and function to the foot and ankle.
- Relieve pain caused by deformities or instability.
- Prevent or delay further progression of deformities.
Surgery is highly individualized, with approaches tailored to the patient’s specific needs, deformities, goals, and overall health.
Expert Insights: Advances in CMT Foot and Ankle Surgery
In 2019, CMTA convened a mini-symposium with leading orthopedic surgeons and CMT specialists to develop a patient-focused consensus on the surgical treatment of CMT-related foot and ankle deformities. This landmark gathering resulted in the publication of the Consensus Statement on Surgical Treatment of CMT, a transformative foundational guide for patients and clinicians navigating these complex procedures.
Key Highlights from the Consensus Statement:
- Patient-Centered Approach: Individualized treatment plans tailored to each patient’s unique deformities, symptoms, and overall health.
- Early Intervention: Recommendations for early surgical intervention to prevent worsening deformities, particularly in younger patients or those with rapidly progressing symptoms.
- Multifaceted Surgical Techniques: Combining procedures like tendon transfers, osteotomies, and joint stabilization for optimal outcomes.
- Multidisciplinary Care: Collaboration among orthopedic surgeons, physical therapists, and CMT specialists for comprehensive care and recovery.
- Postoperative Rehabilitation: Robust rehabilitation programs, including physical therapy and custom orthotics, are essential for maintaining surgical corrections and maximizing mobility.
Practical Guidance for Patients and Surgeons
The consensus also offers detailed recommendations for surgeons, including:
- Utilizing advanced imaging techniques to map deformities and develop precise surgical strategies.
- Prioritizing functional and mobility outcomes over purely cosmetic corrections.
- Establishing realistic expectations for patients regarding surgical outcomes and recovery timelines.
To read the full Consensus Statement on Surgical Treatment of CMT, [add DLC link].
Preparing for Surgery
Planning for foot and ankle surgery involves a detailed discussion with your orthopedic surgeon to understand the risks, benefits, and expected outcomes. A well-thought-out plan can maximize the chances of a successful surgery and a smooth recovery.
Key Considerations Include:
- Timing: Surgery should be scheduled during a stable phase of disease progression to ensure optimal results and recovery. Your surgeon may recommend addressing deformities early to prevent further complications.
- Preoperative Care: Strengthening muscles and improving range of motion through physical therapy can help prepare your body for surgery. Addressing preexisting conditions, such as circulation issues or infections, is also crucial to minimize surgical risks.
- Customized Surgical Plans: Each procedure is tailored to your unique needs. Discussing your goals with your surgeon, such as improving mobility, reducing pain, or improving balance, will help guide the surgical strategy.
- Emotional Readiness: Surgery can be an emotional decision. Taking time to discuss concerns with your care team and loved ones and knowing what the recovery process is expected to be can alleviate anxiety and set realistic expectations.
Postoperative Recovery:
Recovery from foot and ankle surgery varies based on the individual and the procedures performed. A typical recovery plan may include:
- No weight-bearing immobilization with a cast or brace for many weeks to protect surgical corrections.
- Physical therapy to rebuild strength, restore mobility, and retrain balance.
- Custom orthotics or braces to support surgical outcomes and prevent further complications.
- Periodic follow-ups with your surgeon to monitor healing and make necessary adjustments.
Support Systems
Having a strong support network is vital for recovery. Friends, family, or caregivers can assist with daily tasks, transportation, and emotional support during recovery.
Surgery Resources
- 2024 Denver Summit: Watch Here
- 2022 Virtual Summit: Watch Here
Next Steps: Find the Right Care
CMTA Centers of Excellence provide access to expert orthopedic surgeons specializing in CMT-related foot and ankle deformities. These multidisciplinary clinics offer comprehensive care, from surgical consultations to postoperative rehabilitation. Visit the CMTA Center of Excellence directory to find a provider near you and take the next step toward improved mobility and quality of life.
