Page 14 - 2020 Winter CMTA Report

The Surgical Correction of the CMT Foot:

IS SURGERY RIGHT FOR YOU?

T H E F I R S T A R T I C L E I N A F O U R - P A R T S E R I E S

BY GLENN B. PFEFFER, MD twisted shape makes walking very The surgery is done on an
difficult, unbalanced and painful. out-patient basis with general
y father was a general It takes a lot of energy. These are anesthesia and a nerve block. I
surgeon who performed the CMTers who will greatly have operated on hundreds of
huge and difficult opera- benefit from surgery. people with CMT using a nerve
tions. One day he had The underlying problem with block. The block provides pain
M a simple mole removed the cavovarus foot is an imbalance relief for 48 hours or more after
from his face. “I get it now,” he of the muscles: Some are strong surgery. After that, pain meds may
explained to me when I was 13. while others are weak; some of the be needed for up to a week, some-
“I know the difference between nerves still work, while others are times two. A non-weight bearing
a big operation and a small one. compromised. The strong muscles cast is used for a total of six weeks.
It’s big when it’s on you.” overpower the weaker ones, which In the majority of cases, weight-
Decades later I too get it, hav- causes the foot and toes to take an bearing and physical therapy then
ing had an operation on my own abnormal posture. If the problem begin in a removable cast boot.
foot 15 years ago. Surgery Only one foot can be
is scary, especially if it is operated on at a time and
elective and you are get- complete recovery can take
ting by okay. But okay up to a year. Most people
should not be good fix one foot and then the
enough if you can do bet- other a few months later.
ter. No one should accept There is no question that it
impairment as the new takes commitment and a
normal and that’s why I strong support group.
am writing this four-part There are four parts
column. to surgical correction:
To start, we need to The calcaneus (heel bone),
discuss what causes the the metatarsal bones in
CMT foot deformity— the middle of the foot,
Before and after: 19-year-old man’s corrective surgery.
and I think it is fair to the soft tissues and muscles
call it that in the more and the toes. They are all
advanced cases—and how surgery starts during childhood, the bones addressed during the same
can correct it. can develop with an abnormal surgery.
Surgery is definitely not for shape. The longer the imbalance This series begins with a dis-
everyone with CMT. Many people is in place, the worse the defor- cussion of the heel, which has to
have little to no muscle function mity becomes, which is why be brought out of its in-turned
below the knee. For them, one of surgery should ideally be done position (varus) to one that is
the many excellent ground-reac- early in life although it’s never out-turned (valgus). The valgus
tion braces is probably the best too late—I once operated on a position maximizes motion,
solution. An ankle fusion is rarely 78-year-old woman. creates a heel that is flat on the
indicated. The goal of surgery is to bal- ground and balances weight-bear-
Seventy percent of people ance the muscle pull, straighten ing. Everyone with a cavovarus
with CMT have a cavovarus the bones and bring the foot into foot knows the feeling of toppling
foot—a very high arch with an a flat position. Even with people over when walking. I imagine it
in-turned heel. The toes are often who need a brace, the foot has to feels like an impending ankle
drawn up, and the inside of the be flat on the ground to function sprain with every step.
foot is twisted downward. This maximally. (continued on page 16)

14 THE CMTA REPORT WINTER 2020