Foot braces around woman's teal pants.

Understanding Charcot-Marie-Tooth Disease (CMT)

Close-up of feet of a person with CMT.

What is CMT?

CMT is the #1 most commonly inherited peripheral neuropathy in the world, There are over 140 genetic mutations associated with what is now diagnosed as CMT. This progressive peripheral  neuropathy is usually  inherited, however, it can also occur spontaneously as a “de-novo” mutation.

These mutations affect the body’s ability to maintain the health of our peripheral motor and sensory nerve fibers and consequently over time, they fall into disrepair resulting in progressing foot and ankle weakness, along with loss of sensation and balance.

Close-up of three women's legs with foot braces resting legs on blue table.

How CMT Affects Patients

Patients experiencing foot slap, foot drop, toe drag, tripping, and ankle sprains, find that each step is unpredictable and inconsistent which leads to a loss of overall confidence with their movement. Their gait becomes slow and guarded and patients find themselves gazing downward at  the ground in front of them to avoid obstacles and stay upright. To compensate for foot drop patients utilize a steppage gait pattern and lost propulsion requires excessive trunk lean. All these compensatory gait strategies help CMT patients stay ambulatory but come at high energy costs. A guarded gait pattern also results in dis-use atrophy of proximal leg muscles.

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  • Man in blue shirt fitting a foot brace on patient sitting on bed.

Challenges of Traditional Bracing

Many people with CMT have experienced poor results from previous AFOs leaving them less inclined to explore other orthotic options. Parents who have had disappointing experiences are far less likely to have affected children referred for bracing. Traditional plastic AFOs are functionally underwhelming as the plastic is hot, heavy, bulky, and often requires multiple adjustments to address discomfort or skin damage. Worst of all, these AFOs don’t allow normal foot and ankle motion which decreases foot and ankle function. These AFOs along with more flexible, less bulky AFOs designed to address foot drop alone, do not provide enough of a functional benefit to be worth wearing. The truth is nobody wants to wear AFOs or oversized less fashionable shoes unless the functional benefit is a grand slam.

  • Three women in foot braces sitting in blue chairs smiling

Our Hope For Ongoing Research

Organizations like the CMTA and CMTRF are working hard to find a cure. While none have been found yet, there are on-going trials and our researchers get us closer every year.  Ken is very proud to be on the CMTA advisory board and has been speaking at international conferences to share his principles with patients and orthotists all over the world.

CMT Patients And Their Most Common Problems

CMT patients vary dramatically in presentation and can have just one or all of these issues. If the disease had a mission statement, it would be “to slowly weaken all the leg muscles that control the feet and ankles until they are non-functional.” CMT also intends to slowly rob you of sensation below the knee including proprioception, the ability to know where a body part is in space and how it is moving relative to the rest of the body.

  • Foot Slap

    Eccentric dorsi flexor weakness, stance phase, loss of first rocker, the ability to slowly lower the forefoot to the ground at heel strike resulting in an audible foot slap.

  • Foot Drop

    Concentric dorsiflexor weakness, swing phase, as weakness progresses to the point where the muscle cannot lift the weight of the foot. Results in toe drag and requires a steppage gait.

  • Tripping and Falling

    Frequent toe drag and loss of balance contribute to a higher risk of tripping and falling, making walking both difficult and unsafe.

  • Loss of Confidence

    As near falls become more common and each step becomes less predictable and inconsistent, confidence is lost

  • Downward Gaze

    Constantly looking downward on the ground in front of you to assess for any obstacles and avoid tripping or rolling your ankle. This can further exacerbate issues with posture and spatial awareness.

  • Lateral Ankle Instability

    Progressing weakness combined with hind foot inversion results in recurring lateral ankle sprains, limiting mobility and increasing the risk of injury.

  • Guarded Gait Pattern

    Restricted pelvic motion and natural arm swing during gait is typically a protective response associated with fear of falling leading to inefficient and abnormal gait patterns.

  • Inability to Walk on Heels or Toes

    Lack of strength and flexibility to perform heel or toe walking, indicative of severe muscle weakness and balance problems.

  • Fatigue

    Increased tiredness and difficulty sustaining energy, especially during daily activities, due to the extra effort required to compensate for gait deviations.

  • High Energy Requirements

    The need for excessive energy to manage compensatory gait deviations, often leading to faster exhaustion and reduced activity levels.

  • Balance Issues

    Difficulty maintaining stability in open spaces without holding onto stationary objects, reflecting significant proprioceptive deficits and ankle weakness.

  • Postural Impact

    Adverse effects on posture due to the habitual downward gaze and loss of ankle propulsion, often leading to secondary musculoskeletal issues.

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