Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is Charcot-Marie-Tooth Disease?

Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy, affecting approximately 1 in 2,500 people worldwide. CMT is not a single disease but a family of related genetic disorders caused by mutations affecting the myelin sheath or axons of peripheral nerves. The result is progressive weakness and wasting of the distal muscles of the legs and, later, the hands.

Despite sharing a name, Charcot-Marie-Tooth disease is completely unrelated to Charcot foot (Charcot arthropathy) — a complication of diabetic neuropathy. This name confusion causes significant patient anxiety, so it is worth clarifying explicitly.

How CMT Affects the Feet

The characteristic foot presentation of CMT is highly recognizable: high arches (pes cavus), hammertoe deformities of all lesser toes, clawing of the great toe, foot drop (difficulty lifting the forefoot during walking), and progressive weakness of the calf and intrinsic foot muscles. The sensory neuropathy component of CMT causes reduced sensation in the feet, increasing the risk of unnoticed injuries.

The mechanism of the cavus deformity in CMT reflects the differential weakness between muscle groups. The intrinsic foot muscles (lumbricals and interossei) weaken before the extrinsic muscles (peroneus longus, tibialis posterior), leading to the characteristic muscle imbalances that drive arch elevation and toe contracture. The peroneus brevis weakens before the peroneus longus, causing unopposed forefoot plantarflexion that drops the first ray and elevates the arch.

The Functional Consequences

CMT patients walk on the outer edge of their feet (lateral weight-bearing) due to the cavus deformity, creating areas of high pressure under the first and fifth metatarsal heads and the lateral heel. Painful calluses and pressure wounds develop at these sites. Ankle instability is extremely common in CMT — the combination of high arch, peroneal weakness, and sensory deficit creates frequent ankle sprains and chronic instability.

Foot drop — caused by weakness of the tibialis anterior and toe extensors — produces a steppage gait (exaggerated hip flexion to clear the dragging toes) and significantly increases fall risk.

Orthotics and Bracing for CMT

Custom orthotics are central to CMT management but must account for the rigid, non-flexible nature of the CMT cavus foot. Unlike flexible flatfoot orthotics that correct alignment, CMT orthotics focus on accommodating the fixed deformity and redistributing pressure away from high-risk areas. Total contact orthotics with metatarsal pads, lateral forefoot posting, and accommodative cushioning reduce callus formation and painful pressure concentrations.

Ankle-foot orthoses (AFOs) address foot drop and ankle instability. Custom-molded AFOs fabricated from polypropylene support the ankle in neutral position and assist with foot clearance during the swing phase of gait. Carbon fiber AFOs are lighter and more energy-efficient for active CMT patients. Dynamic ankle-foot orthoses with adjustable plantar flexion stops are used in patients with mixed weakness patterns.

Footwear Considerations

Finding appropriate footwear for CMT feet is challenging. High arches and contracted toes require extra-depth shoes with deep toe boxes and wide forefoot accommodations. Rigid-soled shoes with rocker bottoms reduce the mechanical demands on weakened intrinsic muscles. Many CMT patients require custom shoes built over their specific foot shape when commercial extra-depth options are inadequate.

Surgical Options for CMT Foot Deformity

When orthotics and bracing no longer adequately accommodate the deformity or control pain, surgical correction is considered. CMT foot surgery typically involves a combination of: soft tissue releases (plantar fascia release, Achilles lengthening), tendon transfers (to restore lost muscle function — peroneus longus to brevis transfer is classic), osteotomies to realign the heel (calcaneal osteotomy) and first ray, and toe corrections (hammertoe repair, metatarsal head resection).

The goal of CMT surgery is not cosmetic realignment but functional improvement — reducing pain, improving stability, and delaying progressive deformity. Surgery must be timed appropriately — ideally when neurological disease progression has stabilized, as residual progressive weakness can cause deformity recurrence.

Podiatric Management at Balance Foot & Ankle

Dr. Tom has experience managing CMT foot complications and works closely with neurology for comprehensive care. Regular foot evaluations, prompt management of calluses and pressure wounds, custom orthotics and AFO coordination, and surgical consultation when appropriate are all components of the CMT foot care program. Call (810) 206-1402 or book online to schedule at Howell or Bloomfield Township.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Charcot-Marie-Tooth Foot Care

Charcot-Marie-Tooth disease causes progressive muscle weakness and foot deformity that requires specialized podiatric management. At Balance Foot & Ankle, we provide comprehensive CMT foot care including orthotics, bracing, and surgical correction.

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Clinical References

1. Burns J, et al. “Foot and Ankle Characteristics in Charcot-Marie-Tooth Disease.” Journal of the American Podiatric Medical Association. 2005;95(4):357-364.
2. Reilly MM, et al. “Charcot-Marie-Tooth Disease.” Journal of the Peripheral Nervous System. 2011;16(1):1-14.
3. Vinci P, Perelli SL. “Footdrop, Foot Rotation, and Plantarflexor Failure in Charcot-Marie-Tooth Disease.” Archives of Physical Medicine and Rehabilitation. 2002;83(4):513-516.