Charcot-Marie-Tooth Disease: Cavus Foot, Toe Clawing, and AFO Management

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

Charcot-Marie-Tooth (CMT) disease — the most common inherited peripheral neuropathy, affecting 1 in 2,500 people — produces a characteristic foot deformity pattern resulting from progressive intrinsic muscle weakness and selective weakness of peroneals (eversion) and tibialis anterior (dorsiflexion) muscles relative to stronger invertors and plantarflexors. The resulting muscle imbalance produces a pes cavus (high-arched foot), hindfoot varus, forefoot pronation, and progressive toe clawing that worsens throughout adult life.

Pathomechanics of CMT Foot Deformity

The CMT cavus foot deformity develops from characteristic muscle imbalance: peroneus brevis (eversion) weakness relative to preserved peroneus longus strength — the peroneus longus depresses the first metatarsal head, increasing the plantar-flexed first ray and cavus component. Tibialis anterior (dorsiflexion) weakness relative to preserved tibialis posterior — produces hindfoot varus and forefoot supination. Intrinsic muscle weakness (lumbricals, interossei) produces the clawing (MTP hyperextension with IP joint flexion) that is pathognomonic for CMT and differentiates neurogenic from structural clawing. The Coleman block test differentiates flexible (correctable) from fixed (rigid) hindfoot varus — important for surgical planning.

Conservative and Surgical Management

Conservative management: custom AFO (ankle-foot orthosis) to compensate for dorsiflexion weakness and foot drop; accommodative orthotics to cushion the prominent metatarsal heads; wide toe box footwear to accommodate clawed toes. Surgical management for symptomatic deformity: soft tissue procedures (plantar fascia release, peroneus longus-to-brevis tendon transfer, tibialis posterior transfer for foot drop) in younger, flexible deformity; osseous procedures (calcaneal osteotomy for hindfoot varus, first metatarsal dorsiflexion osteotomy for plantarflexed first ray, PIP fusion for clawing) for established fixed deformity. Dr. Biernacki at Balance Foot & Ankle evaluates CMT-related foot deformity with biomechanical assessment and provides AFO fitting and surgical consultation for progressive deformity. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

Related Conditions & Resources

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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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📞 (810) 206-1402

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
• Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
• Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.

Warning Signs That Need Same-Day Care