Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
▶ Watch
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. It is a heterogeneous group of genetic disorders that progressively damage the peripheral nervous system—the motor and sensory nerves that connect the brain and spinal cord to the rest of the body. The feet and lower legs are typically the first and most severely affected region, producing a characteristic constellation of foot deformities, weakness, and sensory loss that requires coordinated neurologic and podiatric management.
CMT Foot: The Classic Presentation
The CMT foot is characterized by a progressive cavus (high-arched) deformity that develops from an imbalance between intrinsic foot muscle weakness and relatively preserved extrinsic muscle function. As the intrinsic muscles atrophy, the toes claw (hyperextend at the MTP joint and flex at the PIP and DIP joints), and the plantar fascia contracts, drawing the arch upward into a progressively rigid cavus configuration. Hindfoot varus (inward heel tilt) develops as the peroneal muscles—the primary evertors—weaken earlier and more severely than the tibialis posterior. The result is a rigid, high-arched foot with clawed toes and a varus heel that is prone to lateral ankle instability, stress fractures of the lateral metatarsals, and painful pressure under bony prominences.
Orthotic and Footwear Management
Custom ankle-foot orthoses (AFOs) are the most important non-surgical intervention for CMT foot management. They address foot drop (from peroneal and anterior compartment weakness), provide mediolateral ankle stability in the setting of varus instability and peroneal weakness, and maintain heel position in dorsiflexion to prevent equinus contracture development. CMT-specific AFO designs must balance structural support with the minimization of pressure on insensate areas—a challenge requiring collaboration between the podiatrist and an experienced orthotist. Footwear must accommodate the AFO, have depth to accommodate clawed toes and custom insoles, and provide adequate toe protection for insensate feet.
Surgical Management of CMT Foot Deformity
Surgical intervention is considered when the deformity becomes rigid and non-braceable, when functional decline is significant, or when pain from pressure complications requires structural correction. The specific surgical plan is individualized to the patient’s deformity pattern and functional goals. Common procedures include plantar fascia release and first metatarsal dorsiflexion osteotomy to correct cavus, calcaneal osteotomy to correct hindfoot varus, flexor-to-extensor tendon transfer for claw toe correction, and peroneal tendon transfer to address foot drop and hindfoot varus. In end-stage rigid deformity, triple arthrodesis (fusion of the subtalar, talonavicular, and calcaneocuboid joints) provides a stable, plantargrade foot that can be successfully braced and accommodated with footwear.
Monitoring Disease Progression
CMT is slowly progressive, and foot deformity advances throughout life at a rate that varies with the specific genetic mutation and type. Annual podiatric evaluation allows early identification of progressive deformity, timely orthotic adjustments, and proactive planning of surgical intervention before deformities become rigid and technically more challenging to correct. Patients with CMT benefit most from a multidisciplinary team including neurology (for disease monitoring and genetic counseling), podiatry (for foot and ankle management), and physical therapy (for strength and balance training to maintain functional independence as long as possible).
Ready to Relieve Your Foot Pain?
Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentWatch: Charcot-Marie-Tooth Disease: Foot Cavus
Dr. Tom on CMT foot — inherited neuropathy cavus-varus deformity, foot drop, hammertoe cascade, EMG/NCV, AFO vs surgical reconstruction, family-history screening.
CMT Foot Support Kit
Conservative stack. Dr. Tom’s kit:
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. This supports our free patient education content.
Gait support.
High-arch offloading.
Neuropathy support.
Topical foot pain relief.
Related: Cavus Foot · Neuropathy Care · Book CMT Eval
In Our Clinic
Diabetic neuropathy patients in our clinic often don’t realize they have it until we put a 10-gram Semmes-Weinstein monofilament to the plantar foot and they can’t feel it. Many arrive for an unrelated concern — an ingrown toenail, a callus — and we catch the neuropathy on screening. The conversation then shifts: we need to discuss daily foot inspections, appropriate footwear, the urgency of any blister or open area, and the timing of vascular referral if pulses are diminished. Comprehensive diabetic foot exams are covered by Medicare annually. If you have diabetes, we want to see you once a year even if nothing hurts.
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)