Although Charcot-Marie-Tooth disease (CMT) is a lifelong condition with no known cure, the symptoms can be managed with appropriate therapies to increase the independence and quality of life of the affected individual.
As CMT is a progressive condition, regular check-ups are required to assess for any relevant changes in symptoms that may require specific attention. Additionally, the type of CMT will also have an impact on the severity of the condition and the appropriate treatment.
Charcot-Marie-Tooth disease (CMT) & Podiatry
Physical therapy has an important role to play in the management of CMT to improve the physical symptoms of the condition and reduce the risk of muscle contractures. This includes massage therapy and manipulation of the muscles to improve symptoms.
Muscle-strengthening exercises, such as stretching, swimming, and weight training, can also sometimes be used to reduce symptoms of foot drop and improve the patient’s ability to walk and move independently. Aerobic exercise is also thought to improve overall fitness, whereas posture or balance exercises may also be useful for some patients. However, strong evidence to support the benefits of exercise therapy in patients with CMT is lacking.
A physiotherapist should work closely with each CMT patient to plan out an appropriate exercise program personalized to their specific needs. This is important to ensure that the program is beneficial to the patient, and does not require them to over-exert themselves and subsequently worsen their symptoms.
An occupational therapist can also help to identify problematic areas in the daily life of patients with CMT and create solutions to enable them to live independently. This may include the use of living aids or modified techniques to complete simple daily tasks, such as writing or getting dressed.
There are several things that patients with CMT can do to take control of the disease and manage the symptoms. Maintaining a healthy weight, for example, can help in reducing the stress that excess weight can place on the body. It is recommended that CMT patients clean and inspect their feet for changes regularly to prevent and detect early signs of injury or infection.
The intake of alcohol, nicotine, and caffeine should be reduced or avoided completely, as these substances can worsen symptoms. General health advice, such as eating nutritious meals and getting regular physical exercise, should also be recommended.
Pharmacotherapy is useful in the management of nociceptive and neuropathic pain, both of which can be present in patients with CMT.
Nociceptive pain in the joints and muscles can be controlled with simple analgesic medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). Neuropathic pain, on the other hand, results from damage to the nerves in the body and responds better to alternative medications, such as tricyclic antidepressants or some antiepileptic medications.
In some cases, surgery may be required to correct significant deformities of the affected limbs. This may include:
- Osteotomy: This procedure involves repositioning the foot to correct severe flatness of the feet.
- Arthrodesis: The arthrodesis procedure of the joints in the feet corrects severe flatness of the feet or other deformities and relieves joint pain.
- Plantar fascia release: A plantar fascia release is the partial removal and repositioning of tendons in the feet to relieve persistent heel pain.
Several recent research projects have begun investigating new treatment techniques that may be used in the future. In fact, some reports have suggested the possibility of using stem cells to repair the damaged nerves. Additionally, hormones and gene therapy have also been proposed methods to slow the progression of the disease.