Although Charcot-Marie-Tooth disease (CMT) is a lifelong condition with no known cure, the symptoms can be managed with appropriate therapies to increase independence and quality of life of the individual.
As it 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.
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, and 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 patient with CMT 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, without over-exerting themselves and worsening 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. These include:
- Maintaining a healthy weight to reduce the stress excess weight can place on the body
- Clean and inspect feet for changes regularly to prevent and detect early signs of injury or infection
- Reduce or avoid intake of alcohol, caffeine and nicotine as they can worsen symptoms
General health advice, such as eating nutritious meals and getting regular physical exercise, should be recommended.
Pharmacotherapy is useful in the management of nociceptive and neuropathic pain, both of which can 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: repositioning of the foot to correct severe flatness of the feet
- Arthrodesis: fusing of the joints in the feet to correct severe flatness of the feet or other deformities and relieve joint pain
- Plantar fascia release: partial removal and repositioning of tendons in the feet to relieve persistent heel pain
There is current research being undertaken to investigate new treatment techniques that may be used in the future.
Some reports have suggested the possibility to use stem cells to repair the damaged nerves. Additionally, hormones and gene therapy have also been proposed as a method to slow the progression of the disease.