J Korean Foot Ankle Soc.  2025 Mar;29(1):16-26. 10.14193/jkfas.2025.29.1.16.

Current Update in Diagnosis and Treatment of Charcot–Marie–Tooth Foot Deformity

• Song JH
• Pfeffer G

• KMID: 2565868
• DOI: http://doi.org/10.14193/jkfas.2025.29.1.16

Abstract

Charcot–Marie–Tooth (CMT) disease is the most common hereditary peripheral neuropathy, affecting the motor and sensory nerves and manifesting a range of systemic symptoms. CMT disease encompasses a range of genetic subtypes, with symptoms often emerging in childhood and progressing into adulthood. More than 70% of CMT patients exhibit cavovarus foot deformities that impair normal gait, often requiring the use of a brace. A diagnosis relies heavily on a thorough physical examination of each tendon contributing to the deformity. Conservative treatments, such as shoe modifications and braces, are initially preferred. Surgical reconstruction may be considered if conservative management fails. Patients who require surgery typically present with progressive cavovarus deformities, muscular imbalances, soft tissue contractures, and abnormal bone morphology. For a CMT foot reconstruction, joint-sparing surgery with soft tissue release and osteotomy is recommended. Fusion surgery is advised for deformities that are irreducible by joint-preserving surgery or in cases with painful arthritis. CMT foot surgery can enhance the patient’s ability to ambulate without a brace, leading to high satisfaction and improved quality of life.

Keyword

Charcot–Marie–Tooth disease; Cavovarus foot deformity; Joint-sparing procedure; Soft tissue release; Osteotomy

Figure

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  Figure 1 Preoperative photographs of CMT foot deformity. (A~C) Standing photographs demonstrating cavovarus deformity with high arch, first ray depression, a supinated midfoot, and a varus hindfoot. CMT: Charcot–Marie–Tooth.

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  Figure 2 Photographs of physical examination of peroneus longus in CMT foot. To assess the peroneus longus strength separately from the toe flexors and gatrocsoleus, (A) the examiner should place both thumbs under the first and fifth metatarsal heads and (B) evaluate the plantarflexion power beneath the first. CMT: Charcot–Marie–Tooth.

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  Figure 3 Key radiographic measurements and signs for evaluation of CMT. (A) Anteroposterior radiograph with CMT shows the axial Meary angle (black angle), or the talonavicular coverage angle (white angle). (B) Lateral radiograph with CMT shows the sagittal Meary angle (black angle), or the calcaneal pitch angle (white angle). Double talar dome sign (dashed rectangle) and the sinus tarsi see-through sign (dashed circle) can be seen. (C) Segmental bone axes (red lines) analyzed by 3D automated analysis software in weight-bearing CT images. CMT: Charcot–Marie–Tooth, CT: computed tomography.

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  Figure 4 Photographs of braces and custom shoe orthoses used in CMT foot deformity. Images showing (A, B) standing and (C, D) ambulation of the patients with braces and orthoses. CMT: Charcot–Marie–Tooth.

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  Figure 5 Preoperative and postoperative radiographic results of the left foot of a 52-year-old female CMT patient who underwent joint sparing surgery. (A) Preoperative and (B) postoperative standing foot radiographs, weight-bearing 3D computed tomography images, and 3D model with segmental bone axes (red lines) generated by the software. CMT: Charcot–Marie–Tooth, WT: weight.

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  Figure 6 Photographs showing the common operative steps of soft tissue release surgery in CMT foot reconstruction. Soft tissue releases are performed before osteotomies and tendon transfers. (A) Foot after percutaneous Achilles triple hemisection. (B) Posterior tibial tendon release and (C) suture. (D) Talonavicular joint capsule and spring ligament release. (E) Posterior tibial tendon passing from medial to lateral lower leg through interosseous membrane. (F) Percutaneous flexor digitorum longus tenotomies of lesser toes. (G) Plantar fascia release in midfoot. (H) Peroneus longus release. CMT: Charcot–Marie–Tooth.

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  Figure 7 Photographs showing the common operative steps of osteotomy and tendon transfer surgery in CMT foot reconstruction. (A~C) Calcaneal triplane derotational osteotomy. (D) Confirmation of neutralized hindfoot. (E) Peroneus longus to peroneus brevis transfer. (F, G) Basilar dorsal closing-wedge osteotomy of the first metatarsal. (H) Posterior tibial tendon transfer through the extensor retinaculum to lateral cuneiform. CMT: Charcot–Marie–Tooth.

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  Figure 8 Preoperative and postoperative radiographic results of the left foot of a 40-year-old female CMT patient who underwent joint fusion surgery. (A) Preoperative and (B) postoperaive standing foot radiographs and weight-bearing 3D computed tomography images. CMT: Charcot–Marie–Tooth.

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  Figure 9 Standing images of preoperative right foot and postoperative left foot. Preoperatively, the left foot had a cavovarus deformity similar to the right foot.

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