Those affected by Charcot-Marie-Tooth disease often display distinct physical symptoms that manifest in their feet. A basic overview of CMT foot symptoms that can be found below.
High Arches and Clawfoot:
The classic, very high arch is formed because the peroneal group no longer properly opposes the tibial muscles. Muscles need to be balanced. The tibial muscles get “free reign” and work without an opposing balance. This results in a pulled up arch, tipping the foot outwards, which creates instability, tiredness, and can lead to ankle sprains.
Motor weakness is the hallmark of CMT and is the cause for clawfeet. The ankle dorsiflexors, the muscles that lift up the foot and ankle, are frequently involved. When the Tibialis Anterior muscle weakens, the foot begins to drop down. This is usually a gradual process, occurring over months or years.
Treatment for Clawfoot
It is very important to keep the Achilles tendon in the calf stretched out. Keeping the Achilles limber can keep a person walking normally for a long time. Stretch the tendon for 60 seconds 3 times each day. There are several stretching programs available, but the easiest and best is to place the front of the foot on a step and let the heel hang over the edge (hold on to the railing to keep your balance).
In more advanced cases, a brace may be required. There are several types available, which are generically called Ankle Foot Orthoses (AFOs). An Orthotist or certified Pedorthist are the professionals who fabricate such braces.
Deformity of the Toes
Deformity of the toes occurs frequently in people that have CMT. An imbalance of muscle pull on the toes causes them to deform. The term “clawing” is used because each toe develops a fixed flexion contracture in the shape of a claw. The contracted toes do not have enough room in shoes and put increased pressure on the ball of the foot, which becomes painful and callused.
Treatment for Deformity of the Toes
While there is nothing one can do to prevent the muscle imbalance, the contractures can be avoided, or at least delayed. Twice a day, once in the morning and once before bedtime, stretch each of the toe joints. Flex down the joint at the base of each toe (Metatarsalphalangeal joint) as far as possible while bringing the middle joint (Proximal Interphalangeal joint) to a straight position. Hold for thirty seconds and then go onto the next toe.
Once a contracture develops, make sure to wear shoes that have a wide toe box to minimize pressure on the toes. A shoe repair shop can stretch out your normal shoes or special wide toe-box shoes can be purchased. Your shoes should have a cushioned sole and be made of a soft, stretchable upper material. A custom orthotic can help relieve pressure on the ball of the foot.
The toenail is produced by its own special nail-generating tissue and grows forward to the end of the toe. In the case of the ingrown toenail, which tends to occur most often with the big toe, the nail groove begins to disappear. This can be the result of ill-fitting shoes, or from a deformed way of walking that places an unusual amount of pressure on this area of the foot.
The chronic pressure of the nail edge rubbing against the nail groove causes irritation and swelling of the surrounding skin. This constant pressure can eventually results with infection, leading to even more pain and swelling. Improper trimming of the toenail can also cause problems. If the corner of the toenail is not allowed to grow out past the skin at the end of the nail groove, it may dig into the skin. This makes pressure when walking even more painful.
Ingrown toenails are a common problem for people with CMT due to the pressure placed on the front and side of the foot while walking. When hand dexterity difficulties are an issue, this further exacerbates the problem as nail and foot care can be a challenging task to perform.
Treatment for Ingrown Toenails
Due to sensory loss association with CMT, especially in the foot, it is an important practice to take extra precautions with foot care. If necessary, seek professional assistance to ensure your toenails are regularly trimmed and monitored for ingrown toenails and other problems.
There are various surgical procedures to assist if the condition has been longstanding and resulted in permanent hypertrophy of the tissue surrounding the nail margin. A wedge resection procedure removes of a portion of the hypertrophied tissue and therefore reduces the pressure and irritation. In this procedure, a wedge of tissue is removed and the healing process allows the nail groove to reform itself a partial nail and matrix removal is done in more severe cases; this removes a portion of the toenail and the germinal matrix that produces that portion of the nail. For extreme deformity, a nail and matrix ablation is done to remove the entire nail and its germinal matrix. No new toenail will grow back and this is usually done only as last resort.
According to Dr. Hal Ornstein on footdoctorsnj.com, many people do not realize they have a fungal nail problem and, therefore, do not seek treatment. Yet, fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail’s color, is often considered nothing more than a mere blemish. Left untreated, however, it can present serious problems.
You can prevent fungal nail infections by taking these simple precautions:
- Exercise proper hygiene and regularly inspect your feet and toes.
- Keep your feet clean and dry.
- Wear shower shoes in public facilities whenever possible.
- Clip nails straight across so that the nail does not extend beyond the tip of the toe.
- Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe.
- Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks, especially for those with lifestyles that are more active.
- Disinfect home pedicure tools and don’t apply polish to nails suspected of infection.
- In severe cases, surgical treatment may be required to remove the infected nail. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.
Swollen Feet and Ankles
Dr. Greg Carter, one of our CMT advisors, says:
“People with CMT have swelling in their feet and ankles because they don’t have the normal muscle strength and activity in the legs that helps pump the venous blood and lymphatic fluids back towards the heart. This is common in many neuromuscular disorders. Breathing and/or heart problems can definitely cause swelling of the feet and ankles, and can be an early sign of heart failure. People with CMT have to be particularly careful because swollen feet and legs can lead to skin breakdown and ulcers. These ulcers may get infected and sometimes lead to loss of the foot or leg (i.e., if they get gangrene). CMT people are already prone to neuropathic ulcers so they are at very high risk.”
Treatment for Swollen Feet and Ankles
Dr. Carter suggests CMT patients should treat their feet just like diabetics do: daily inspection; gentle soak and cleansing; emollient creams to keep the skin supple; proper foot- wear and correctly fitted braces/orthotics (CMT people should always use custom-fitted braces/orthotics, not off-the-shelf models). TED hose are okay as long as they are taken off for part of the day and the skin thoroughly inspected. Further, CMT people should not smoke because this can lead to peripheral vascular disease (hardening/clogging of the arteries), which worsens the situation.
Heel calluses, also called plantar calluses, develop when one metatarsal bone is longer or lower than the others and it hits the ground with more force than it is equipped to handle. As a result, the skin under this bone thickens. The resulting callus causes irritation and pain.
Treatment for Calluses
Because people with CMT often have an imbalanced gait, calluses easily can form. In most cases, heel calluses can be treated without surgery. In severe cases, however, a surgical procedure called an osteotomy is performed to relieve the pressure on the bone.
Restless Leg Syndrome
Restless Leg Syndrome is a sensory-motor disorder and is evidentially related to periodic limb movement disorder (PLMD). Similar to CMT there is often a family history of RLS. People describe the sensation in their legs in a variety of ways such as, tingling, pins and needles, creepy-crawling sensations, sudden jerky movements, and having an irresistible urge to move their legs. Movement temporarily helps to relief the discomfort. RLS becomes more apparent when individuals are at rest and can be very disruptive to the onset of sleep, which ultimately lessens the restfulness that we require from sleeping. It can be disturbing for partners of people who experience RLS as well.
Treatment for Restless Leg Syndrome
There are OTC and prescription medication for the treatment of symptoms. Some lifestyle changes also may alleviate symptoms.