Many patients with Charcot-Marie-Tooth (CMT) disease, a subtype of muscular dystrophy, undergo surgeries to correct foot deformities. Yet a new study finds that surgeons vary significantly in their choice of procedures for the same operation.
The study, “Prevalence and orthopedic management of foot and ankle deformities in Charcot Marie Tooth disease,” will appear in the journal Muscle and Nerve.
CMT is an inherited motor and sensory nerve disorder that causes progressive loss of muscle tissue and touch sensation across various parts of the body. CMT is classified as a subtype of muscular dystrophy, and CMT1A is the most common type of CMT, with onset in adolescence.
CMT patients with foot deformities often receive physical therapy, braces and other devices. When these options fail, doctors recommend orthopedic surgery, which usually involve different procedures.
In this study, researchers examined records of patients enrolled in the Inherited Neuropathy Consortium, a network based at the University of Iowa that conducts clinical research on different forms of CMT. They looked for details on diagnoses, presence of foot deformities, use of orthotic aids and details of foot surgery, and found that 1,914 out of 2,706 CMT patients, or 71 percent, had foot deformities.
In addition, 30 percent of those patients underwent surgery to correct those deformities, while 25 to 41 percent of patients with CMT and related neuropathies used ankle foot orthoses and shoe inserts.
Sixteen orthopedic surgeons responding to an INC questionnaire said they performed an average of five procedures when correcting a child’s deformity, and six when operating on adults. Only two of the 16 surgeons answered with the same combination of procedures for a hypothetical child’s deformity. However, for an adult case, none of the combinations the surgeons listed matched.
These findings, the study concluded, “highlight the need for further research and the need for guidelines for foot surgery which should include indications for and timing of surgery, type of surgery and guidance for follow-up.”