Charcot-Marie-Tooth Disease (CMT): The Role of Physiotherapy in Long-Term Management

Physiotherapy for Charcot-Marie-Tooth Disease: Slowing Progression, Maximizing Function

Charcot-Marie-Tooth (CMT) disease represents a group of inherited neuropathies affecting the peripheral nervous system. While the underlying genetic mutation cannot currently be treated, physiotherapy plays a vital role in managing the functional consequences of progressive distal muscle weakness.

Clinical Features Relevant to Physiotherapy

• Foot drop (equinovarus): Weakness of tibialis anterior causes foot drop during gait — the classic CMT presentation
• Pes cavus (high arches): Intrinsic foot muscle weakness causes the characteristic high arch deformity
• Claw toes: Imbalance between foot intrinsic muscles and extrinsic long toe extensors
• Distal sensory loss: Reduced proprioception increases fall risk
• Hand intrinsic weakness: Fine motor difficulties, weak grip
• Progressive fatigue: CMT patients fatigue easily with exertion

Evidence-Based Exercise Program

Aerobic Conditioning (3×/week)

Cycling and swimming are preferred — they do not require ankle stability and minimize fall risk while providing cardiovascular benefit. 30 minutes, moderate intensity.

Resistance Training

Target the most affected muscles:

• Tibialis anterior: Dorsiflexion resistance with theraband (3×15 reps)
• Peroneal muscles: Eversion against resistance
• Intrinsic foot muscles: Towel scrunching, short foot exercise
• Hand intrinsics: Putty squeezing, finger extensions with elastic

Stretching Protocol

• Achilles tendon/calf stretch: 3×45 seconds daily (prevents equinus contracture)
• Toe extensor stretch: Combats claw toe formation
• Plantar fascia stretch: Morning foot stretch

Balance & Proprioception

Tandem stance, single-leg balance on foam pad (use parallel bars for safety). This is critical given sensory loss.

Orthotic Management

• Ankle-foot orthoses (AFOs): Correct foot drop, improve gait efficiency
• Custom insoles: Accommodate pes cavus and distribute pressure away from prominent metatarsal heads

Energy Conservation Strategies

CMT patients fatigue rapidly. Physiotherapists teach activity pacing, rest break scheduling, and adaptive equipment use (lightweight tools, jar openers, button hooks) to maintain independence.