Charcot-Marie-Tooth Orthotics in London
Charcot-Marie-Tooth disease is an inherited condition affecting the peripheral nerves, and the feet usually show it first. Because the changes are gradual and mechanical, orthotic management tends to play a larger and longer role here than it does in many other neurological conditions.
We assess adults and children with Charcot-Marie-Tooth (CMT) across four London clinics, considering foot shape, muscle weakness, balance, walking, skin health, footwear and day-to-day mobility to understand how CMT affects each person and recommend the most appropriate orthotic support.
What Cmt Does to the Foot and Ankle
The pattern is reasonably characteristic, although its severity varies widely:
- Weakness and wasting in the lower legs and feet, with the muscles that lift the foot usually affected earlier than those that push off
- A high arched foot shape, known as pes cavus, driven by imbalance between the muscle groups acting on the foot
- Clawed or hammered toes, which increase pressure under the ball of the foot and on the tops of the toes
- Foot drop, producing a high stepping gait as the leg lifts higher to clear the ground
- Instability at the ankle, with a tendency to roll outwards and a history of repeated sprains
- Reduced sensation, so heat, cold, pressure and pain are less reliably felt
- Weakness in the hands at later stages, affecting grip and fine tasks
Why Ordinary Shoes and Off the Shelf Insoles Often Fall Short
A high arched, rigid foot loads very differently to an average one. Pressure concentrates under the heel and the ball of the foot rather than spreading across the whole sole, and the toes take loads they were never meant to carry.
Standard insoles are shaped for a foot that flattens under load. In a foot that does not, they tend to bridge rather than support, leaving pressure exactly where it was. Depth is a second problem, since clawed toes need vertical space that most shoes do not provide.
Sensation and Skin Protection
Reduced sensation is one of the most important considerations in CMT, and one of the easiest to overlook. If you cannot feel a rubbing seam or a hot spot developing, the first sign of a problem may be a callus, a blister or a broken area of skin.
That shapes how we design and how we advise. Pressure distribution takes priority over minor gains elsewhere, and we will talk through skin checking as part of fitting rather than assuming it is already happening.
What Happens at Your Assessment
Assessment covers the shape and flexibility of the foot, joint ranges, muscle strength, sensation, skin condition, balance and how you walk. We will look at the shoes and any orthoses you are currently wearing and at where they are showing signs of wear, which is often more informative than anything else in the room.
Because CMT is inherited, we will also ask about family history and about how things have changed for you over recent years, since the direction of travel matters for what we prescribe.
Orthoses Used in Charcot-marie-tooth
- Custom insoles, contoured to a high arched foot to spread load rather than concentrate it, and built with cushioning where pressure is highest
- Carbon fibre and posterior leaf spring ankle foot orthoses, which address foot drop while keeping weight low
- Hinged and rigid ankle foot orthoses, where ankle instability or weakness is more marked
- Modular and custom footwear, providing the depth, width and fastening that clawed toes and a high instep require
- Footwear adaptations, including sole modifications where balance or leg length needs addressing
- Wrist and hand orthoses, where hand weakness begins to affect daily tasks
Children and Young People With Cmt
CMT often shows itself in childhood or adolescence, and the signs are easy to attribute to something else. Frequent tripping, difficulty keeping up, shoes wearing through unevenly and reluctance to take part in sport are all common early presentations.
Assessment in this age group focuses on foot shape while it is still developing, on footwear that a young person will actually wear, and on protecting a foot that will be under load for many decades to come. Growth means review needs to be more frequent than it is for adults.
Managing a Condition That Progresses Slowly
CMT typically changes over years rather than months, which can make it tempting to leave a device in place long after it has stopped matching the foot. Periodic review picks up gradual changes that are hard to notice from the inside, and allows the prescription to be adjusted before problems with skin or balance develop.
Common Questions
Can orthotics stop CMT progressing?
No. CMT is a genetic condition and orthotic treatment does not act on the underlying nerve disorder. What it addresses is the mechanical consequences, including pressure distribution, foot position, stability and the strain placed on the rest of the limb.
Will I be able to wear normal shoes?
Many people can, particularly where a custom insole is the main device and the shoe has enough depth. Where foot shape makes that impractical, modular and custom footwear options exist.
How often should devices be replaced?
That depends on wear, activity and how much the foot has changed, so it is set individually rather than to a standard interval.
My relatives have CMT too. Should they be assessed?
CMT runs in families, and family members with foot symptoms are welcome to be assessed. Diagnosis itself sits with a neurologist rather than with us.
Do I need a referral?
No, we accept self-referrals as well as referrals from consultants, physiotherapists and podiatrists.