Orthopedic surgery fails to improve foot function in CMT children

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Despite improvement in some physical characteristics, orthopedic foot surgery does not appear to improve strength, foot function, or the overall quality of life of children with Charcot-Marie-Tooth disease (CMT), suggests a small study.

However, the authors note, more studies are needed in larger trials to fully determine the impact of the procedure on outcome in children.

The study, “Surgical Outcomes of Foot Deformity in Cavovarus in Children with Charcot-Marie-Tooth Disease, ”Was published in Neuromuscular disorders.

Cavovarus foot is the most common foot deformity associated with CMT. It is characterized by a high cavus (arch) associated with an inwardly turned heel (varus), resulting in an abnormal shape of the foot. Overall, it is estimated that foot deformities affect 60-90% of all patients diagnosed with the disease.

Orthotics (external devices that adapt to the deformity and help reduce foot pain) and physiotherapy are generally recommended for relieving and managing foot pain. However, in more severe cases, orthopedic foot surgery may be the only option.

Very few studies have examined whether orthopedic surgery to correct foot deformities results in improved health outcomes in children with CMT.

In this study, a team of researchers from the Australian University of Sydney set out to assess the impact of orthopedic foot surgery on physical characteristics, foot strength, function and overall quality of life in a group of children with CMT.

The study involved 21 children with CMT who had undergone orthopedic surgery to correct deformities of the foot by the age of 12.5 years, on average.

All children were assessed before and after surgery (approximately 15.7 months after) and their results were compared to data from a natural history study involving 206 children with CMT who received no intervention.

Parameters of the Pediatric CMT Scale (CMTPedS) were used to assess foot alignment (foot posture index), ankle flexibility (lunge test), strength (foot dorsiflexion / plantar flexion by manual dynamometry), function (balance, long jump, six-minute walk test) and self-reported symptoms.

The quality of life of the children was assessed by completing the Child Health Questionnaire and walking by the pressure load test (a test that measures the pressure of the foot on the ground).

The results showed that foot alignment (6.0 point increase in foot posture index) and ankle flexibility (6.1 degree increase) improved after surgery, and were all two significantly different from the children who had received no intervention.

Likewise, walking (higher pressure under the extremity and middle part of the foot) improved considerably after orthopedic surgery. In addition, the number of self-reported daily trips and falls decreased from 60% at baseline to 13% after surgery, reflecting an improvement in self-reported symptoms.

However, orthopedic foot surgery had no impact on the strength, function or overall quality of life of children’s feet; their clinical results were identical to those of the children in the natural history study who received no intervention.

“Our results show that a combination of bone and soft tissue surgery improves foot alignment, ankle flexibility, self-reported trips / falls, and plantar pressure load in this population. However, the surgery had no effect on strength, function or quality of life, which generally reflected the natural course of the disease, ”the researchers said.

They noted several limitations, namely the small sample size and the fact that the data cannot be generalized to other types of CMT since most of the participants had CMT1A.

“Future studies using self-reported pain severity measures and radiographic data on a large sample of participants are needed to fully understand the impact of surgery on patient outcomes,” they said.


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