Library Type: Condition

Diagnosis

CMT occurs when there are mutations in the genes that affect the nerves that control muscles your feet, legs, hands, and arms. Symptoms of CMT typically appear in adolescence or early adulthood, but may also develop in midlife.

Signs of CMT

Symptoms usually begin in the feet and legs, but they may eventually affect your hands and arms. Signs and symptoms of CMT may include:²

• Weakness in your legs, ankles, and feet
• Smaller muscles in your legs and feet
• Foot deformities, such as high foot arches or curled toes (hammertoes)
• Difficulty walking and decreased ability to run
• Difficulty lifting your foot at the ankle (footdrop)
• Awkward or higher than normal step (gait)
• Frequent tripping or falling
• Decreased sensation or a loss of feeling in your legs and feet

As CMT progresses, symptoms may spread from the feet and legs to the hands and arms. The severity of symptoms can vary greatly from person to person, even among family members. Your physician may recommend tests including nerve conductions studies, electromyography (EMG), nerve biopsy, or genetic testing to help provide information about the extent of your nerve damage and what may be causing it.

Treatment

CMT generally progresses slowly. There is no cure, but there are treatments to help manage it.

• Foot care. Foot deformities and loss of sensation are associated with CMT. Regular foot care such as inspecting your feet, taking care of your nails, and wearing the right shoes is important to help relieve symptoms and to prevent complications.

• Physical therapy. Physical therapy can help strengthen and stretch your muscles to prevent muscle tightening and loss. Exercise and stretching at home as directed by your physician can also help and improve stability.

• Occupational therapy. Weakness in the arms and hands can cause difficulty with gripping and finger movements, such as fastening buttons or writing. Occupational therapy can help through the use of assistive devices.

• Orthotic devices. Many people with CMT may require orthotic devices to maintain function and mobility. The certified orthotists at Hanger Clinic understand how the different types of CMT present clinically and have expertise across a full range of orthotic devices, including custom ankle-foot orthoses (AFOs), to assist in daily activities such as walking and climbing stairs.

1. National Institute of Neurological Disorders and Health.
2. Mayo Clinic.

Diagnosis

The diagnosis is made by a doctor and confirmed by an orthopedist who will order an X-ray and other tests.

Treatment

The curvatures of the spine caused directly by the affected bones are very rigid and will not straighten. Many times, there are other abnormal curvatures, called compensatory curves, that form above or below due to the rigid, affected sections of the spine. These compensatory curves are flexible and may be considered for treatment with spinal bracing, most commonly a thoracic lumbar sacral orthosis (TLSO).

Mehta Casting

Serial, or Mehta, spinal plaster casting is used to stop the progression of the curve and delay surgical intervention. Mehta casting is designed to utilize patient growth in a corrected position to correct scoliotic curves. The procedure is typically performed under sedation and fluoroscopy (a live X-ray) to ensure a high degree of accuracy by the orthopedic surgeon. 

Spinal bracing plays a role in the spinal serial casting program. Braces are used during “brace holidays” in order to maintain the correction achieved in the casts before the next cast is applied.  Your orthopedic surgeon will determine the best opportunity for these brace holidays. 

Your Hanger orthotist can help determine the proper type of spinal brace with a diagnosis of congenital scoliosis. Braces need to be worn for 18-22 hours per day. Lesser time in a TLSO can lead to an increased risk of curve recurrence after improvement with Mehta casting. 

Both the congenital and compensatory curves are at risk of worsening during skeletal growth. Orthotic intervention can help delay the need for surgical correction, allowing the child normal growth potential.

Treatment

The most common treatment for pectus carinatum is the use of a compressive brace during times of growth. This brace wraps around the chest and applies a light, gradual pressure over the projected area to reshape the chest wall while the patient is growing. This can be custom-made or off-the-shelf, depending on the child’s body shape and location of the projected area. The amount of correction achieved directly relates to the amount of time the child wears the brace. Ideally, they will wear the brace 16 to 23 hours a day through their adolescent growth spurt. As the chest wall reshapes and the patient grows, follow-up appointments will be necessary to make sure the brace continues to fit and function correctly.

Research has shown that patients who wear their brace for the prescribed amount of time have significant improvement in appearance and long-term correction, eliminating the need for surgical intervention. If left untreated, pectus carinatum can progress, becoming more noticeable and permanent as a person reaches skeletal maturity. Once a patient has finished growing and has reached skeletal maturity, an orthotic brace is no longer an effective treatment and surgical intervention may be an option. 

Treatment

Many patients do not experience serious problems, but in severe cases, and if left untreated, kyphosis can cause damage to the spine and other areas of the body. 

There are three proven treatments for kyphosis: — monitoring, bracing, and surgery. Your physician will recommend which one of these treatments is appropriate based on the severity of the curve and age of your child.

• Bracing can be effective in many cases to stop the progression of kyphosis, and treatment will be needed until your child stops growing. The goal of bracing is to prevent additional kyphosis by hyperextending the spine to reduce wedging of the affected bones. Kyphosis braces are usually worn 16-20 hours per day and removed for all contact sports until the child is through puberty.
• Physical therapy may also be suggested to stretch and strengthen the muscles of the spine and core, concentrating on extension exercises.
• Surgery is also an option your physician may discuss. Oftentimes, surgery may be recommended if bracing was ineffective or the curve is being treated after puberty.

Treatment for kyphosis should be considered a team approach that involves the physician, orthotist, physical therapist, your family, and most importantly the patient.

Wearing time for the compression therapy is anywhere from 6-12 months, or as long as the burn team feels the burns are still “active”. Active refers to the state in which the burn is still healing and can change into hypertrophic scarring.

Compression therapy is widely viewed as essential to minimize scarring. The theory behind compression therapy is to reduce the blood flow to the area of the burn, as well as to apply continuous pressure to the burn to stop the growth of scar tissue. It is important to note that compression therapy is just one part of the rehabilitation of burn injuries. Your burn team will most likely include splinting (bracing), exercise, and scar mobility as part of the plan.

<sub><sup>1. Atiyeh, B S et al. “Pressure garment therapy (PGT) of burn scars: evidence-based efficacy.” Annals of burns and fire disasters vol. 26,4 (2013): 205-12.
2. Krishnamoorthy, Vijay et al. “Pediatric burn injuries.” International journal of critical illness and injury science vol. 2,3 (2012): 128-34.</sup></sub>