Ankle, foot surgery allows adults with CMT to achieve personal goals
Correcting deformities also shown to significantly improve patients' balance
Surgery to correct ankle and foot deformities enabled adults with Charcot-Marie-Tooth disease (CMT) to achieve certain personal goals, such as walking barefoot or walking on uneven ground with shoes on, a new study revealed.
Undergoing a surgical correction also significantly improved balance among CMT patients, the researchers noted — though surgery had no impact on walking speed or other functional and gait assessments, according to the data.
The researchers had sought to better understand the patients’ personal goals, so as to enable “effective counselling.” Their study involved more than two dozen people in the Netherlands with CMT who underwent surgery.
“These insights can aid clinicians in preoperative counseling, helping to set realistic expectations regarding the potential benefits and limitations of foot and ankle surgery for persons with CMT,” researchers wrote, noting that “foot and ankle surgery in people with CMT aims to improve functional mobility.”
The study, “Surgical correction of foot deformities in Charcot-Marie-Tooth-disease: effects on personal goals and gait capacity,” was published in the journal Neuromuscular Disorders.
CMT is a group of conditions marked by damage to the nerves that control movement and sensation in the limbs, resulting in weakness and sensory issues.
Weakness in the lower leg and foot can lead to foot deformities, such as high arches, an inward curving of the heel, or curled toes. These can make walking difficult and sometimes require corrective foot surgery.
After foot and ankle surgery, adults with CMT able to walk barefoot
In a previous study, most CMT patients who underwent foot and ankle surgery reported improved walking abilities and were generally satisfied with the outcomes.
Yet, little is known about the impact of surgery on CMT patients’ personal goals — such outcomes as the ability to walk in shoes or barefoot, or engage in work, social events, sports, or other activities.
“Further research is essential to enhance knowledge about personal goals in CMT patients undergoing foot and ankle surgery,” the researchers wrote.
To that end, a research team recruited 28 adults with various types of CMT who underwent foot and ankle surgery. Among them, eight had surgery on both limbs.
Before surgery, most participants — 22, or 79% — had downward-pointing feet and bent ankles. A total of 86%, or 24 patients, wore either orthopedic shoes or inserts. The participants reported moderate balance, but a high risk of falling.
To identify the personal goals of these CMT patients, researchers used the Canadian Occupational Performance Measure (COPM) — a gold standard in personal goal-setting assessments that captures a person’s self-perceived performance in everyday living.
Before surgery, COPM identified 137 goals. The most common were having fewer problems when walking on uneven ground with shoes, as sought by 79%, having fewer problems during sports and cycling, as sought by 57%, and having fewers problems during work, school, household activities, and social activities, as sought by 46%.
“The current study underscores the wide variability in goals of people with CMT scheduled for foot and ankle surgery,” the team noted.
Satisfaction scores increased by nearly 4 points on 10-point scale
After surgery, COPM assessments showed a mean improvement of 2.8 points on a 10-point scale in patients’ self-perceived performance. Satisfaction scores, meanwhile, increased by 3.8 points, the data showed.
Surgery particularly helped achieve the personal goals of walking barefoot, walking on uneven ground with shoes, and experiencing fewer pressure sores or shoe fitting problems.
All participants reported meaningful improvements in performance and satisfaction on at least one of their personal goals after surgery. Overall, 69% of goals showed a performance increase of at least two points, and 78% showed a satisfaction increase of at least two points.
The finding that foot and ankle surgery in persons with CMT does not lead to an increase in gait speed is crucial for setting realistic expectations regarding surgical outcomes [among patients].
Using minimal important change, or the minimum change in scores that a patient perceives as beneficial, from other populations, 48% of performance scores and 64% of satisfaction scores surpassed these levels, showing improvements of three points or more.
Balance was also significantly better after surgery, according to the researchers.
For eight individuals, improved alignment of the ankle after surgery enabled them to wear orthoses, “whereas preoperatively they could not due to fitting issues,” the team noted.
Even so, surgery did not improve other functional measurements, such as walking speed and step width.
“The finding that foot and ankle surgery in persons with CMT does not lead to an increase in gait speed is crucial for setting realistic expectations regarding surgical outcomes” among patients, the team concluded.
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