Foot Surgery Improves Quality of Life for Patients in Small Study

Corrective foot surgery lessened pain and improved foot alignment and quality of life in patients with Charcot-Marie-Tooth (CMT) disease, according to data collected over four years.

The findings were published in an article, “A prospective study on surgical management of foot deformities in charcot marie tooth disease,” in the Journal of the Peripheral Nervous System.

CMT, the most frequent inherited neuromuscular disease, is characterized by sensory loss and weakness of the upper and lower limbs that worsens with time.

Deformities in the feet, including pes cavus (high arch foot) and so-called hammer toes, are estimated to affect 71% of CMT patients. Such complications often require corrective surgery.

A prior study reported that 30% of CMT patients underwent foot surgery. The procedure is usually recommended when conservative measures, such as physiotherapy and orthotics, fail.

Currently, surgery in CMT has no official guidelines. However, at the 2016 European Neuromuscular Centre workshop, a consensus was reached on the surgical procedures acceptable for correcting foot deformities in CMT, along with a recommendation for more studies in children and adults.

In the new study, researchers analyzed the long-term outcomes of foot surgery in a group of CMT patients.

The analysis included 25 patients (mean age of 39.5 years at the time of surgery and 72% men) at the National Hospital for Neurology and Neurosurgery, Queen Square in London, U.K. Overall, 30 feet were operated on, as five patients had surgery on both feet. Twenty‐five feet were assessed after one year, 19 after two years, 15 after three years, and three at year four.

CMT1A was the most frequent type of CMT, found in 68% of patients (17 out of 25). Surgical correction of pes cavus was performed on 19 feet (62%), followed by ankle fusion, a type of surgery to fuse the bones of the ankle into one piece, which was performed in eight feet (26%). Ten patients (40%) had had previous surgery.

Eight participants (32%) had complications early after surgery, including delay in wound healing, blisters, and superficial wound infection. One patient had a periostal reaction, which indicates irritation in the tissue covering the bones. Another patient developed Charcot neuroarthropathy, a progressive degeneration of the joints, following ankle fusion surgery.

Follow-up data, for up to four years after the surgical interventions, showed a significant improvement in foot alignment, as measured by the foot posture index (FPI) that evaluates standing foot posture. Pain, measured using a visual analogue scale, was significantly lessened.   

Patient-reported outcomes in the Manchester-Oxford Foot Questionnaire showed that perception of pain was significantly lessened, while ability to walk and to interact socially improved.

Also, the team found a trend in fewer falls after surgery and significantly less callosities — hardened skin that develops when the skin tries to protect itself against friction or pressure — the result of better foot alignment.

FPI evaluation also confirmed that foot posture significantly improved in the first year after surgery.

However, no long-term effects were noticed in the perception of fatigue, foot function, and CMT examination scores, which are used to assess disease severity. No differences in pain and foot posture were found throughout follow-up.

Overall, this study suggests that “surgery resulted in significant improvement of pain, foot alignment, callosities and quality of life,” the researchers wrote.

“Although evidence based guidelines on surgical management in CMT are not available, this study suggests that surgery for foot deformity in adults with CMT in a specialised foot and ankle unit is beneficial,” they concluded.

However, more studies with longer follow‐ups and a larger number of patients are needed, the team said. Among the study’s limitations were the reduced number of participants evaluated at three and four years after surgery due to loss to follow‐up and visits conducted after the data collection window.