Foot Care and Podiatry
For many people with CMT, the feet and lower legs are where symptoms show up first. A podiatrist who understands neuromuscular conditions can help you stay active, stay comfortable, and avoid bigger problems down the road.
At a glance
- CMT often shows up in the feet first, which makes a podiatrist one of the most valuable members of your care team.
- A high, rigid arch (pes cavus) is one of the most reliable signs of CMT.
- Look for a podiatrist or orthotist who has experience with CMT or other neuromuscular conditions.
- Clawed toes, ankle instability, and drop foot are all common and usually manageable.
- Most people start with conservative care: supportive shoes, custom inserts, and bracing.
- Reduced sensation in your feet raises the risk of skin sores, so daily foot checks matter.
- Pairing podiatry with physical therapy tends to give the best results.
- An early visit means earlier help and better long-term outcomes, even if your symptoms feel mild.
Why CMT affects your feet first
CMT slowly weakens the muscles in your lower legs and feet. When some muscles weaken faster than others, the balance between them shifts. Over time that imbalance pulls your foot into new positions.
Because the nerves and muscles farthest from your spine are usually affected earliest, your feet and lower legs tend to feel the changes first, and most noticeably. That is why foot symptoms are often the earliest clue that something is going on, and why a podiatrist is often on the front line for spotting CMT.
How this looks can vary a lot from person to person and by CMT subtype. If you have not yet confirmed your subtype, CMT Genie can help you understand your genetic testing options.
What a podiatrist looks for
High arches (pes cavus or cavovarus): An unusually high arch caused by muscle imbalance. A rigid high arch is one of the most reliable signs of CMT.
Claw toes: Toes that curl downward, creating pressure points and spots where skin can break down.
Equinovarus: The foot points downward and inward because of weakness and imbalance.
Ankle instability: Repeated sprains, or a feeling that your ankle gives way, which is common with high-arch feet.
Tripod foot: A rigid forefoot that touches the ground in a triangular pressure pattern, a sign of bigger structural change.
Gait changes: A high-stepping walk, shuffling, pelvic tilt, or heel tilt, which a full biomechanical exam will check for.
Sensory changes: Reduced ability to feel vibration, pressure, or where your foot is in space, which can raise the risk of unnoticed sores.
How a podiatrist diagnoses foot problems
A careful clinical exam is highly reliable. Your podiatrist will take a detailed history, check the structure and flexibility of your foot, watch how you walk, and test your strength and sensation.
Imaging like MRI has not proven especially useful for diagnosing CMT itself, though it can help assess muscle changes and rehabilitation potential in some cases. Ask a specialist what makes sense for your situation.
Conservative (non-surgical) care
Because CMT usually progresses slowly, the first goal is often to control the deformity with supports and keep you comfortable and functional for as long as possible. This approach fits people with a manageable deformity, and those who are not good candidates for surgery.
Supportive footwear: Extra-depth shoes with cushioned, multi-density insoles take pressure off bony spots and can slow the forces that worsen claw toes. Look for shoes wide and deep enough to hold a custom insert, and ask your podiatrist or orthotist about options that work with your braces.
Custom bracing: A molded ankle-foot orthosis (MAFO) wraps around your lower leg and foot to support a weak ankle, help control drop foot, and give you stability as you push off and clear the ground with each step. Good bracing can noticeably cut your risk of tripping. Learn more on our bracing and orthotics page.
Therapy: A team approach that combines podiatry with physical therapy and occupational therapy tends to work best. Targeted strength work can slow joint stiffening and make the most of the muscles you still have. Even modest strength gains can lead to real improvements in day-to-day function.
When surgery is an option
When supports and therapy are no longer enough, surgery may be worth considering. Surgical planning for CMT is more complex than standard foot surgery, so it is important to work with a surgeon experienced in neuromuscular conditions.
Before recommending a procedure, a surgeon weighs several things: exactly where and how the foot is deformed, which muscles and tendons still work, whether the deformities are flexible or rigid, and whether the ligaments have become loose.
The goals are to correct fixed deformities, rebalance the pull of muscles and tendons, and prevent the problem from coming back. Addressing deformities earlier, before they progress further, tends to lead to better long-term results, including a more comfortable and functional foot over time.
Specific procedures vary by person and surgeon. Ask your care team to walk you through every option and what recovery looks like, in plain terms, before you decide.
Goals for your foot care
Whether you choose conservative care or prepare for surgery, good podiatric management of CMT aims to keep you walking and active, prevent skin sores and other complications, reduce pain, slow structural change, and support your work in rehabilitation.
A visit with a podiatrist is worth it for anyone who has CMT or suspects they might. Earlier assessment means earlier help, and better outcomes over the long run. If foot pain is part of your picture, our pain management page has more support.
Finding the right care team
Look for a podiatrist or orthotist with experience in neuromuscular conditions. If your current provider is not familiar with CMT, it is reasonable to ask for a referral or to reach out to HNF for guidance. Our Centers of Excellence are a good place to start when you need a specialist who knows CMT.
You can also connect with others in the CMT community through the GRIN Registry, where people share their experiences and what they have learned about building a care team in their own area.
Frequently asked questions
Why does CMT affect the feet first?
CMT slowly weakens the muscles in your lower legs and feet, and when some muscles weaken faster than others, the imbalance gradually pulls your foot into new positions. Because the nerves and muscles farthest from your spine are usually affected earliest, your feet and lower legs tend to feel the changes first. That is why foot symptoms are often the earliest clue, and why a podiatrist is frequently on the front line for spotting CMT. If you have not confirmed your subtype yet, CMT Genie can help you understand your genetic testing options.
What kind of shoes are best for CMT?
Look for extra-depth shoes with cushioned, multi-density insoles that take pressure off bony spots and can slow the forces that worsen claw toes. They should be wide and deep enough to hold a custom insert, and it helps to ask your podiatrist or orthotist about options that work with your braces. Supportive footwear paired with a molded ankle-foot orthosis can also help control drop foot and improve stability, as covered on our bracing and orthotics page.
What is pes cavus, and is it a sign of CMT?
Pes cavus is an unusually high arch caused by muscle imbalance in the foot. A rigid high arch is one of the most reliable signs of CMT. Podiatrists also watch for related changes such as claw toes, ankle instability, and gait changes when assessing the foot.
Can CMT foot problems be treated without surgery?
Yes. Because CMT usually progresses slowly, the first goal is often to control the deformity with supports and keep you comfortable and functional for as long as possible. Conservative care typically includes supportive footwear, custom inserts, and bracing, and it works best when combined with physical and occupational therapy. Even modest strength gains can lead to real improvements in day-to-day function.
Should I see a podiatrist if my CMT symptoms feel mild?
Yes. A visit is worth it for anyone who has CMT or suspects they might, because earlier assessment means earlier help and better outcomes over the long run. Reduced sensation in the feet also raises the risk of skin sores, so regular checks matter even when symptoms feel minor. Look for a podiatrist experienced in neuromuscular conditions, and our Centers of Excellence are a good place to start when you need a specialist who knows CMT.
Start with your subtype
The most useful first step in living well with CMT is confirming your subtype. From there, the right care and research opportunities fall into place.