Braces are orthotic devices that hold a part of the body in proper alignment to support function. For people with Charcot-Marie-Tooth disease (CMT, an inherited nerve condition that causes progressive muscle weakness and sensory loss in the limbs), braces can help compensate for weakness, muscle wasting, and reduced sensation. Many people with CMT use specialized footwear, foot orthoses, or ankle-foot orthoses (AFOs) to maintain independent walking. Bracing options are also available for the knees, hands, neck, and spine.

What bracing options are available for children with CMT who are still growing?

Children with CMT should receive the same thorough clinical evaluation and goal-setting as adults, with one additional consideration: growth. Because growth rates cannot be precisely predicted, practitioners may choose to build extra length into a device to accommodate potential growth without compromising fit, stability, or function. Factors used to prescribe an orthosis include muscle strength in various areas, age, overall strength, hand involvement, and the extent of changes to muscles, tendons, ligaments, bones, joints, and balance.

What is the difference between an orthosis and a brace?

An orthosis is an orthopedic device (and a clinical service) used to support, align, prevent, or correct musculoskeletal problems or to improve the function of movable body parts. The clinical assessment must come first and must be biomechanically sound for the orthosis to work effectively. A brace is a type of orthosis. Bracing in CMT most commonly involves the lower limbs, though options exist for the spine, hands, and arms.

Common orthotic types used in CMT include:

  • Ankle-foot orthoses (AFOs): devices that enclose the ankle and foot without extending above the knee, intended to prevent foot drop by stabilizing the foot and ankle
  • Knee-ankle-foot orthoses (KAFOs): devices extending from above the knee to the foot, used when weakness has spread to the thigh muscles and affects knee stability during walking
  • Posterior leaf spring AFO
  • Solid ankle AFO
  • Floor reaction AFO
  • Jointed AFO
  • Range-of-motion adjustable jointed AFO
  • Energy-storing carbon fiber AFO
  • Energy-storing KAFO
  • Off-the-shelf AFOs (generally not recommended for people with CMT who have moderate or significant deformity)

Consult your doctor or orthotist to explore which options are appropriate for you.

What outcomes can I expect from bracing?

Corrective bracing for people with CMT aims to align joints, restore balance, prevent further deformity, and support a more functional walking pattern. Many people find themselves significantly more capable when wearing their AFOs. Custom-made devices are generally best, and adjustments are normal before a good fit is achieved.

Some people with CMT manage well without AFOs using supportive flat shoes, lace-up footwear, or in-shoe orthotics. Many people with CMT wear athletic or walking shoes consistently; high-top shoes can also help stabilize the ankle during physical activity.

Simple wrist supports can help extend the time a person can work comfortably. More broadly, avoiding repetitive activities that place excessive demand on already weakened areas is important. Even hobbies involving repetitive movement that engages affected muscles can contribute to further weakness over time.

Why does CMT affect mobility, and how do braces help?

CMT is characterized by the gradual deterioration of motor and sensory nerve function, resulting in progressive muscle weakness and reduced sensation in the limbs. In the lower extremities, the primary problems are impaired standing balance and walking, which often stem from foot drop (difficulty lifting the front of the foot), foot rotation, and reduced ability to flex the foot.

Foot drop and balance loss are among the most common concerns when people with CMT are evaluated for AFOs. Balance difficulties can make an already uneven walking pattern more pronounced, increase the need to lean on objects while standing or walking, cause early muscle fatigue in the areas that are still functioning, and raise the risk of tripping and falling. One study (Vinci, Paoloni, and colleagues, 2010) found that with each trip or fall, people with CMT reported feeling less secure and more aware of their limitations. The study also noted that increased fatigue reduces people’s ability to participate in activities they want to do, which can be isolating.

For more information on living with CMT and managing symptoms, visit our CMT overview and patient resources pages.