Quick answer
Charcot-Marie-Tooth disease (CMT) is an inherited group of disorders that damage the peripheral nerves — the nerves running to the legs, feet, and hands. It is the most common form of hereditary peripheral neuropathy. The feet are usually the first place symptoms appear, often in late childhood or adolescence. Hallmark signs: high arches, hammertoes, frequent ankle sprains, and difficulty lifting the foot when walking.
How to recognize it
In the feet specifically, the classic constellation:
- High arches (pes cavus) — often striking, can be the most obvious sign
- Hammertoes or claw toes
- Foot drop — difficulty lifting the front of the foot
- Frequent ankle sprains from instability
- “Stork leg” appearance — atrophy of muscles below the knee
- Weakness in pushing off the toes
- Difficulty walking heel-to-toe
- Tripping on rugs, curbs, uneven ground
In the hands (later or simultaneously):
- Weakness gripping
- Difficulty with fine motor tasks (buttons, writing)
- Wasting of small hand muscles
Why CMT often gets diagnosed late
The condition develops slowly over years. Early signs are easy to attribute to other things:
- “She’s just clumsy” (frequent tripping)
- “He has bad ankles” (frequent sprains)
- “Just runs in the family” (high arches)
Many CMT patients are diagnosed in their 20s, 30s, or even later — sometimes only after a podiatrist or orthopedist notices the pattern of high arches plus ankle weakness plus subtle hand involvement.
Types and inheritance
CMT is an umbrella term for many genetically distinct conditions. The main groups:
- CMT1 (most common, ~50% of cases) — affects the myelin sheath that insulates nerves; slow nerve conduction
- CMT2 — affects the nerve fiber itself; normal-speed but reduced-amplitude nerve signals
- CMTX — X-linked, more severe in males
- CMT4 — autosomal recessive, often more severe
Most CMT is autosomal dominant — a 50% chance of passing to each child. Family history is common but not universal (some cases are spontaneous mutations).
Diagnosis
A clinician will typically:
- Take a detailed history including family members
- Examine the feet, ankles, hands, reflexes, sensation
- Order nerve conduction studies and EMG — distinguishes CMT1 from CMT2 and rules out other neuropathies
- Genetic testing to confirm the specific subtype
Treatment
There is no cure for CMT, but the symptoms are managed effectively in most patients.
Foot and ankle care
- Bracing — ankle-foot orthoses (AFOs) help with foot drop and ankle stability
- Custom shoes or orthotics for high arches and toe deformities
- Physical therapy to maintain strength and prevent contractures
- Stretching to prevent calf and Achilles tightening
- Surgery for severe foot deformities — selected procedures including tendon transfers, osteotomies, and arthrodesis
Other supports
- Occupational therapy for hand involvement
- Assistive devices as needed (canes, walkers — sometimes years away from current function)
- Genetic counseling for family planning
- Avoid neurotoxic medications — certain drugs (vincristine, taxanes) can dramatically worsen CMT and should be avoided when possible
Emerging therapies
Several gene therapies and small molecules are in clinical trials for specific CMT subtypes. The CMTA tracks current research and trials.
When the workup is appropriate
CMT is worth considering when:
- High arches plus weakness or instability
- Family history of CMT or unexplained gait/balance problems
- Foot drop, especially bilateral
- Progressive foot deformity
- Hand weakness or atrophy alongside foot problems
A neurologist with peripheral nerve experience is the right specialist for the workup.
Living with CMT
Most people with CMT have a normal lifespan and lead full lives. The condition usually:
- Progresses slowly over decades
- Doesn’t typically affect cognition, vision, hearing, or organs other than peripheral nerves
- Is highly variable — even within a family, severity can range from minimal to substantial
The CMTA and similar organizations provide community, current research updates, and practical support.
Last updated: April 25, 2026
About the author
Written and reviewed by a Doctor of Podiatric Medicine (DPM) practicing in Arizona for 6+ years. Board-certified by the American Board of Podiatric Medicine (ABPM); graduate of Midwestern University Arizona College of Podiatric Medicine.
Last clinically reviewed: April 25, 2026