# Charcot-Marie-Tooth disease (CMT)

> Charcot-Marie-Tooth disease (CMT) is a group of inherited conditions that slowly damage the nerves in the feet and legs, and later the hands, causing weakness, high arches and tripping. There's no cure, but exercise, braces and other care can help manage symptoms.

Guide in [Diabetes, arthritis and other conditions](https://footanklelowerlimb.com.au/learn/topics/diabetes-arthritis-and-other-conditions), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/charcot-marie-tooth-disease
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 11 November 2026.
Next review by 11 November 2027.

- **It's inherited:** CMT is a group of conditions passed down in families that damage the nerves to the feet, legs and, later, the hands.
- **It usually starts in the feet:** weakness, high arches, tripping and dulled feeling are common early signs.
- **There's no cure,** but care aims to keep you moving and manage symptoms.
- **Planned exercise is the best-supported step,** and overdoing it can make symptoms worse.
- **It's slowly progressive,** and for most people it doesn't affect life expectancy.

## What is Charcot-Marie-Tooth disease, and how common is it?

Charcot-Marie-Tooth disease (CMT) is a group of inherited conditions that damage the peripheral nerves, the nerves outside your brain and spinal cord [1]. You may also see it called hereditary motor and sensory neuropathy. It's the most common inherited neuropathy [2]. It's progressive: symptoms slowly get worse and everyday tasks become harder [1].

Estimates of how common it is vary. About 1 in 2,500 people is one estimate [3], and other counts come out differently [4].

There are several main types. In CMT1, the most common, the insulating layer around the nerves (the myelin sheath) slowly breaks down. CMT2 is less common and usually less severe, with the damage in the nerve fibre itself (the axon). CMT3 is rare and severe, with symptoms starting in early childhood [5]. Most people first show signs by the age of 20 [6].

## What causes it, and who gets it?

CMT is caused by faults in genes that damage the peripheral nerves [5]. No single gene is responsible: dozens have been linked to it [7][3], and the faulty genes can be passed on in several different ways [5]. The most common cause is an extra copy (a duplication) of a gene called PMP22, behind more than half of all cases [7]. In some types the faulty genes make the myelin sheath break down. In others the axons are damaged and don't carry signals as strongly [5].

Nearly all cases are inherited [7], so a family history of CMT is the main known risk. The pattern of inheritance can differ between types.

## What does it feel like, how is it diagnosed, and what can make it serious?

CMT usually starts in the feet and lower legs, because the longest nerves are affected first. Weakness often becomes noticeable in the teens or early adulthood, but it can start at any age [7]. Common early signs are weak muscles that make it hard to lift the foot (foot drop), a high-stepped walk with frequent tripping or falls, and balance problems [7]. The feet can change shape, with high arches, flat feet or curled toes (hammer toes) [7][8], and foot deformities are common [9]. Feeling in the feet and lower legs is often dulled for touch, heat and cold, and some people have aching or burning sensations [8]. Nerve pain can range from mild to severe [7]. Foot drop and a high-stepped walk raise the risk of tripping, falls and ankle injury [8][9]. Later, weakness and numbness can spread to the hands and arms [10], and some people develop tremor or scoliosis (a curved spine) [10].

CMT is diagnosed from your symptoms, family history and an examination, followed by a nerve conduction test (a test of how well your nerves carry signals) [11]. High arches with wasting of the lower leg muscles are a prompt to look for a nerve problem, and family history is always explored [12]. Genetic testing is then done step by step, starting with the PMP22 duplication [11].

> [!tip] Try this
> Jot down when your symptoms began and whether any relatives have foot, walking or hand problems. Family history is part of the assessment.

Some features can mean a more serious form of CMT, though they're rare. Trouble swallowing, vocal cord problems that affect the voice, and difficulty breathing are linked to certain types. Some CMT2 types may involve the vocal cords or the nerve to the diaphragm, which can cause speech or breathing problems [7]. Breathing problems are a leading cause of serious illness in neuromuscular conditions [13]. A severe, early-onset form called CMT4D has also been reported with deafness, a curved spine and cognitive delay [13]. Most types have normal hearing, though CMT4C can bring mild hearing loss [14].

Some medicines can make CMT worse. The cancer drug vincristine, and possibly paclitaxel, can occasionally cause a harsher form of nerve damage in people with CMT, so care is advised and nerve function should be closely monitored [15][16]. People with CMT shouldn't be denied effective treatments, such as cancer treatment, that may prolong life or improve health [16]. Whether nitrous oxide (a gas sometimes used for pain relief) can worsen CMT isn't settled [17].

CMT can also sit alongside other nerve conditions. A chronic inflammatory nerve condition (CIDP) has been reported with one common type, and an unusual pattern on a nerve conduction test can point to another or an extra neuropathy [12].

## What helps first?

There's no cure for CMT, and no medicine that changes its course [11][2]. Care focuses on managing symptoms with a team of health professionals, ideally starting early, with personalised exercise advice, adapted orthoses (braces and supports) and assessment for conservative surgery [11]. The aim is to keep your mobility, flexibility and muscle strength as much as possible, using physical and occupational therapy, braces and other devices [2].

Exercise has the most support. Strengthening the muscles that lift the ankle can limit how much weakness progresses in children with CMT1A [18]. Strength or endurance training may improve function and daily activities in people with CMT, though the role of orthoses isn't completely clear yet, and an agreed exercise programme can't yet be set [19]. For other outcomes the evidence is weak [18].

People with CMT usually can't train at the intensities recommended for healthy people, and high-intensity training is linked with reduced performance and more injuries in neuromuscular disease [3]. Overexertion, or not following exercise instructions, can make symptoms worse [16]. It helps to keep exercise planned and personalised, and to follow the instructions you're given.

## What helps if that isn't enough?

Nothing beyond first-line care has been shown to change the condition itself. Management stays focused on symptoms, with orthotic adaptation and assessment for conservative surgery such as tendon transfer (where a tendon is moved) [11]. Braces, other orthopaedic devices and orthopaedic surgery are among the treatments that can help with symptoms [2]. Some people rely on foot or leg braces to keep walking, and medicines to relieve nerve pain may be prescribed when it is severe [7].

Vitamin C (ascorbic acid) gives little worthwhile improvement in fatigue for people with CMT1A, though it seemed safe and well tolerated [20].

## What is the outlook with CMT?

CMT is slowly progressive, and for most people it doesn't affect life expectancy [8]. Lower-leg muscles usually weaken further, and hand weakness can make writing, doing up buttons and turning doorknobs harder [8]. Symptoms vary from person to person, even within a family. It isn't possible to predict when they will start, how fast they'll progress or how severe they'll be [10].

Foot drop is the most prominent walking pattern in CMT, and people with CMT fall often [9]. Taking steps to lower the chance of falls and ankle injury makes sense.

Because CMT is inherited and progressive rather than something that clears and returns, there's no coming back to guard against. Rehabilitation aims to keep you moving and manage symptoms, and no evidence-based rehabilitation protocol can yet be set [19].

## Common questions

### Will I pass CMT on to my children?

CMT is inherited, and the faulty genes can be passed on in several different ways depending on the type. So the chance for your children depends on which type runs in your family. Symptoms also vary, even between relatives with the same condition, so how mild or severe it would be can't be predicted.

### Do people with CMT end up in a wheelchair?

Leg and foot problems rarely require a wheelchair. CMT does progress slowly, and weakness and loss of feeling can spread to the hands and arms, which can make writing, doing up buttons and turning doorknobs harder. How quickly it progresses varies from person to person and can't be predicted.

### Is pregnancy safe with CMT?

Pregnancy in women with genetic neuromuscular conditions is considered higher-risk. CMT has been linked with preterm labour and caesarean delivery, and care shared between neurologists and obstetricians is advised. This describes risks in general; it doesn't mean every pregnancy will have problems.

## Further reading

- [Charcot-Marie-Tooth disease (CMT) on Clindice](https://clindice.com/charcot-marie-tooth-disease)
- [Charcot-Marie-Tooth disease (CMT)](https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/charcot-marie-tooth-disease-cmt), Better Health Channel
- [Charcot-Marie-Tooth disease (CMT) | Healthify](https://healthify.nz/health-a-z/c/charcot-marie-tooth-disease-cmt), Healthify
- [Charcot-Marie-Tooth disease: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/charcot-marie-tooth-disease/), MedlinePlus
- [Charcot-Marie-Tooth disease - Diagnosis](https://www.nhs.uk/conditions/charcot-marie-tooth-disease/diagnosis/), NHS

## Sources

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2. Charcot-Marie-Tooth Disease · National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/charcot-marie-tooth-disease
3. Telecoaching: a potential new training model for Charcot-Marie-Tooth patients: a systematic review. · Leale I, Di Stefano V, Costanza C et al. · Frontiers in Neurology · 2024. https://doi.org/10.3389/fneur.2024.1359091
4. A meta-analysis on the prevalence of Charcot-Marie-Tooth disease and related inherited peripheral neuropathies. · Ma M, Li Y, Dai S et al. · Journal of Neurology · 2023. https://doi.org/10.1007/s00415-023-11559-8
5. Charcot-Marie-Tooth disease - Causes · NHS. https://www.nhs.uk/conditions/charcot-marie-tooth-disease/causes/
6. Charcot-Marie-Tooth disease · Healthdirect Australia. https://www.healthdirect.gov.au/charcot-marie-tooth-disease
7. Charcot-Marie-Tooth Disease · National Institutes of Health. https://www.ninds.nih.gov/sites/default/files/2025-05/charcot-marie-tooth-disease.pdf
8. Charcot-Marie-Tooth disease | About the Disease | GARD · National Institutes of Health. https://rarediseases.info.nih.gov/diseases/6034/charcot-marie-tooth-disease
9. The effect of ankle-foot orthoses on gait characteristics in people with Charcot-Marie-Tooth disease: A systematic review and meta-analysis. · Kim A, Frecklington M, Philps A et al. · Journal of Foot and Ankle Research · 2024. https://doi.org/10.1002/jfa2.70003
10. Charcot-Marie-Tooth disease - Symptoms · NHS. https://www.nhs.uk/conditions/charcot-marie-tooth-disease/symptoms/
11. Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease. · Sivera Mascaró R, García Sobrino T, Horga Hernández A et al. · Neurologia · 2025. https://doi.org/10.1016/j.nrleng.2024.02.008
12. PMP22-Related Neuropathies: A Systematic Review. · Cesaroni CA, Caiazza L, Pisanò G et al. · Genes · 2025. https://doi.org/10.3390/genes16111279
13. Clinical and pathological findings in two Italian siblings of Romani ancestry with charcot-marie-tooth type 4D and review of the current literature. · Abati E, Ferrari Aggradi CR, Magri S et al. · Journal of Neuromuscular Diseases · 2026. https://doi.org/10.1177/22143602261438536
14. Charcot-Marie-Tooth Disease and Hearing Loss: A Systematic Review With Meta-Analysis. · Mills JF, Heiland LD, Nguyen SA et al. · Otology & Neurotology · 2024. https://doi.org/10.1097/mao.0000000000004243
15. Toxic medications in Charcot-Marie-Tooth patients: A systematic review. · Cavaletti G, Forsey K, Alberti P · Journal of the Peripheral Nervous System · 2023. https://doi.org/10.1111/jns.12566
16. Charcot-Marie-Tooth disease - Treatment · NHS. https://www.nhs.uk/conditions/charcot-marie-tooth-disease/treatment/
17. Safety of nitrous oxide administration in patients with Charcot-Marie-Tooth disease. · Isbister GK, Burns J, Prior F et al. · Journal of the Neurological Sciences · 2008. https://doi.org/10.1016/j.jns.2007.12.004
18. Effectiveness of exercise therapy for individuals diagnosed with Charcot-Marie-Tooth disease: A systematic review of randomized clinical trials. · Conde RM, Senem I, Dos Santos M et al. · Journal of the Peripheral Nervous System · 2023. https://doi.org/10.1111/jns.12548
19. Rehabilitation Management of the Charcot-Marie-Tooth Syndrome: A Systematic Review of the Literature. · Corrado B, Ciardi G, Bargigli C · Medicine · 2016. https://doi.org/10.1097/md.0000000000003278
20. Interventions for fatigue in peripheral neuropathy. · White CM, van Doorn PA, Garssen MPJ et al. · The Cochrane Database of Systematic Reviews · 2014. https://doi.org/10.1002/14651858.cd008146.pub2

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