Charcot-Marie-Tooth Disease

Systemic Conditions Affecting the Feet· Also known as: CMT, hereditary motor and sensory neuropathy, HMSN, peroneal muscular atrophyUpdated Nov 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, November 2026

At a Glance

Charcot-Marie-Tooth disease (CMT) is a group of inherited conditions that damage the nerves running to your muscles and skin. It is the most common inherited nerve condition, affecting about 1 in 2500 people. Most people first notice it before age 20, as weakness and thinning of the muscles in the lower legs and feet, often with high-arched feet. It slowly worsens and has no cure, but life expectancy is not affected in most people, and care from a team can help you stay mobile.

What is it?

Charcot-Marie-Tooth disease (CMT) is a group of inherited conditions that damage the peripheral nerves. These are the nerves outside your brain and spinal cord that carry messages to your muscles and bring back feelings like touch, heat and cold.

As these nerves become less able to do their job, muscles weaken and shrink, feeling is dulled, and the feet can change shape. The condition is progressive, which means symptoms slowly get worse over time.

There are several main types. CMT1 is the most common, and the protective coating around the nerves (the myelin sheath) breaks down. CMT2 is less common and usually less severe, and the nerve fibre itself (the axon) is affected. CMT3 is rare and severe, and starts in early childhood.

Who does it affect?

CMT is the most common inherited nerve condition. It is thought to affect about 1 in 2500 people. Another estimate puts it at 17.69 per 100,000 people. The two figures differ, and it isn't clear why.

Most people first show signs by age 20, often in the teenage years or early adulthood. It can begin at any age, though. Because CMT is inherited, a family history is the main known risk.

Signs and symptoms

CMT usually starts in the feet and lower legs, because the longest nerves are affected first. Common early signs are:

weakness and thinning of the muscles in the feet and lower legs
foot drop, which means difficulty lifting the front of the foot
a high-stepped walk with frequent tripping or falls, and poor balance
high arches (sometimes called pes cavus) and curled toes (hammer toes)
dulled feeling for touch, heat and cold in the feet and lower legs

Up to 74 per cent of people with CMT develop foot deformities. Some people have aching or burning nerve pain, which can range from mild to severe. Some also have a tremor or scoliosis (a sideways curve of the spine).

Over time, weakness and loss of feeling spread to the hands and arms. This can make writing, doing up buttons and turning doorknobs harder.

The pattern varies a lot from person to person, even between relatives. A few features point to a rarer or more severe type. Trouble swallowing, vocal cord paralysis or difficulty breathing can mean the nerves that control these have been affected. These problems are rare and are linked to certain types. They can lead to chest infections from food or drink going down the wrong way, or serious breathing problems. A severe form that starts very early can also involve deafness, scoliosis or delayed thinking skills. One type, CMT4C, causes mild hearing loss on average, but most types leave hearing normal.

Some medicines that harm nerves can make CMT worse. The cancer drug vincristine, and possibly paclitaxel, can occasionally cause a more severe than usual course of nerve damage in people with CMT. At the same time, people with CMT should not be denied effective treatments, such as cancer treatment, that may prolong life or improve health.

What causes it?

CMT is caused by faults (mutations) in genes that help make or run the peripheral nerves. No single gene causes it. More than 40 genes have been identified, and the many types of CMT come from different gene changes. The faults can be passed down through families in several ways.

The most common cause is an extra copy (a duplication) of a gene called PMP22. It is behind more than half of all cases. In some types the faulty gene makes the nerve's coating break down. In others the damage is directly to the nerve fibres.

How is it diagnosed?

CMT is diagnosed mainly from your story and an examination. Your podiatrist, or another health professional, will ask when your symptoms began and whether any relatives have foot, walking or hand problems. High arches and thinning of the lower leg muscles often lead them to look for a nerve problem.

A nerve conduction study usually follows. This test measures how well electrical signals travel along your nerves. Genetic testing is then done step by step. The first step is to check for the PMP22 duplication. If that isn't found, a broader gene test called next-generation sequencing may be considered.

Other nerve conditions can look similar or occur alongside CMT. One is chronic inflammatory demyelinating neuropathy (CIDP), which is an immune-related nerve condition. An unusual pattern on a nerve conduction study can point to another or an extra nerve problem. Another is hereditary neuropathy with liability to pressure palsies (HNPP), which comes from a missing copy of the same gene region that is duplicated in the most common type of CMT.

Treatment

There is no cure, and no medicine yet that changes the course of CMT. Care focuses on managing symptoms, ideally with a team that includes rehabilitation and orthopaedic care. Starting soon after symptoms begin can help people keep their quality of life.

Looking after it at home

Exercise is a central part of care, but it needs to be planned and personalised. People with CMT usually can't train at the intensities recommended for healthy people. Overexertion, or ignoring exercise instructions, can make symptoms worse. High-intensity training is linked to poorer performance and a higher risk of injury.

Foot drop and a high-stepped walk raise the risk of tripping, falls and ankle injury, so many people think carefully about the surfaces and footwear they use.

Treatment from your podiatrist

Your podiatrist may be part of your care team. Braces, orthoses (shoe inserts) and other orthopaedic devices are used to support the foot and ankle and help you keep moving. How much orthoses help isn't completely clear yet.

Other options

Strengthening exercise has the most support. Building up the muscles that lift the ankle slows how fast weakness progresses over 24 months in children with CMT1A. Strength or endurance training may also help daily activities in people with CMT, though an exact exercise programme can't yet be set.

Vitamin C (ascorbic acid) has been tried for fatigue in CMT1A and gave little meaningful benefit, although it seemed well tolerated. When nerve pain is severe, medicines to relieve it may be prescribed.

Surgery

Orthopaedic surgery is one of the ways symptoms are managed. This can include conservative surgery such as a tendon transfer, where a working tendon is moved to do a different job. Surgery can also address the high-arched foot that tips inwards (a cavovarus foot), which often goes with CMT. How well foot surgery works over time, and the best timing, isn't clear yet.

Recovery

CMT is lifelong and slowly progressive. Weakness and loss of feeling gradually worsen and spread to the hands and arms. Leg and foot problems rarely lead to needing a wheelchair, and life expectancy is not affected in most people.

When it starts, how fast it progresses and how severe it becomes all vary, even within a family, and can't be predicted. Falls are common, and many people with CMT report reduced quality of life. Care aims to keep you mobile, flexible and strong for as long as possible.

Preventing it

Because CMT is inherited, there is no known way to prevent it. Care is aimed at the symptoms: keeping exercise planned and personalised, using braces or orthoses where they help, and lowering the chance of falls and ankle injuries.

Frequently asked questions

Is Charcot-Marie-Tooth disease curable?

No. There is no cure and no medicine that changes the course of the condition. Care focuses on managing symptoms and keeping you mobile, with exercise, braces or orthoses and, for some people, orthopaedic surgery.

Do people with CMT end up in a wheelchair?

Rarely because of leg and foot problems. Weakness does slowly worsen and spreads to the hands and arms over time, but life expectancy is not affected in most people. How quickly it progresses varies from person to person.

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. Severity can differ even between relatives. Genetic testing can help work out which type runs in a family.

Is pregnancy safe with CMT?

Pregnancy in women with genetic nerve and muscle conditions is considered higher risk. CMT has been linked to preterm labour and caesarean delivery. Shared care between neurologists and obstetricians is advised.