Charcot-Marie-Tooth Cavovarus Foot: Current Concepts and Emerging Strategies for Deformity Correction

Charcot-Marie-Tooth (CMT) disease is the most prevalent inherited peripheral neuropathy, characterized by progressive motor and sensory dysfunction resulting from a wide spectrum of genetic abnormalities. More than 70% of affected individuals develop cavovarus foot deformities, which impair gait mechanics, reduce functional mobility, and frequently necessitate orthotic support. The diagnosis of CMT-related foot deformity requires a comprehensive clinical evaluation, with particular emphasis on identifying muscle imbalance and assessing the function of individual musculotendinous units contributing to the deformity. Conservative management, including customized footwear and orthotic bracing, remains the first-line treatment for flexible and less severe deformities. However, surgical intervention should be considered in patients with progressive deformity, persistent symptoms, or failure of nonoperative treatment. Patients requiring surgical correction commonly present with a combination of cavovarus malalignment, muscle imbalance, soft-tissue contracture, and secondary osseous deformities. Current surgical management favors joint-sparing surgery through a combination of soft-tissue procedures, corrective osteotomies, and tendon transfer whenever feasible. Arthrodesis is generally reserved for rigid deformities that cannot be adequately corrected with joint-sparing surgery for patients with painful degenerative arthritis. When appropriately indicated, surgical reconstruction can substantially improve functional outcomes, reduce dependence on bracing, and enhance overall quality of life. This narrative review summarizes current concepts in the diagnosis and management of CMT-related cavovarus foot deformity, with particular emphasis on individualized deformity assessment and contemporary joint-sparing reconstruction.