Basic Lifestyle Changes Can Have a Positive Impact on Joint Health
Mobility and joint health can be a serious issue for people with CMT. While dietary changes can be made to improve joint health, regular exercises designed to improve joint mobility are crucial for keeping joints healthy.
STIFFENED JOINTS (CONTRACTURES)
A prominent impact of CMT is the mechanical impacts it has on the feet and legs, ranging from high arched feet to deformities such as claw toe. A common occurrence in people with CMT is that joints in the feet, especially the toes, can become stiff, and ultimately to the point where flexibility no longer remains in the joint. This can make walking and other movements difficult and even painful as the foot or toes no longer have full flexibility. If contractures occur in fingers, this can severely limit someone's autonomy, as activities such as typing, opening lids and closing shirt buttons can become extremely challenging.
KEEPING JOINTS MOBILE
Stretching and joint mobilization, through the entire possible range of movement (ROM), is a way of preventing contractures and has been shown to be effective for people with CMT. This involves moving the limb through the entire motion possible repeatedly. As a limb being static can result in contractures, this helps to prevent stiffness and should be done frequently, daily if possible, but as over-exercising is possible, an ideal regime should be determined by a medical professional. Research has shown that a minimum of 2 to 3 hours of daily standing and walking is necessary in addition to passive stretching to prevent contracture formation.
Where muscle weakness or sensory degradation has impeded someone with CMT enough to make walking difficult, or impaired mobility in the hands, an orthotics device may be recommended by a medical professional. An orthotic device, sometimes referred to as a brace or splint, is a device used to hold a limb in a static position to allow the person to carry out their day-to-day activities without being impeded, or to allow recovery. An orthotic brace in relation to joint health can be beneficial in helping to maintain correct movement, and in the feet, preventing shortening of the Achilles tendon. If the tendon becomes too short, this can result in contractures.
If contractures have become severe enough, surgery may be required.
Ramdharry GM, Day BL, Reilly MM, Marsden JF. Foot drop splints improve proximal as well as distal leg control during gait in Charcot-Marie-Tooth disease. Muscle Nerve. 2012;46(4):512‐519. doi:10.1002/mus.23348
Osteoarthritis, a condition where the cartilage between joints becomes worn away, resulting in limited mobility and significant pain, can be a symptom of CMT, and range from mild to severe through different mechanisms. Finding ways to minimise damage to cartilage and early detection of any joint deformity is regarded as the best practice in order to prevent arthritis or relates surgery, such as hip replacements.
MAINTAINING HEALTHY JOINTS
As exercise can increase the chance of osteoarthritis, especially if the person has abnormal or injured joints, a way of minimising cartilage damage is to ensure that all exercise done is low-impact. Low impact exercise is where there is no sudden weight placed on the body e.g. swimming, yoga, cycling. This helps to protect the joints from quick and potentially damaging compression, seen in high impact sports such as football and running.
Improving a person's gait can help prevent cartilage damage and can be achieved through specialist insoles. These are not available from the high street and should be created by an orthotic specialist if they deem it appropriate.
DIET AND SUPPLEMENTS
While the supplement market contains many products that claim to help joint health, many are either underdosed or relatively ineffective. Versus Arthritis, the largest arthritis charity in the UK, has done extensive research in studies regarding what supplements are effective for either maintaining joint health or improving the symptoms of arthritis. More information can be found on the supplement page dedicated to joint support, linked below:
CMT HIP DYSPLASIA
Research has shown that people with CMT have between at least a 6 - 8% chance of developing hip dysplasia, which can emerge at a young age and is likely to be more severe than if it occurs in a person without CMT. Hip dysplasia is a serious condition that can result in back pain, limping, and osteoarthritis if not detected early. Severe osteoarthritis can lead to major corrective surgery, such as replacement of the affected joint e.g. hip surgery.
If you suspect you may have hip dysplasia, contact a medical professional for advice, as a thorough analysis may be required, which might include MRI scans, arthrograms, and other such analysis methods.
Bamford NS, White KK, Robinett SA, Otto RK, Gospe SM Jr. Neuromuscular hip dysplasia in Charcot-Marie-Tooth disease type 1A. Dev Med Child Neurol. 2009;51(5):408‐411. doi:10.1111/j.1469-8749.2008.03234.x
Novais EN, Bixby SD, Rennick J, Carry PM, Kim YJ, Millis MB. Hip dysplasia is more severe in Charcot-Marie-Tooth disease than in developmental dysplasia of the hip. Clin Orthop Relat Res. 2014;472(2):665‐673. doi:10.1007/s11999-013-3127-z
Ward CM, Dolan LA, Bennett DL, Morcuende JA, Cooper RR. Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie-Tooth disease. J Bone Joint Surg Am. 2008;90(12):2631‐2642. doi:10.2106/JBJS.G.01356