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Charcot Marie Tooth:

Surgery treatmeant

Dr. Fernando Noriega


@drfnoriega
http://www.drfernandonoriega.com/

At present, there is no specific treatment or cure for the underlying


genetic cause of CMT. Neither are there any drugs to stop or reverse
the damage caused to the peripheral nerves. But, although there is no
cure for CMT, there are a number of treatments available. These can
slow the development, or ease, some of the secondary complications
linked to CMT, greatly improving your quality of life.
Reconstructive Surgery
Must be made by a qualified Neuro-Orthopedics foot and ankle
orthopedic surgeon. Surgery in patients with CMT is very common
and it is only performed in highly specialized centers. It is the only way
to cure injuries which occur on the feet as a result of the muscles
paralysis that produce the disease. The evolution of surgical
procedures and an excellent performance makes the Ankle Foot
Orthotics and Splints become obsolete. The goal of surgery is:

Align feet and remaining plantgrados


Give stability
Balancing muscle function

Some things to consider before going ahead with any surgery:


1. Make sure the surgeon performing the operation is expert in the
reconstruction of feet with CMT or neurological foot.
2. Find the percentage of good results that have had an experience in
treating these injuries
3. Check how long itll take to recover. Time you will be immobilized
without any support for the operated foot on the ground. If other
professionals such as physical therapists will treat postoperatively.
The operations consist basically align the bones, making mergers of
small joints, while maintaining ankle mobility. Furthermore tendon
transfers are made to balance the muscle function. Generally
transferred tendons are the ones causing deformities of the feet.

Osteotomy consists on cutting the bone and reposition correctly, this


is usually done in the distal part of the tibia, in the heel, midfoot and
toes. It can be fixed with plates and screws or with fine needles.
Arthrodesis: are operations that consist in establishing a joint, aimed
at providing stability while walking. It can be done in the middle and
back of the foot from 9 years of age.
Cavus Varus Foot
The foot is deformed into more arch than normal and twisted inwards.
Its correction is performed through fascia and tendon lengthening,
minimally setting the midfoot and transferring tendons on the back of
the foot. In many cases the distal part of the tibia is poorly positioned
so it is necessary to make an osteotomy in order to position it
correctly.
If the heel varus continues despite the above corrections to cut the
heel bone and move it may be necessary, this is done rarely.

Equinus Foot
There are cases where the paralysis produced by the CMT is extensive
producing a horse or foot drop, although in these cases the muscles do
not work, we are able to transfer tendons on the back to make the
walk not fall. You should never fix the ankle, it is a big mistake and very
difficult gait of patients with CMT
Claw Toes
Generally when fingers are fixed in claw, these joints are not usually
set. What works best is to release the joint capsule and tendon
transfer that balance muscle forces on the fingers.

Skin transplant
In patients with severely deformed cavus varus feet and inelastic. By
aligning the foot, the skin of the middle part is shrunk, so that putting
the right foot, can happen in exceptional cases, you can not close the
medial incision. In these cases the same operation is needed to
remove small skin grafts, from the leg and place them on areas that
can not be closed.
Anesthesia
All patients are operated with the use of local anesthetics and deep
sedation. General anesthesia with intubation is used. Local
anesthetics are used by blocking the nerves of the leg, with the
placement of small tubes called catheters next to the nerves, which
are located using nerve stimulators.

Through catheters the local anesthetic regulated infusion pump is


supplied to the patients. This type of anesthesia called lock allows the
operated leg asleep for 48-72 hours after surgery, so the patient has
no pain during that time. In addition to that the patient is quiet during
the duration of the surgery, fully sedated, without being aware of
anything that happens in the operating room, quietly waking to
complete the operation. In cases where it is necessary to operate both
feet, a spinal level locking is performed by an epidural.

Do you suffer from Charcot Marie Tooth disease? Learn


everything you need to know about to find the best
treatment for your case.
Charcot Marie Tooth is a hereditary peripheral neuropathy with
different variants which requires a very specific type of treatment to
be carried out by a specialist. If you suffer this disease in the Guide
you will find everything you need to know about how to find the best
treatment for you.