The efficacy of functional surgery associated with early intensive rehabilitation therapy in Charcot-Marie-Tooth Type 1A disease

Ferraro, Francesco; Dusina, Barbara; Carantini, Irene; Strambi, Roberto; Galante, Emanuela; Gaiani, L.

doi:10.23736/s1973-9087.17.04448-3

Cited by 7 publications

(10 citation statements)

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“…They showed that Baumann surgery pes equinus treatment could signi cantly improve the gait of children and adults with cerebral palsy. Ferraro et al 15 studied the e cacy of rehabilitation therapy in CMT disease, and revealed that functional surgery associated with early intensive rehabilitation was an effective method of improve the effectiveness of CMT treatment, warranting the importance of appropriate physical therapy. Tejero et al 11 Therefore, we advocate that it is necessary to fully evaluate the risk of postoperative complications and take appropriate measures to reduce the occurrence of complications, and that more rigorous RCT studies are needed to identify surgical procedures predisposing speci c complications.…”

Section: Discussionmentioning

confidence: 99%

“…Range of motion outcomes were reported by a total of 3 studies(Table 2). Gould et al 16 , Dreher et al 17 , and Ferraro et al 15 reported signi cant improvements of tibiotalar exion parameters with the knee in full extension post-operation.…”

Section: Range Of Motionmentioning

confidence: 98%

“…He found that the genetic mutations in these patients included PMP22 (CMT1A), MPZ (CMT1B), HK1 (CMT4G), NDRG1 (CMT4D), and CMT2 (GDAP1), which may account for the development of CMT originally. Carantini et al13 , Lin et al14 , and Ferraro et al15 also studied the types of CMT, and reported that CMT1A accounted for over 50%, while other types ranged from 1-14%. Roper et al11 classi ed the include patients into Dyck and Lambert Type I and other types based on the Dyck and Lambert's classi cation system.…”

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confidence: 99%

“…Roper et al11 also reported that soft tissue procedures could correct foot deformities and postpone the need for triple arthrodesis.Although the results of this review indicate that bone or soft tissue surgery can effectively correct foot deformities in patients with CMT disease, the proportion of potential surgical complications in CMT patients remains unclear. Of the 11 included studies reporting postoperative complications, all except Roper 11 et al, Ferraro et al15 and Gould et al16 reported that clinical complications or secondary surgery were seen after surgical procedures. Tejero et al 11 reported that 15.3% patients required reoperation at the end of follow-up, though early surgical intervention may delay or prevent future complications.…”

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confidence: 99%

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The safety and efficacy of surgery for foot deformity in patients with Charcot-Marie-Tooth disease: a systematic review and meta-analysis

Song,

Wu,

Zhang

et al. 2024

Preprint

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Background The objective of this study is to conduct a comprehensive meta-analysis to assess the safety and effectiveness of surgical treatment in patients with Charcot–Marie–Tooth disease (CMT), the most prevalent inherited peripheral neuropathy. The aim is to assess if surgical interventions improve functional scores in CMT patients, filling literature gaps and guiding evidence-based surgical management. Methods We conducted a systematic review and meta-analysis, searching articles in PubMed, Embase, the Cochrane Library databases, and Web of Science from their inception to December 10, 2023. Inclusion criteria involved studies reporting primary data, focusing primarily on surgical treatments for CMT foot deformity, having available full text, and reporting outcomes from more than three patients. Non-surgical treatment studies, review articles, basic research, and cadaveric studies were excluded. Outcomes associated with the surgical management of CMT were obtained using random-effects meta-analysis. Results From a total of 572 identified and screened studies, 11 studies (1.9%) comprising 322 feet undergoing surgical procedures for CMT were included. Among them, there were 2 prospective observational studies, 8 retrospective cohort studies, and 1 case report. However, while post-operative ankle function scores showed improvement, patient satisfaction and reintervention rates remained unsatisfactory. Notably, three studies reported significant improvements in the range of motion parameters for tibiotalar flexion with the knee in full extension post-operation. Radiographic examination was conducted to evaluate deformity correction and force lines. Furthermore, complications such as early post-op or subsequent operations, delayed wound healing, blisters, and Ward were monitored in all 11 studies. Conclusion Surgical management is effective in improving assessment scores, foot and ankle function, and enabling a faster return to work and sports for patients with CMT. However, caution is needed to minimize complications. Further research, including RCT, is necessary to assess detailed outcomes and identify prognostic factors for treatment decision-making in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Range Of Motionmentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

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The safety and efficacy of surgery for foot deformity in patients with Charcot-Marie-Tooth disease: a systematic review and meta-analysis

Song,

Wu,

Zhang

et al. 2024

Preprint

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“…FS aims at restoring the physiological tibiotalar and foot joint biomechanics and correcting foot rockers during gait as best as possible, improving walking safety ( 11 , 12 ). FS usually includes soft tissue procedures such as customized tendon transfer, muscle-tendon lengthening interventions, and bone procedures such as metatarsal osteotomy ( 13 ). Previous studies on foot FS in CMT patients have reported a lower rate of additional surgeries and joint degeneration after years compared to those who underwent triple arthrodesis ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Short-term effects of foot surgery on walking-related pain, function, and satisfaction in patients with Charcot–Marie–Tooth disease: a prospective cohort study

Basini,

Rambelli,

Galletti

et al. 2024

Front. Neurol.

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IntroductionPatients with Charcot–Marie–Tooth disease (CMT) often suffer from walking-related pain (WRP), muscle weakness, foot deformities, and reduced ankle dorsiflexion (DF), which affects their ability to walk and daily activities. Functional surgery (FS) can restore foot deviations, affecting the loading ability during gait. We assessed the short-term effects of FS in patients with CMT on WRP, foot and ankle structure, and function, along with patients’ perceived improvement.MethodsThis is a prospective cohort study on CMT patients who had undergone FS and rehabilitation. We analyzed the changes after 1 month, focusing on WRP, DF, the center of pressure progression (COPP) during walking, and measures of walking ability. The non-parametric Wilcoxon test was used.ResultsTen patients were included. One month after FS, WRP reduced from 5.5 (IQR = 3.5) to 2 (IQR = 3.5), p = 0.063, with an effect size of 0.615. The highest decrease was found in patients with very high pre-surgical pain levels. DF almost reached 10° for both active and passive movements (p < 0.05), and COPP improved from 44 to 60% (p = 0.009) of foot length. Gait speed, lower limb functioning, and balance did not change. More than half of the sample felt improved or much improved after FS.ConclusionFS can be effective in reducing WRP and restoring foot posture in CMT patients in the short-term, which allows them to wear shoes, and leads to a perceived improvement and satisfaction. Lack of improvement in functional skills may be due to muscle weakness typical of CMT. Studies with longer follow-ups may confirm these hypotheses.

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Effects of intensive rehabilitation on functioning in patients with mild and moderate Charcot–Marie-Tooth disease: a real-practice retrospective study

Ferraro¹,

Calafiore²,

Curci³

et al. 2023

Neurol Sci

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Charcot–Marie-Tooth (CMT) disease is one of the most common inherited neuropathies and can lead to progressive muscular weakness, pes cavus, loss of deep tendon reflexes, distal sensory loss, and gait impairment. There are still no effective drugs or surgical therapies for CMT, and supportive treatment is limited to rehabilitative therapy and surgical treatment of skeletal deformities. Many rehabilitative therapeutic approaches have been proposed, but timing and cadence of rehabilitative intervention are not clearly defined, and long-term follow-up is lacking in literature. The aim of this real-practice retrospective study was to assess the effectiveness of an intensive neurorehabilitation protocol on muscle strength and functioning in CMT patients. We analyzed data of patients with diagnosis of mild to moderate CMT. The rehabilitation program lasted 2–4 h a day, 5 days a week, for 3 weeks and consisted of manual treatments, strengthening exercises, stretching, core stability, balance and resistance training, aerobic exercises, and tailored self-care training. Data were collected at baseline (T0), after treatment (T1), and at the 12-month mark (T2) in terms of the following outcome measures: muscle strength, pain, fatigue, cramps, balance, walking speed, and ability. We included 37 CMT patients with a median age of 50.72 ± 13.31 years, with different forms: demyelinating (n = 28), axonal (n = 8), and mixed (n = 1). After intensive rehabilitation treatment, all outcomes significantly improved. This improvement was lost at the 1-year mark. Taken together, these findings suggest that an intensive rehabilitation program improves short-term symptoms and functional outcomes in a cohort of inpatients affected by mild to moderate CMT.

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The efficacy of functional surgery associated with early intensive rehabilitation therapy in Charcot-Marie-Tooth Type 1A disease

Cited by 7 publications

References 0 publications

The safety and efficacy of surgery for foot deformity in patients with Charcot-Marie-Tooth disease: a systematic review and meta-analysis

The safety and efficacy of surgery for foot deformity in patients with Charcot-Marie-Tooth disease: a systematic review and meta-analysis

Short-term effects of foot surgery on walking-related pain, function, and satisfaction in patients with Charcot–Marie–Tooth disease: a prospective cohort study

Effects of intensive rehabilitation on functioning in patients with mild and moderate Charcot–Marie-Tooth disease: a real-practice retrospective study

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