Clinical Characteristics of Gait Disturbance in Charcot-Marie-Tooth Disease and Future Directions in Physical Therapy.

Charcot-Marie-Tooth disease (CMT) is a hereditary and progressive peripheral neuropathy affecting both motor and sensory nerves. It is among the most common inherited neuropathies and is primarily classified into demyelinating (type 1) and axonal (type 2) forms based on motor nerve conduction velocity, with over 100 genetic subtypes identified. Due to this genetic and clinical heterogeneity, the onset, severity, and degree of motor and sensory impairments vary widely among individuals.  One of the hallmark manifestations of CMT is gait disturbance. As the disease progresses, individuals often develop foot drop and foot deformities such as pes cavus and equinus, leading to a significant decline in gait function. This results in limitations in activities of daily living, increased risk of falls, reduced social participation, and decreased quality of life. Currently, no curative treatment exists for CMT. Management focuses on symptomatic interventions, including orthotic support, surgical procedures, and physical therapy. While physical therapy may improve muscle strength and physical function, the quality of evidence remains moderate, and no standardized rehabilitation protocols have been firmly established. Tailored physical therapy programs are considered essential for effective intervention. Given these challenges, the need for quantitative and objective assessment of gait disturbances in CMT has become increasingly important. Conventional clinical scales, such as the CMT Neuropathy Score, rely heavily on subjective grading and offer limited value in detailed gait analysis. In contrast, recent advances in motion analysis - such as three-dimensional gait analysis, ground reaction force measurement, and wearable sensors - have provided more precise assessments. However, issues related to standardization and clinical applicability remain unresolved. This review aims to summarize the neuropathology and clinical characteristics of gait disturbances in CMT, discuss current gait assessment methodologies, explore physical therapy strategies, and highlight the need for quantitative evaluation and future research directions in rehabilitation for this patient population.