Abstract
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.