Had a new patient attend saying she had been referred from the pain clinic. No written details except GP's letter saying she had bilateral foot pain and could I please help. Her history was of a long period of evolving pain in both feet. Now at the point where she has great difficulty in ambulating around a supermarket without needing to rest. Objectively she walks flat footed with all her toes extended especially the great toe. She has a marked pes cavus. She is unable to flex her toes. The harder she tries to the more they want to extend. She is extremely tender to gentle palpation to the point of evoking a teary response. She says the pain clinic have prescribed Capadex, but will review her in a few weeks. Seems to me she may have Charcot-Marie-Tooth disease. Is there anyone out there who has any suggestions for management of this lady. I am trying to organise a podiatry referral for her. Regards Ben

Here are a selction of images that will help shed some light on the patient.

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