aerobic exercise, while ot can provide education on energy conservation strategies and activities of daily living. physical therapy should be involved in designing an exercise program that fits a person's personal strengths and flexibility. bracing can also be used to correct problems caused by cmt. an orthotist may address gait abnormalities by prescribing the use of orthotics. appropriate footwear is also very important for people with cmt, but they often have difficulty finding well-fitting shoes because of their high-arched feet and hammertoes. due to the lack of good sensory reception in the feet, cmt patients may also need to see a podiatrist for assistance in trimming nails or removing calluses that develop on the pads of the feet. lastly, patients can also decide to have surgery performed by a podiatrist or an orthopedic surgeon. surgery may help to stabilize the patients' feet or correct progressive problems. these procedures include straightening and pinning the toes, lowering the arch, and sometimes, fusing the ankle joint to provide stability. cmt patients must take extra care to avoid falling as fractures take longer to heal in someone with an underlying disease process. additionally, the resulting inactivity may cause the cmt to worsen. the charcot–marie–tooth association classifies the chemotherapy drug vincristine as a "definite high risk" and states, "vincristine has been proven hazardous and should be avoided by all cmt patients, including those with no symptoms." several corrective surgical procedures can be done to improve the physical condition of the affected individuals. orthotics ankle-foot orthosis if the muscles of the lower extremities are weak, it makes sense to prescribe custom-fabricated orthotics. depending on which muscle groups are affected, the correct orthoses with appropriate functional elements should be prescribed. a weakness of the musculus tibialis anterior, which lifts the feet, is usually accompanied by an atrophy of the musculus gastrocnemius which, together with the musculus soleus, forms the musculus triceps surae (distal calf muscles), occurs causing the known "stork leg deformity". in most cases, ankle-foot orthoses that have functional elements for the foot lifting and adjustable control of the lowering of the forefoot make sense. weak calf muscles lead to insufficient activation of the forefoot lever. this leads to an additional increasing uncertainty when standing and walking. if the calf muscles are weak, an orthosis should therefore be equipped with functional elements to activate the forefoot lever. an orthotic joint with an adjustable dynamic dorsiflexion stop with strong spring in combination with a lower leg shell in front of the shin is recommended for this. such orthoses help to control foot drop, instability of the foot and ankle and offer the patient a better sense of balance when standing and walking without restricting mobility and the dynamics of the ankle joint. studies confirm the positive effect of orthoses with adjustable functional elements in patients with paralysis of these muscle groups. it is of great advantage if the resistances of the two functional elements can be set separately from one another in the two directions of movement, dorsiflexion and plantar flexion. prognosis the severity of symptoms varies widely even for the same type of cmt. cases of monozygotic twins with varying levels of disease severity have been reported, showing that identical genotypes are associated with different levels of severity (see penetrance). some patients are able to live a normal life and are almost or entirely asymptomatic. a 2007 review stated that, "life expectancy is not known to be altered in the majority of cases." history jean-martin charcotpierre mariehoward henry tooth the disease is named after those who classically described it: the frenchman jean-martin charcot (1825–1893), his pupil pierre marie (1853–1940), and the briton howard henry tooth (1856–1925).