Kisho is an information platform, not a medical provider. Nothing on this site constitutes medical advice, diagnosis, or treatment recommendations. All content is aggregated from publicly available sources (including ClinicalTrials.gov, PubMed, FDA.gov, and Orphanet) and is provided for informational purposes only. Clinical trial eligibility, treatment decisions, and any health-related actions should always be discussed with a qualified healthcare professional. Kisho does not endorse any specific therapy, organization, or clinical trial. Terms of use · Privacy policy
Autosomal dominant form of distal myopathy.
No HPO annotations are available for this condition.
Age of onset: adulthood.
To date, more than 500 individuals have been identified with a pathogenic variant in the last exon 364 of TTN causing Udd distal myopathy – tibial muscular dystrophy (UDM-TMD) [, , , , ]. The following description of the phenotypic features associated with this condition is based on these reports.
Udd distal myopathy – tibial muscular dystrophy (UDM-TMD) should be suspected in individuals with the following:
Distal myopathy. Ankle dorsiflexion weakness manifesting in the fourth to seventh decade
EMG abnormality. Profound myopathic changes in the anterior tibial muscle but preservation of the extensor brevis muscle
No approved treatments are currently available for autosomal dominant distal myopathy. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with Udd distal myopathy – tibial muscular dystrophy (UDM-TMD), the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 5. Recommended Evaluations Following Initial Diagnosis in Individuals with UDM-TMD
Table 7.
Recommended Surveillance for Individuals with UDM-TMD
System/Concern | Evaluation | Frequency
| Evaluate disease progression need for rehabilitation orthotic treatment. | Every 1-4 yrs
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
No clinical trials have been registered for autosomal dominant distal myopathy.
15 publications have been identified in PubMed for autosomal dominant distal myopathy. Research spans Case Report / Case Series (40%), Basic Science / Preclinical (33%), and Review / Meta-Analysis (20%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 6 | 40% |
Data assembled from 4 of 12 sources · Last updated Sep 19, 2026, 11:57 PM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Features of UDM-TMD
Feature | % of Persons w/Feature
Ankle dorsiflexion weakness | 100%
Drop foot at age 60 | 60%
Knee flexion weakness at age 60 | 60%
Waddling gait at age 60 | 25%
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
Serum CK concentration that is normal or slightly elevated
Muscle biopsy showing progressive dystrophic changes in the tibialis anterior muscle, with rimmed vacuoles at the early stages and end-stage replacement with adipose connective tissue at later stages of the disease
The diagnosis of UDM-TMD i...
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
Genes and disorders in the differential diagnosis of Udd distal myopathy – tibial muscular dystrophy (UDM-TMD) are listed in . Table 4. Genes of Interest in the Differential Diagnosis of UDM-TMD
Gene(s) | Disorder | MOI | Mean Age at Onset | Initial Muscle Group Involved | Serum Creatine Kinase Concentration | Muscle Biopsy | Comment |
|---|---|---|---|---|---|---|---|
ACTN2 | Distal actininopathy2 (OMIM 618655) | AD | 15-35 | Lower legs; later, also proximal limbs | 3-8x | ± rimmed vacuoles | — |
ANO5 | ANO5 muscle disease (distal anoctaminopathy) | AR | 15-55 | Asymmetric calf involvement | 10x | Nonspecific dystrophic myopathology | May present w/similarities to Miyoshi myopathy; Calf involvement starting w/pain hypertrophy weakness atrophy; Nonspecific dystrophic myopathology w/scattered fiber necrosis; Evolves slowly; persons remain ambulant into late adulthood. |
CRYAB | Alpha-B crystallinopathy (OMIM 608810) | AD | 32-68 | Distal limbs | 1.5-2.5x | Rimmed vacuolar pathology | — |
DES | Desminopathy (OMIM 601419) | ADAR | Juvenile / early adulthood | Distal limbs | Moderately | Consistent w/myofibrillar myopathy | DUX43SMCHD1 |
Facioscapulo-humeral muscular dystrophy | ADDigenic | 20 | Some may present w/ankle dorsiflexion weakness | 1-4x | Nonspecific | — | — |
DYSF | Miyoshi myopathy (See Dysferlinopathy.) | AR | Early adult | Posterior compartment in legs | 50x | Myopathic changes | Manifests as difficulty climbing stairs toe-walking; progresses to other distal proximal muscles (as in LGMD2B) |
FLNC | Distal actin binding domain (ABD)-filaminopathy (OMIM 609524) | AD | Early adulthood | Distal upper limbs calves | Normal or slightly | Scattered, grouped atrophic fibers | — |
GNE | GNE-related myopathy (Nonaka distal myopathy) | AR | 15-20 | Anterior compartment in legs in toe extensors | 10x | Rimmed vacuoles | Foot drop steppage gait w/progression to loss of ambulation after 12-15 yrs |
LDB3 | Zaspopathy4 (OMIM 609452) | AD | 40 | Anterior compartment in legs | Normal or slightly | Vacuolar myofibrillar myopathy | Weakness of ankle dorsiflexion followed by slow progression to calf muscles, finger wrist extensor muscles, intrinsic muscles of the hand; Proximal leg muscles eventually become involved.; Cardiomyopathy may occur at late stages. |
MATR3 | Vocal cord pharyngeal distal myopathy5 (See ALS Overview.) | AD | 35-60 | Lower legs hands; dysphonia, respiratory | 1-8x | Rimmed vacuoles | MYH7 |
Laing distal myopathy | AD | 20 | Anterior compartment in legs neck flexors | Moderately | Type 1 fiber atrophy in tibial anterior muscles; disproportion in proximal muscles | Early-onset (usually age 5 yrs) weakness, 1st of dorsiflexors of the ankles great toes then of finger extensors; Weakness of neck flexors; After ... | — |
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
System/Concern | Evaluation | Comment |
|---|---|---|
Neuromuscular | Muscle MRI | Can identify affected muscles w/high specificity EMG |
Other | Consultation w/clinical geneticist /or genetic counselor | Treatment of Manifestations Table 6. |
Treatment of Manifestations in Individuals with UDM-TMD Manifestation/Concern | Treatment | Considerations/Other Foot drop |
(typical) | Orthotic devices | Foot drop |
(severe) | Tibial posterior tendon transposition | Can be performed in patients in their 40s 50s to replace lost function of anterior tibial muscle long toe extensor muscles Surveillance Table 7. |
Recommended Surveillance for Individuals with UDM-TMD System/Concern | Evaluation | Frequency |
Neuromuscular | Evaluate disease progression need for rehabilitation orthotic treatment. | Every 1-4 yrs Agents/Circumstances to Avoid Heavy muscle force training of weak muscles should be avoided. Evaluation of Relatives at Risk See for issues related to testing of at-risk relatives for genetic counseling purposes. Search ClinicalTrials. |
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
Heavy muscle force training of weak muscles should be avoided.
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Udd Distal Myopathy – Tibial Muscular Dystrophy"
View trials for autosomal dominant distal myopathy
Laboratory research
5 |
33% |
Research summaries | 3 | 20% |
Disease patterns and progression | 1 | 7% |
Zhou W (2026). [PMID: 41951012](https://pubmed.ncbi.nlm.nih.gov/41951012/). *Biochim Biophys Acta Mol Basis Dis*. [Review / Meta-Analysis]
Zhao T (2026). [PMID: 41786146](https://pubmed.ncbi.nlm.nih.gov/41786146/). *The Journal of biological chemistry*. [Basic Science / Preclinical]
Alghamdi OA (2025). [PMID: 40487049](https://pubmed.ncbi.nlm.nih.gov/40487049/). *International medical case reports journal*. [Case Report / Case Series]
Chitimus DM (2025). [PMID: 40447473](https://pubmed.ncbi.nlm.nih.gov/40447473/). *Revue neurologique*. [Case Report / Case Series]
De Winter J (2025). [PMID: 40023774](https://pubmed.ncbi.nlm.nih.gov/40023774/). *Genetics in medicine : official journal of the American College of Medical Genetics*. [Basic Science / Preclinical]
Khadilkar SV (2025). [PMID: 41099380](https://pubmed.ncbi.nlm.nih.gov/41099380/). *Annals of Indian Academy of Neurology*. [Review / Meta-Analysis]
Fernández-Eulate G (2025). [PMID: 40493734](https://pubmed.ncbi.nlm.nih.gov/40493734/). *Brain : a journal of neurology*. [Basic Science / Preclinical]
Llansó L (2025). [PMID: 40693562](https://pubmed.ncbi.nlm.nih.gov/40693562/). *Annals of clinical and translational neurology*. [Epidemiology / Natural History]
Izumi R (2025). [PMID: 40818927](https://pubmed.ncbi.nlm.nih.gov/40818927/). *Neuromuscular disorders : NMD*. [Basic Science / Preclinical]
Perrin A (2024). [PMID: 37935568](https://pubmed.ncbi.nlm.nih.gov/37935568/). *Journal of medical genetics*. [Basic Science / Preclinical]