Skip to main content

Advertisement

Log in

Orthopaedic management of spina bifida—part II: foot and ankle deformities

  • Current Concept Review
  • Published:
Journal of Children's Orthopaedics

Abstract

Both congenital and acquired orthopaedic deformities are common in patients with spina bifida. Examples of congenital deformities, which are present at birth, include clubfoot and vertical talus. Acquired developmental deformities are related to the level of neurologic involvement and include calcaneus and cavovarus. Orthopaedic deformities may also result from postoperative tethered cord syndrome. The previously published Part I reviewed the overall orthopaedic care of a patient with spina bifida, with a focused review of hip, knee, and rotational deformities. This paper will cover foot and ankle deformities associated with spina bifida, including clubfoot, equinus, vertical talus, calcaneus and calcaneovalgus, ankle and hindfoot valgus, and cavovarus. In addition, this paper will address the issues surrounding skin breakdown in patients with spina bifida.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Swaroop VT, Dias L (2009) Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities. J Child Orthop 3:441–449

    Article  Google Scholar 

  2. Guille JT, Sarwark JF, Sherk HH, Kumar SJ (2006) Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg 14:294–302

    Google Scholar 

  3. Westcott MA, Dynes MC, Remer EM, Donaldson JS, Dias LS (1992) Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 12:1155–1173

    Article  CAS  Google Scholar 

  4. Noonan KJ, Didelot WP, Lindseth RE (2000) Care of the pediatric foot in myelodysplasia. Foot Ankle Clin 5(2):281–304

    CAS  Google Scholar 

  5. Maynard MJ, Weiner LS, Burke SW (1992) Neuropathic foot ulceration in patients with myelodysplasia. J Pediatr Orthop 12:786–788

    Article  CAS  Google Scholar 

  6. Torosian CM, Dias LS (2000) Surgical treatment of severe hindfoot valgus by medial displacement osteotomy of the os calcis in children with myelomeningocele. J Pediatr Orthop 20(2):226–229

    CAS  Google Scholar 

  7. Roach JW, Short BF, Saltzman HM (2011) Adult consequences of spina bifida: a cohort study. Clin Orthop Relat Res 469:1246–1252

    Article  Google Scholar 

  8. Kancherla V, Romitti PA, Caspers KM, Puzhankara S, Morcuende JA (2010) Epidemiology of congenital idiopathic talipes equinovarus in Iowa, 1997–2005. Am J Med Genet A 152A(7):1695–1700

    Article  Google Scholar 

  9. Gerlach DJ, Gurnett CA, Limpaphayom N, Alaee F, Zhang Z, Porter K, Kirchhofer M, Smyth MD, Dobbs MB (2009) Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele. J Bone Joint Surg Am 91(6):1350–1359

    Article  Google Scholar 

  10. Akbar M, Bresch B, Seyler TM, Wenz W, Bruckner T, Abel R, Carstens C (2009) Management of orthopaedic sequelae of congenital spinal disorders. J Bone Joint Surg Am 91:87–100

    Article  Google Scholar 

  11. de Carvalho Neto J, Dias LS, Gabrieli AP (1996) Congenital talipes equinovarus in spina bifida: treatment and results. J Pediatr Orthop 16(6):782–785

    Article  Google Scholar 

  12. Flynn JM, Herrera-Soto JA, Ramirez NF, Fernandez-Feliberti R, Vilella F, Guzman J (2004) Clubfoot release in myelodysplasia. J Pediatr Orthop B 13:259–262

    Article  Google Scholar 

  13. Sharrard WJ, Grosfield I (1968) The management of deformity and paralysis of the foot in myelomeningocele. J Bone Joint Surg Br 50:456–465

    CAS  Google Scholar 

  14. Janicki JA, Narayanan UG, Harvey B, Roy A, Ramseier LE, Wright JG (2009) Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method. J Pediatr Orthop 29(4):393–397

    Article  Google Scholar 

  15. Gurnett CA, Boehm S, Connolly A, Reimschisel T, Dobbs MB (2008) Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Med Child Neurol 50:498–502

    Article  Google Scholar 

  16. Ponseti IV, Smoley EN (1963) Congenital club foot: the results of treatment. J Bone Joint Surg Am 45:261–344

    Google Scholar 

  17. Laaveg SJ, Ponseti IV (1980) Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 62:23–31

    CAS  Google Scholar 

  18. Cooper DM, Dietz FR (1995) Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am 77:1477–1489

    CAS  Google Scholar 

  19. Lourenco AF, Dias LS, Zoellick DM, Sodre H (2001) Treatment of residual adduction deformity in clubfoot: the double osteotomy. J Pediatr Orthop 21:713–718

    CAS  Google Scholar 

  20. Dias LS, Stern LS (1987) Talectomy in the treatment of resistant talipes equinovarus deformity in myelomeningocele and arthrogryposis. J Pediatr Orthop 7:39–41

    Article  CAS  Google Scholar 

  21. Sherk HH, Ames MD (1975) Talectomy in the treatment of the myelomeningocele patient. Clin Orthop Relat Res 110:218–222

    Article  Google Scholar 

  22. Frawley PA, Broughton NS, Menelaus MB (1998) Incidence and type of hindfoot deformities in patients with low-level spina bifida. J Pediatr Orthop 18:312–313

    Article  CAS  Google Scholar 

  23. Frischhut B, Stöckl B, Landauer F, Krismer M, Menardi G (2000) Foot deformities in adolescents and young adults with spina bifida. J Pediatr Orthop B 9:161–969

    Article  CAS  Google Scholar 

  24. Broughton NS, Graham G, Menelaus MB (1994) The high incidence of foot deformity in patients with high-level spina bifida. J Bone Joint Surg Br 76:548–550

    CAS  Google Scholar 

  25. Kodros SA, Dias LS (1999) Single-stage surgical correction of congenital vertical talus. J Pediatr Orthop 19(1):42–48

    CAS  Google Scholar 

  26. Alaee F, Boehm S, Dobbs MB (2007) A new approach to the treatment of congenital vertical talus. J Child Orthop 1:165–174

    Article  Google Scholar 

  27. Dobbs MB, Purcell DB, Nunley R, Morcuende JA (2006) Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am 88:1192–1200

    Article  Google Scholar 

  28. Ogata K, Schoenecker PL, Sheridan J (1979) Congenital vertical talus and its familial occurrence: an analysis of 36 patients. Clin Orthop Relat Res 139:128–132

    Google Scholar 

  29. Rodrigues RC, Dias LS (1992) Calcaneus deformity in spina bifida: results of anterolateral release. J Pediatr Orthop 12(4):461–464

    Article  CAS  Google Scholar 

  30. Bliss DG, Menelaus MB (1986) The results of transfer of the tibialis anterior to the heel in patients who have a myelomeningocele. J Bone Joint Surg Am 68:1258–1264

    CAS  Google Scholar 

  31. Park KB, Park HW, Joo SY, Kim HW (2008) Surgical treatment of calcaneal deformity in a select group of patients with myelomeningocele. J Bone Joint Surg Am 90(10):2149–2159

    Article  Google Scholar 

  32. Dias L (2002) Myelomeningocele and intraspinal lipoma. In: Sponseller PD (ed) Orthopaedic knowledge update: pediatrics, 2nd edn. American Academy of Orthopaedic Surgeons, Newton, MA, pp 249–259

    Google Scholar 

  33. Mitchell GP (1977) Posterior displacement osteotomy of the calcaneus. J Bone Joint Surg Br 59:233–235

    CAS  Google Scholar 

  34. Dias LS (1985) Valgus deformity of the ankle joint: pathogenesis of fibular shortening. J Pediatr Orthop 5:176–180

    Article  CAS  Google Scholar 

  35. Dias LS (1978) Ankle valgus in children with myelomeningocele. Dev Med Child Neurol 20:627–633

    Article  CAS  Google Scholar 

  36. Lubicky JP, Altiok H (2001) Transphyseal osteotomy of the distal tibia for correction of valgus/varus deformities of the ankle. J Pediatr Orthop 21(1):80–88

    Article  CAS  Google Scholar 

  37. Stevens PM, Belle RM (1997) Screw epiphysiodesis for ankle valgus. J Pediatr Orthop 17(1):9–12

    CAS  Google Scholar 

  38. Koutsogiannis E (1971) Treatment of mobile flat foot by displacement osteotomy of the calcaneus. J Bone Joint Surg Br 53:96–100

    CAS  Google Scholar 

  39. Levitt RL, Canale ST, Gartland JJ (1974) Surgical correction of foot deformity in the older patient with myelomeningocele. Orthop Clin North Am 5:19–29

    CAS  Google Scholar 

  40. Gallien R, Morin F, Marquis F (1989) Subtalar arthrodesis in children. J Pediatr Orthop 9:59–63

    Article  CAS  Google Scholar 

  41. Coleman SS, Chesnut WJ (1977) A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop Relat Res 123:60–62

    Google Scholar 

  42. Schwend RM, Drennan JC (2003) Cavus foot deformity in children. J Am Acad Orthop Surg 11:201–211

    Google Scholar 

  43. Mubarak SJ, Van Valin SE (2009) Osteotomies of the foot for cavus deformities in children. J Pediatr Orthop 29(3):294–299

    Article  Google Scholar 

  44. Bartonek A, Saraste H, Samuelsson L, Skoog M (1999) Ambulation in patients with myelomeningocele: a 12-year follow-up. J Pediatr Orthop 19(2):202–206

    Article  CAS  Google Scholar 

  45. Díaz Llopis I, Bea Muñoz M, Martinez Agulló E, López Martinez A, García Aymerich V, Forner Valero JV (1993) Ambulation in patients with myelomeningocele: a study of 1500 patients. Paraplegia 31(1):28–32

    Article  Google Scholar 

  46. Plaum PE, Riemer G, Frøslie KF (2006) Risk factors for pressure sores in adult patients with myelomeningocele—a questionnaire-based study. Cerebrospinal Fluid Res 3:14–15

    Article  Google Scholar 

  47. Harris MB, Banta JV (1990) Cost of skin care in the myelomeningocele population. J Pediatr Orthop 10(3):355–361

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vineeta T. Swaroop.

About this article

Cite this article

Swaroop, V.T., Dias, L. Orthopaedic management of spina bifida—part II: foot and ankle deformities. J Child Orthop 5, 403–414 (2011). https://doi.org/10.1007/s11832-011-0368-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-011-0368-9

Keywords

Navigation