Orthotic management of Spina bifida

Definition
Spina bifida is a congenital neural tube defect affecting fetal development of the central nervous system. The three types of spina bifida include spina bifida occulta, meningocele, and myelomeningocele.

Causes
The cause of spina bifida is unknown, but it’s thought to result from a combination of genetic and environmental factors.

Signs & Symptoms
• In spina bifida occulta, spinal cord does not protrude through the skin, although a patch of hair, a birthmark, or a dimple may be present on the skin over the lower spine.
• In meningocele, a fluid-filled sac visible on the back. The sac is often covered by a thin layer of skin and can be as small as a grape or as large as a grapefruit.
• In myelomeningocele also have a sac-like mass that bulges from the back, but a layer of skin may not always cover it. In some cases, the nerves of the spinal cord may be exposed.

Complications
• In myeomeningocele, usually present paralysis of hip and knee flexor, inversion and inversion, and plantar flexion weakness.
• If left untreated, usually deformity occurred, such as: equino valgus, calcaneo valgus, equinovarus, Club foot etc

Orthotic Options
It depends in the location and severity of conditions. Most orthoses prescribed are custom-made ankle-foot orthoses (AFOs), either floor-reaction or posterior solid in design AFOs. Floor-reaction AFOs are particularly beneficial in providing a knee-extension force at the knee, due to the plastic being formed anteriorly at the proximal tibia region and the toe lever footplate, restricting dorsiflexion. Knee-ankle-foot orthoses (KAFOs) and hip-knee-ankle-foot orthoses (HKAFOs) are also can be prescribed.

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