Foot deformities in spina bifada

NewsBot · May 28, 2008

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Spina bifida occulta. Foot deformities, enuresis and vertebral cleft: clinical picture and neurophysiological assessment.
Zambito A, Dall'oca C, Polo A, Bianchini D, Aldegheri R.
Eur J Phys Rehabil Med. 2008 May 23. [Epub ahead of print]

AIM: The aim of the study was to investigate the relationship between the clinical evidence of foot deformities in spina bifida occulta and the associated neurophysio-logical damage.

METHODS: The authors studied 47 patients with foot deformities (37 flat foot, 10 pes cavus) and vertebral cleft, variably associated with enuresis, midline cutaneous lesions, and further orthopaedic deformities. An electrophysiological evaluation was performed in an attempt to investigate the peripheral nervous system in greater detail, including conventional motor and sensory nerve conduction, F-wave recording and electromyogram (EMG) testing.

RESULTS: The peroneal nerve F wave latency was longer in patients with pes cavus than in those with flat foot (P<0.04). Conversely, the posterior tibial nerve F-wave latency was longer in patients with flat foot than in those with pes cavus (P<0.02). Needle EMG showed large amplitude motor unit potentials during voluntary recruitment in all patients, suggesting a neurogenic origin of these EMG changes. Neurophysiological study makes it possible to distinguish between myogenic and lower motor neuron involvement. The existence of some degree of spinal cord dysraphism may be pathophysiologically associated with foot deformities.

CONCLUSION: Children with foot deformities and clinical evidence of occult spinal dysraphism should have a neuro-physiological assessment in order to obtain an early diagnosis and avoid ineffective foot surgery.
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admin · Nov 11, 2010

Foot and ankle problems in spina bifada

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida
Qin SH, Ge JZ, Guo BF.
Zhonghua Wai Ke Za Zhi. 2010 Jun 15;48(12):900-3.

OBJECTIVE: To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida.

METHODS: The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed.

RESULTS: One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment.

CONCLUSIONS: Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.
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NewsBot · Jun 21, 2012

Combined procedure for the treatment of ankle and foot deformities secondary to spina bifida
Jiao SF, Qin SH, Ren LX, Ge JZ, Wu HF, Wang ZJ, Zheng XJ.
Zhongguo Gu Shang. 2012 Mar;25(3):237-40.

OBJECTIVE:
To study surgical strategies for ankle and foot deformities secondary to spina bifida and treatment methods for different types of deformities.

METHODS:
From January 1990 and July 2009, 107 patients with ankle and foot deformities secondary to spina bifida were retrospectively analyzed. There were 44 males and 63 females, with an average age of 17.7 years (rangd from 1.3 to 52 years). Among the patients, 58 patients had double ankle deformities, 49 patients had unilateral deformities (22 cases on the left side, 27 cases on the right). Ninety-nine patients with equinus deformities were treated by achilles tendon lengthening and tendon transfering; 25 patients with talipes were treated by release of anterior tendon of ankle and tendon transfer; 17 patients with valgus and varus deformities were treated by tendon transfer and calcaneal osteotomy; 15 patients with flail deformities were managed treated by bone fusion between calcaneus and talus and shortening of achilles tendon; 9 patients with claw toe deformities were treated by bone fusion of interphalangeal joint or Ilizarovs distraction. AOFAS (American Orthopaedic Foot & Ankle Society) comprehensive scoring system was used to evaluate subjective pain and objective functional.

RESULTS:
Seventy-nine (127 feet) of 107 patients were followed up, and the duration ranged from 48 to 180 months (averaged, 64 months). According to AOFAS scoring system, the results were rated as excellent in 89 feet, good in 26 feet, moderate in 9 feet and poor in 3 feet.

CONCLUSION:
Treatment strategies for ankle-foot deformities mainly included four principles, deformity correction, muscular balance, joint stability and reservation of foot elasticity. Different combined procedure was applied for different foot deformities and received good therapeutic effects.
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NewsBot · Jun 22, 2012

The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida.
Küçükdurmaz F, Ağır I, Saygı B, Bezer M.
Indian J Orthop. 2012 May;46(3):333-8.

BACKGROUND:
Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft.

MATERIALS AND METHODS:
Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months).

RESULTS:
The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05).

CONCLUSION:
Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.
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NewsBot · Dec 4, 2012

Orthopaedic management of spina bifida-part II: foot and ankle deformities.
Swaroop VT, Dias L.
J Child Orthop. 2011 Dec;5(6):403-14.

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.
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NewsBot · Oct 29, 2013

Effect of Pulsed Nd:YAG Laser in the Treatment of Neuropathic Foot Ulcers in Children with Spina Bifida: A Randomized Controlled Study.
Ebid AA, Abd El-Kafy EM, Alayat MS.
Photomed Laser Surg. 2013 Oct 25.

Objective: This study assessed the effects of pulsed Nd:YAG laser treatment of neuropathic foot ulcers in children with spina bifida.

Background data: Children with spina bifida face increased risk for developing neuropathic foot ulcers.

Methods: In a randomized controlled trial, 39 children and adolescents (ages 6-15 years) with spina bifida and stage III neuropathic foot ulcers were randomly assigned to the laser group or the placebo laser group. The former received pulsed Nd:YAG laser treatments (i.e., total energy of 300-350 J during three sessions/week) plus standard wound care, and the latter received sham laser treatments plus standard wound care. Wound size and wound appearance were assessed for all patients at the beginning of the treatment, after 5 weeks, and after 10 weeks.

Results: The decrease in wound surface area at 5 and 10 weeks post- treatment was significantly greater in the laser group (i.e., 2.44±0.33 and 0.29±0.25 cm2, respectively) than in the placebo group (i.e., 3.81±0.18 and 3.24±0.44 cm2, respectively). Also, the decrease in the total score for the Pressure Sore Status Tool (PSST) at 5 and 10 weeks post-treatment was significantly different for the laser group (i.e., 32.76±2.30 and 17.52±1.66, respectively) than for the placebo group (i.e., 46.50±2.12 and 38.11±3.17, respectively).

Conclusions: Treatment with pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser combined with standard wound care decreases wound size and improves wound appearance for stage III neuropathic foot ulcers in children with spina bifida.
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NewsBot · Aug 14, 2014

The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida: A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework
Barbara Ivanyi et al
Prosthet Orthot Int August 8, 2014

Background: To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance.
Objectives: To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida.
Study design: Systematic literature review.
Methods: A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework.
Results: Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle–foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance.
Conclusions: Some data support the efficacy of using ankle–foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated.
Clinical relevance This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment on gait parameters, walking capacity, and walking performance.
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NewsBot · Nov 2, 2015

Incidence and type of foot deformities in patients with spina bifida according to level of lesion.
Gunay H et al
Childs Nerv Syst. 2015 Oct 30

AIM:
The previously suggested association between the incidence of high-level foot deformity and muscle imbalance is no longer supported, when evaluated independent from motor and sensory loss and level of lesion, by current studies. The purpose of this study was to evaluate the association between level of lesion and foot deformity.
METHODS:
Of 545 patients, a total of 136 (272 feet) patients admitted to the spina bifida clinic between 2010 and 2014 were included in this study. Levels of all lesions were evaluated using initial operation data, the motor-sensory exams, and direct radiography. All patients were categorized into four different groups: Thoracic region (group 1), high-level lumbar-L1-2 region (group 2), mild and lower lumbar regions (L3-4-5) (group 3), and Sacral region (group 4).
RESULTS:
The mean follow-up time was 34.9 months (range 8-176 months). Group 1, group 2, group 3, and group 4 included 24 (17.6 %), 14 (10.3 %), 19 (14 %), and 79 (58.1 %) patients with regards to level of lesion, respectively. The incidences of foot deformity were 85.4, 85.7, 81.5, and 50.6 % in groups 1, 2, 3, and 4, respectively. Of all patients, 22 % (61 feet) had clubfoot, 16 % (44 feet) pes cavus, 10 % (26 feet) pes valgus, 6 % (17 feet) isolated equinus, 6 % (17 feet) pes calcaneus, and 5 % (13 feet) metatarsus adductus. Patients without a foot deformity (81 % of normal feet) usually had a lesion at the sacral level (p ≤ 0.05). On the other hand, isolated equinus (70 %) and clubfoot (49 %) deformities were mostly observed in spinal lesions (p > 0.05). The incidence of pes calcaneus, pes valgus, and adductus deformities inclined as the lesion level decreased (p > 0.05).
CONCLUSION:
In this study, it was concluded that foot deformities were directly related to the level of lesion. The comparison of higher and lower level lesions revealed that the types of foot deformity differed significantly. The muscle imbalance due to spina bifida was not sufficient to explain the pathology. On the other hand, the level of spinal lesion is an important factor for the type of deformity.
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NewsBot · Mar 14, 2016

PUBLIC RELEASE: 14-MAR-2016
Excessive fat in legs of children with spina bifida suggests risk for metabolic disorders

Children with a severe type of spina bifida called myelomeningocele have a high prevalence of obesity and excess fat accumulation in their lower extremities. In a study designed to assess bone, muscle and fat tissue distribution in the lower legs of children with this disease, researchers at Children's Hospital Los Angeles determined that this excess fat tissue is within the muscle boundary (muscle-associated) rather than subcutaneous. These findings are significant as muscle-associated fat tissue has been linked to insulin resistance and metabolic disorders. The study is published online in the Journal of Child Neurology.

Myelomeningocele is the most severe type of spina bifida and the impact on patients' health goes beyond the characteristic nerve damage and other neurologic disabilities. The condition is estimated to affect 3.4 per 10,000 live births in the United States and the incidence is even higher among certain populations, including Hispanic Americans. In addition to direct neurologic deficits, affected patients also have higher incidence of other adverse health outcomes including osteopenia, pathologic fractures and obesity.

The team of investigators studied the lower leg bone, muscle and adipose tissue volume in children with myelomeningocele to classify the fat accumulated as either subcutaneous (more commonly found just under the skin) or muscle-associated (where the fat tissue in embedded within the muscle tissue and between muscles). Using computed tomography scans, they saw that increases in lower leg adiposity in children with the disorder are primarily attributable to accumulation of muscle-associated adipose, which may signify increased risk for metabolic disorders such as diabetes.

"We found that children with high level myelomeningocele have more adipose tissue, subcutaneous and muscle-associated, as well as less muscle and bone compared with typically developing children," said Tishya Wren, PhD, of the Children's Orthopaedic Center of Children's Hospital Los Angeles. "These children tend to have mobility limitations and as a result they don't walk and are inclined to gain weight."

The distinction is important because the specific health risks of adiposity depend largely on its location. While total leg fat content has been linked with favorable insulin sensitivity, adipose tissue within the deep fascia of leg muscles has been associated with insulin resistance. This previously unknown finding may impact our understanding of long-term health risks in this population.

"Our findings may also have important implications for long-term health management in children with myelomeningocele," adds Wren. "They may be at increased risk for type 2 diabetes which, to our knowledge, has not been studied in the spina bifida population."

The study also found that higher BMI was a significant predictor of more muscle-associated fat, which suggests that lowering BMI through diet and exercise may have a positive effect on intramuscular fat and associated disease risks.
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NewsBot · Oct 22, 2016

Neuropathic Ulcers Among Children With Neural Tube Defects: A Review of Literature.
Pandey A et al
Ostomy Wound Manage. 2015 Dec;61(12):32-38.

A trophic ulcer is a pressure ulcer caused by external trauma to a part of the body that is compromised due to disease, vascular insufficiency, or loss of afferent nerve fibers. Spinal dysraphism (ie, neural tube defects [NTD]) such as meningomyelocele is a risk factor for developing these ulcers in adults and pediatric patients. Information regarding the occurrence of trophic ulcers in pediatric patients with NTD is lacking. A review of the English-language literature on skin/neuropathic ulcers in patients with NTDs, irrespective of study design, published between 1975 and 2014, was undertaken using the PubMed database. Search terms included trophic ulcer, neuropathic ulcer, NTDs, and meningomyelocele. From among the more than 200 papers related to skin care in neonates and pediatric patients, 11 addressed skin ulcers in patients of NTD - 1 in French (a review article), 1 in German (a case report), and 9 in English (7 cohort studies and 2 reviewing surgical techniques). Typically, ulcers in patients with NTD are neuropathic (ie, related to nerve pathology). The most common type is meningomyelocele. Patients with NTD present with a spectrum of functional and sensory deficits that impair mobility; other causative factors that may contribute to the occurrence of ulcers include stress to the tissue, the length of time the stress occurs, muscle spasticity, infection, moisture, and nutritional status of the patient. Awareness of ulcer risk and preventive measures, such as maintaining foot flexibility or careful handling bony prominences such as kyphosis, is important. Once an ulcer occurs, management is challenging and involves collaboration of multiple medical, surgical, nutrition, and other specialists. If an ulcer develops and NTD has not been previously treated surgically or the MRI shows evidence of retethering, surgical treatment is needed. More research is needed to help guide ulcer prevention and treatment strategies in pediatric patients with NTD.
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NewsBot · Dec 7, 2018

Skin breakdown of the feet in patients with spina bifida: Analysis of risk factors.
Conklin MJ et al
J Pediatr Rehabil Med. 2018 Nov 19.

PURPOSE:
Recent studies on patients with spina bifida have noted an increased incidence of skin breakdown with more proximal functional neurologic level. We hypothesized that there would be an inverse relationship between skin breakdown of the foot and severity of functional level of lesion, because patients with more caudal levels of lesion spend more time ambulating.

METHODS:
The National Spina Bifida Patient Registry (NSBPR) at Children's of Alabama was queried for the presence of skin breakdown of the foot, ambulatory status, functional neurologic level, and diagnosis of myelomeningocoele (MMC) vs. non-myelomeningocoele (non-MMC). Univariate and multivariate analysis were performed.

RESULTS:
Of 491 total patients, 378 were MMC and 113 were non-MMC. Eighty-five of 378 (22.5%) patients with MMC and 5 of 113 (4.4%) non-MMC patients reported skin breakdown (p= 0.009). Thoracic and lumbar levels were compared to the sacral level for statistical analysis. Skin breakdown occurred in 26.2% of thoracic (p= 0.001), 33.3% of high-lumbar (p= 0.001), 21.5% of mid-lumbar (p= 0.008), 26.2% of low-lumbar (p= 0.001), and 6.1% of sacral level patients. Ambulatory status was not significant on multivariate analysis.

CONCLUSION:
A diagnosis of MMC is a significant, independent risk factor for skin breakdown of the foot. Compared to sacral level, thoracic and lumbar levels of function were also independently significant. Ambulatory status was not significant.
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NewsBot · Sep 6, 2019

The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida.
Rethlefsen S et al
Disabil Rehabil. 2019 Sep 4:1-5

Aim: To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida. Method: Retrospective cohort study of 72 ambulatory children (age range 0-23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors. Results: Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11-15 (17%), than ages 0-10 (5%) and 16+ years (7%), p < 0.0001], and varus/valgus foot deformities (p < 0.001) and brace use (0.32 risk difference, p = 0.01), but not with standing foot position, deformity rigidity, body mass index, spina bifida type, lesion level, ambulatory level or co-morbidities. Most common sites were the heel (21/96, 22%), lateral malleolus (12/96, 13%), and plantar 5th metatarsal head (11/96, 12%). Conclusion: Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable. Implications for Rehabilitation Foot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces. Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus. Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors.
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NewsBot · May 26, 2021

Gait profile score and gait variable scores in spina bifida
Hiroyori Fusagawa et al
J Pediatr Orthop B. 2021 May 20

Objective: Quantitative data assessment on the basis of three-dimensional gait analysis has been routinely used in the evaluation of pathological gait of children with cerebral palsy. However, a similar quantitative methodology has not been applied for spina bifida patients in whom atypical gait patterns are thought to correlate with various levels of neurological paralysis. To investigate the differences among gait patterns in spina bifida between different levels of neurological lesions using quantitative methods: Gait profile score (GPS) and gait variable scores (GVS), scoring subject's gait deviation from a reference.

Methods: In this cross-sectional study, 22 children with spina bifida (11 women, 11 men; mean age 9.4 years, SD 3.8 years, range 3-17 years), were examined using three-dimensional gait analysis from 2008 to 2018. Physical examination allowed for classification of each of the 44 limbs as either L4, L5 or S1 and comparison with the GPS and GVS using a linear mixed model.

Results: GPS and the GVS of the pelvis and hip range of motion in the coronal plane were significantly higher in the L4 group than in the L5 and S1 groups (GPS, P = 0.041, P = 0.003, respectively; GVS of pelvis, P = 0.001, P = 0.001; GVS of hip, P < 0.001, P < 0.001) GVS (foot progression angle) was significantly lower in the S1 group than in L4 and L5 groups (P < 0.001, P = 0.037).

Conclusions: We found that GPS and GVS enable us to quantitatively assess the differences among gait patterns between different neurological levels. The scoring tool showed the potential for detecting individual neurological changes.
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NewsBot · Jul 17, 2022

Distal lower extremity manifestations in spina bifida
patients of the Yucatan Peninsula: A 24-year retrospective
case series
Alexandra Heidtmann, et al
The Foot and Ankle Online Journal 13 (4): 8

Spina Bifida, a rare congenital disorder with an incidence of 7.85 per 10,000 births in Mexico. It
results from the failed closure of the neural tube leading to the incomplete development of the
neural arches. This case series is part of the Yucatan Crippled Children’s Project that began in 1996
by Charles Southerland, Doctor of Podiatric Medicine and former professor of Barry University’s
School of Podiatric Medicine. All patients in this study were assessed and treated at the Red Cross
hospital in the city of Merida, Yucatan, Mexico. Attendings, residents and medical students travel to
the Yucatan Peninsula four times a year for a period of one week. Given that this study was built
from reports of medical mission trips that occur four times a year with limited resources and time,
the lack of documentation of treatment plans and follow-ups made it difficult to identify surgical
procedures and assess the success of surgeries. Additionally, we did not have access to the patients
birth records or their mothers medical records to accurately determine the etiology of their
deformities. Based on our data, we conclude that intervention should be considered as early as possible in any flexible deformity to prevent them from becoming rigid.
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NewsBot · Jun 6, 2023

Foot deformity and quality of life among independently ambulating children with spina bifida in South Korea
Hyeseon Yun et al
BMC Pediatr. 2023 Jun 5;23(1):281

Background: Children with spina bifida (SB) may have congenital or acquired foot deformities due to neurological defects in the spinal cord. As the musculoskeletal system keeps growing, foot deformities can develop or become aggravated. Thus, healthcare providers should provide constant monitoring and proper orthopedic management. Since foot deformities can affect not only the gait but also the daily life of children with SB, it is necessary to investigate the impact of foot deformities on everyday life. The purpose of this study was to examine the relationship between foot deformity and health-related quality of life (HRQoL) among independently ambulating children with SB.

Methods: This cross-sectional study examined the associations between foot deformity and HRQoL using two patient-reported outcome measures (Oxford Ankle Foot Questionnaire, Pediatric Outcomes Data Collection Instrument) in 93 children with SB aged 7-18 years between January 2020 and July 2021.

Results: Children with foot deformity (n = 54) reported lower scores in all subscales (physical, school and play, emotional, and footwear) of the Oxford Ankle Foot Questionnaire for children than those without foot deformity (n = 39; p < 0.001). Additionally, in terms of the Pediatric Outcomes Data Collection Instrument, children with foot deformity also reported poorer scores in four subscales (transfer and basic mobility, sports and physical functioning, comfort and pain, happiness with physical functioning; p < 0.001) than those without foot deformity, whereas upper extremity functioning was not significantly affected. Children with foot deformities, particularly those with bilateral foot deformities, equinus deformities, or mixed deformities, which are different types of right and left foot deformities, have a lower perceived HRQoL (p < 0.05).

Conclusions: Among independently ambulating children with SB, those with foot deformities showed lower HRQoL. Moreover, children with foot deformities tend to have other clinical problems, including bladder and bowel dysfunction. Therefore, orthopedic management should consider the multifaceted factors that affect children's daily life and HRQoL.
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