Page 128 - ASOP ROT Study Guide

Etiology
The condition is relatively common and is seen in a mild, postural form and a fixed form. The mild form
is seen after a breech birth and is probably related to the baby's position (posture) while in the womb. The
fixed form is associated with developmental abnormalities of nerves and muscles of the leg. In both
cases the condition can be bilateral.

Management
The mild form is usually easily corrected at birth by manipulation. The severer forms require surgery.

In both forms the initial treatment consists of gentle stretching in two phases. The first phase corrects
the hindfoot equinus and the second phase corrects the mid and forefoot varus. In the mild cases, six weeks
of stretching and strapping in a corrected or over-corrected position is all that is required. In severe cases,
after six weeks of stretching the deformity should be reassessed and if correction is incomplete or cannot
be maintained, then surgery is necessary.

The children all need to be followed up until their feet stop growing, at around the age of fourteen, as late
relapse requiring further surgery is not uncommon. The affected foot is often significantly smaller than the
normal foot which can give difficulties in shoe fitting.

8 . 3 Neurological Conditions

Conditions affecting the neurological structures at birth lead to abnormalities of the muscular and skeletal
system during growth and development.

8 . 3 . 1 Spina bifida and meningomyelocele

Abnormal developments of the spine during the first three months of the development of a newly forming
baby may result in the abnormal formation of the spinal cord and vertebrae.

Spina bifida occulta
This may be a minor bony abnormality which affects 2% of the population. It is usually of no significance,
although some people who are affected develop mechanical backache and a very small number may get
tethering of the spinal cord to the higher lumbar vertebrae during growth -diastamatomy elia.

Spina bifida cystica
A small and decreasing number of babies are born with the neural plate tissues open with little or no skin
or bony cover. This is spina bifida cystica. The nerve tissue may be covered by a cyst (a meningocele) or
the nerve tissue may be incorporated in the cyst wall (a meningomyelocele). Many children also have
an abnormal increase in the amount of fluid in the brain,hydrocephalus, which leads to mental retardation
and an increase in the size of the head.

Many children suffering from this condition die at, or soon after, birth. Some survive and undergo surgery
to close the lesion on their back. These children have formidable problems: paralysis; growth deformities
through muscle imbalance; and incontinence. Many, but by no means all are mentally retarded. All this is a
major burden for the child and the family, who need support from a team consisting of surgeons,
therapists and social workers.

Many of the children need early surgery to their feet to maintain a functional shape. Others develop joint
contraction resulting in a fixed flexed position of their knees and dislocation of their hips. Every effort
should be made to keep the children mobile until adolescence so that they may grow to