Foot diseases caused by spina bifida (hypoplasia of the spinal cord)
2016/07/05 14:50:41
Spina bifida (hypoplasia of the spinal cord)
Neural tube failed to close during spinal cord development. 60% of the sick children develop into foot deformities. In most cases, feet are unconscious.
Two. Types and treatment of foot diseases caused by spina bifida (spinal cord dysplasia)
1. Stubborn toes.
Seen in patients with low lumbar spine level. The imbalance between the gastrocnemius muscle and the anterior tibial muscle and the extensor digitorum digitorum extended from the calf.
Neonatal: through passive stretching to deal with deformity. If petrified, gypsum can be considered. After correction: there may be a relapse. In this case, it should be controlled by the support of ankle orthosis (AFO).
Surgery: it is recommended to ulcerate the heels that are resistant to plaster, with a high recurrence rate or secondary to deformities. The anterior muscles should then be transferred to the calcaneus through the interosseous membrane. If the foot is located in the calcaneus, the tendons are transferred to the middle. If the foot is arched, the tendons are on the side. After surgical correction and plaster correction, ankle and orthosis (AFO) should be maintained.
2. Horseshoe feet
Secondary to fibrous disease and triceps contracture. It is difficult to wear shoes.
Minor deformity can be corrected by manual operation and plaster in the first few months after birth. Ankle orthosis (AFO) must be used during the day, and splint should be used to maintain correction in the evening.
Serious deformities cannot be corrected by plaster: it is necessary to perform Achilles tenotomy for the removable part of the tendon. The most serious deformities can only be corrected by tenotomy and resection of the Achilles tendon, as well as by posterior capsule of the ankle and talus. Ankle orthosis (AFO) must be used during the day, and splint should be used to maintain correction in the evening.
3. Talipes talipes varus
Most cases: stiff feet and severe deformities. Even if the correction is good, the recurrence rate will be very high. The foot should be treated with gypsum in the first March. Three months later, uncorrected feet need surgery to completely eliminate flat feet. Further surgical treatment is needed to minimize the recurrence of malformation after surgical correction. For children with stiff feet, it is necessary to correct them through the extraction of talus. Avoid three party arthrodesis, because the possibility of failure is very high.
4. Nerve vertical talus
* Muscle imbalance secondary to paralysis causes vertical talus; congenital vertical talus is found in patients with normal muscle innervation. The foot and the protruding part of the foot are protruded from the medial side of the sole. Hind foot hallux valgus, with feet abducted and dorsiflexion.
Treatment: surgical correction. Operation: about 6 months old. After operation: ankle ankle orthosis (AFO).
5. Arch foot.
• seen in the hip bone (belonging to the hip bone, the posterior wall of the pelvis) nerve abnormalities in children. Feet were not abnormal at birth, but gradually deformed in the next five years. Usually developed into the inner toe of the toe, accompanied by claw foot deformity.
Treatment: slight passive stretching and orthosis should be taken according to the severity of the disease. Severe: the fascia plantaris is needed and the extensor digitorum longus is transferred to the head of metatarsal bone. The most serious: the more rigid parts of the deformity. To correct the deformity, we need the first metatarsal and calcaneal osteotomy. All corrections require a special orthosis to maintain.
6. Hallux valgus
• common in children with low lumbar nerve function. Treatment: because the hind foot is valgus, the front foot must change with it. To compensate for this, the forefoot should be turned back, and the hind foot is taken out of the valgus and aligned with the long axis of the tibia. Orthosis will take into account this supination condition.