Incidence and type of hindfoot deformities in patients with low-level spina bifida

In a consecutive series of 174 children with low-level spina bifida, there was hindfoot deformity in 263 of the 348 feet; 86 were in equinus, 108 were in calcaneus, 41 were in valgus, 20 were in varus, and eight had convex pe s valgus. Surgery was performed on 222 (64%) feet. The deformities were sym metric in 114 children. Spasticity causing deformity necessitated surgery i n only 44 feet. Calcaneus deformity in the foot is considerably more common in patients with L4 lesions, and in these circumstances, muscle imbalance is clearly a major factor. However, many patients with calcaneus deformity had L5 or sacral lesions. This suggests that muscle imbalance is not so imp ortant a factor as has been thought in the causation of deformity in the lo wer limb in myelomeningocele.