**7. Foot deformities**

Foot and ankle deformity are very prevalent in spina bifida patients, with an incidence ranging from 60 to 90%. They can be present at birth or developed later on in life in close relationship with the spinal defect level [34]. In addition to the muscle imbalance and deformity the patients present with insensate feet which places a risk for skin breakdown and infections. The most common foot deformities are calcaneus, equinus, Varus, valgus, clubfeet and vertical talus and they can present as a single deformity or in combination [35]. Treatment of foot and ankle deformities is aimed at achieving a braceable plantigrade foot. In general treatment may start with casting or bracing and potentially a soft tissue surgical intervention to avoid fixed bone deformities. Once those are present osteotomies are needed to correct the foot. The patient needs to be examined regularly by a specialized pediatric orthopedist to detect tightness and incipient deformities can be early addressed (**Figure 10**).
