**7.1 Clubfoot**

Spina bifida patients present with a rigid clubfoot deformity that is in general resistant to casting. This type of deformity can occur in up to 30–50% of the patients and the frequency increases with higher levels of the spine defect [36]. Casting with the Ponseti technique should be attempted and even though most of the patients achieve correction by this method almost 70% will relapse [37].

**Figure 10.** *Patient with a bilateral cavovarus deformity being examined in clinic with the help of a podoscope.*

Additionally, if serial casting is being implement is paramount to assess skin integrity at every cast change in these patients due to their insensate feet. After correction is achieved by casting the treatment is followed by an Achilles tendon tenotomy, usually open in these patients [38]. If a wider soft tissue release is needed later on due to a recurrence a radical posteromedial release is recommended. In this procedure the subtalar, talonavicular and calcaneocuboid joints are completely released. After surgery casting followed by ankle foot orthosis (AFO) is required to maintain the correction. If a recurrence is then again noted, which may occur in 20–50% of the patients, a talectomy is indicated to achieve a plantigrade braceable foot [39].
