Paralysis, Foot Deformities (Myelomeningocele)

turu_17a_n.jpg: 7-day-old girl with a large thoracolumbar myelomeningocele and a gibbus of the spine. turu_17b_n.jpg: Besides the flatfoot deformity of the right and clubfoot deformity of the left foot an overextension of the legs in the knees (genua recurvata) and an extreme flexion posture in the hips is obvious. In contrast to the patients in $$turu_6??££alternate figure 1§§ and $$turu_16??££alternate figure 2§§ a deficit of the muscles may be seen, for instance of the lower leg. turu_17a_n.jpg and turu_17b_n.jpg: The neurological presentation of spina bifida is often asymmetric. It is determined by the neurological level of the still innervated muscles, by the completeness and the segment breadth of the distal paraplegia, and by the residual, more distal reflex activity. In the presented case a reflex activity (without any volitional control) with extension of the knees and flexion of the hips simulates a volitional activity of these muscle groups. Nevertheless, the neurological level is Th 12, and the child's malformation belongs to a high level type of myelomeningocele; this in contrast to the low and neurologically favorable types of the demonstrated case reports. $$turu_16??££Figure 1§§ and $$turu_6??££figure 2 for comparison§§ . In low types of myelomeningocele the last still innervated level is L 3 or lower; therefore, at least a volontary extension of the knees is possible.