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Podatrists play a key role in spina bifida management

Photo: The Foot Hub
While common foot problems such as fungal toenail infections, ingrown toenails, heel pain and arch pain prompt many a visit to podiatry clinics, what many people don’t realise is that their foot health can be heavily impacted by other conditions like diabetes, arthritis and even blood disorders and kidney problems.

Podiatrists are lower limb specialists whose treatment modalities range from footwear modifications to pharmaceutical therapy to surgery intervention.

“A number of complex medical conditions affect the feet in two ways: cardiovascular and neurological,” says podiatrist, Rudo Makuyana.

“Cardiovascular impact results in diminished circulation which leads to higher chances of infection, vascular ulcers etc.

“Neurological impacts are usually a loss in sensation. A loss in sensation can result in ulcers, altered gait, neuropathic symptoms, such as burning, tingling and numbness.”
What some people are unaware of is that in severe cases, and left unchecked, some foot complications can result in lower limb amputations.
“We have research that tells us that following a below the knee amputation patients have a 75% chance they will die in 5 years,” says Mr Makuyana.
Once such condition that can be well assisted by podiatry treatment is Spina Bifida.
Almost all patients with spina bifida will experience problems with foot deformity which could present as calcaneus, equinus, varus, valgus, or a combination of these. Also common is Clubfoot and vertical talus.
Foot deformities not only have a cosmetic impact on the individual, but can also lead to problems with ambulation, by causing difficulty with bracing and shoe wear. This type of deformity can also cause skin irritation, which may lead to breakdown and pressure sores.
“Spina bifida has various forms and is classified by the type of spinal defect,” Mr Makuyana says.

“The disease will have varied presentation and impact on the lower limbs depending on the area of the spinal lesion.”

Spina bifida has two primary types: occulta and manifest. Occulta is a less serious form which may have no neurological involvement and thus those affected may have little or no lower limb issues.

“Manifest has two forms, the most severe form is spina bifida myelomengiocele, characterised by the failure of the spinal cord to form a tube and portion of the undeveloped cord protrudes from the back.

The severity of spina bifida is determined by the site of protrusion and the nerves affected. 

“In severe cases spina bifida can cause loss of motor and sensory nerve conduction in the lower limbs leaving patients susceptible to neuropathic injury.

“Examples of neuropathic injury include burns, fracture from blunt force or repetitive trauma or ulceration due to pressure and friction in footwear.”

Podiatry helps with the functional limitations that occur because of that nerve damage.

“Neurological impairment in the feet, lower limb paralysis and sensory dysfunction.

“Lower limb weakness and in some cases foot deformity like talipes equinovarus (clubfoot) can occur.”

Like other orthopaedic deformities, deformities of the foot and ankle due to spina bifida may result from congenital, developmental, or iatrogenic causes.

Congenital deformities are those present at birth and include clubfoot and vertical talus.

Acquired developmental deformities generally relate to the level of neurologic involvement. Conditions such as calcaneus and cavovarus, are caused by paralysis, decreased sensation in the lower extremities, and muscle imbalance.  Iatrogenic injury, such as postoperative tethered cord syndrome, may also cause deformities.

Regardless of the type of deformity, podiatrist may be able to assist with gait and functional movement.

“Things like footwear, AFOs and walking aids are many ways we can help.

“If the patient is non-weightbearing – ankle foot orthoses may help protect the feet and legs when transferring.

“Podiatrists can also help with skin and nail issues that may result when the patient has altered weightbearing or is non-weightbearing.

“Examples of common issues include ulceration, corn formation and ingrown or deformed toenails.”

As Spina Bifida is a congenital condition present at birth, Mr Makuyana recommends constantly monitoring developmental milestones in the first 6 months.

“Conditions like talipes equniovarus are treated early in children for better outcomes.

“Podiatry intervention in later life should be based on clinical need. Different developmental milestones occur at different stages. Neuropathic injury as well as skin and nail issues usually occur later in life.”

It is recommended that people with spina bifida see a podiatrist regularly once they turn 16.

All podiatrists receive training in neurological conditions that occur in the feet, enabling anyone with a formal qualification to be able to effectively help people with spina bifida.

Undergraduate podiatry courses in Australia are generally 4 years, with one 3 year course available. The podiatry registrant data released by AHPRA revealed that there are almost 5,000 podiatrists registered in Australia. Many of them are among the 25 – 29 age group and most are women.

“We always advise in complex medical conditions that patients should always have a multidisciplinary approach to treatment,” says Mr Makuyana.

“If we find that our patients require another specialist to come onboard we always refer and bring them onboard.”

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.