Symptoms

Spina bifida occulta normally rarely causes any problems. People may have hair growth or a dimple in the bottom of their back.
Spina bifida cystica has different levels of severity. A cyst like sac is evident on the spine. In the mildest form, the sac contains spinal fluid and the tissues that cover the spinal cord. The nerves can be intact or mildly damaged, normally by tethering. In the most severe type, the sac also contains nerves and part of the spinal cord. This can lead to paralysis, muscle wastage and loss of sensation. Hydrocephalus (an accumulation of fluid which causes a significant enlargement of the head) is almost always present in the most severe type, approximally 90% of cases.

Treatments

Will vary depending on the severity but can include:
• Bespoke footwear

• Ankle Foot Orthoses (AFO’s)

• Knee Ankle Foot Orthoses (KAFO’s)

• Hip Knee Ankle Foot Orthoses (HKAFO’s)

Symptoms

Common symptoms include aching or tenderness along the front inner side of the lower leg. Symptoms will often increase with activity such as running.

Treatments

Functional Foot Orthotics to control the over pronation are very effective as it improves foot biomechanics and reduces the stresses in the leg which allows the soft tissues to recover.

What is Runner Knee?

Particularly common in runners, hence the name, it is also referred to as Patella-femoral Pain Syndrome. It is caused by musc

Symptoms

There is often a pain around and sometimes behind the patella (knee cap). The pain is usually of gradual onset. There may sometimes be a clicking sound on flexing (bending) or extending (straightening) the knee.

Treatments

• Pull-on knee sleeve with patella donut to assist in improved patella tracking

• Where over pronation is present, the use of functional foot Orthotics to improve foot biomechanics and improve knee alignment is appropriate

What is Quadriceps Weakness?

There are numerous possible causes of weakness in the quadriceps muscle (the large muscle in the front of the thigh). Some of the more common causes are Motor Neurone Disease (MND), CVA (stroke), Polio,osteoarthritis, rheumatoid arthritis and disuse atrophy (muscle wasting) e.g. following immobilisation of the knee joint in a plaster cast for a number of weeks.

Symptoms

There may be a difficulty in actively extending (straightening) the knee joint. There may also be difficulty in maintaining the stability of a slightly flexed (bent) knee joint when it is loaded. There may be some pain associated with activity of the quadriceps muscle group.

Treatments

Treatment will depend on the severity of the problem; options include:

• A lightweight pull-on knee sleeve to provide sensory input.

• Ground Reaction AFO for significant weakness where considerable forces are required to stabilise the joint for weight bearing

• A Knee Ankle Foot Orthosis (KAFO) when the knee joint has to be held in full extension to allow weight bearing

Symptoms

An individual with RA of the knee may have Knee joint pain, swelling or inflammation (a combination of heat, redness, swelling and pain), knee joint stiffness and warmth around the knee joint.

Treatments

The effects of RA cannot be reversed but the aim of orthotic intervention is to reduce symptoms associated with joint changes/deformity. This may be achieved using:

• Pull-on elasticated/neoprene knee sleeve

• Hinged  knee support

What is it?

The PCL is one of four ligaments which together provide stability to the knee joint. It is a less common injury the anterior Cruciate ligament as it is a stronger than the ACL. The most common method of injury is a direct impact to the front of the tibia (shin bone) with a bent knee e.g. a tackle from the front.

Symptoms

When the injury occurs there is often a loud popping sound. Swelling usually occurs immediately and can be extensive. There is tenderness to touch at the injury site and also a restriction of movement, particularly in the ability to fully straighten the knee.

Treatments

Where the injury does not require surgical intervention or as a protection whilst surgery can be performed the use of:

• A functional ACL knee brace to maintain knee stability and assists in preventing excessive motions in the joint caused by the now deficient ligament.

What is Polio – Knee?

Polio is caused by an infectious virus which attacks the motor neurones (nerve cells which control muscle movement) causing damage or destruction of these cells. This can lead to muscle paralysis.

Symptoms

For those who have paralytic Polio, symptoms include muscle pain, muscle cramps, weakness and paralysis.

Treatments

Treatment will vary dependent upon the level of involvement of the disease. Options include:

• Fixed ankle AFO to align the foot and ankle to improve foot/ankle biomechanics

• Ground reaction AFO will additionally improve knee biomechanics without structurally stabilising the joint

• Knee ankle foot Orthosis will improve lower limb biomechanics and provide structural control to the foot, ankle and knee joints

Symptoms

Common symptoms are knee pain and also a feeling of the knee giving way. In a Valgus knee, more stress is placed on the lateral (outside) part of the joint so outer knee pain is common. In a varus knee, more stress is placed on the medial (inside) part of the knee so inner knee pain is common. Due to altered lower limb biomechanics hip and/or back pain may also be experienced.

Treatments

Orthotic treatment will depend on the severity of the problem. Options include:

• Hinged knee support to provide mild control and sensory input and can reduce pain and the feeling “giving way”

• Off-loading knee brace where more control is required to attempt to improve knee alignment/biomechanics