onal deficits which create dynamic imbalances between agonist anatogonist muscle groups in the lower extremity. They tend to be most severe when a spastic muscle group overpowers its flaccid antagonist. Moreover, the imbalances often increase as the disease process progresses.
Besides club foot, patients may also present with genu valgum, pes planus, metatarsus adductus, equinus, and pes cavus. Spina bifida occulta should be considered any time that an adult presents with unexplained paresthesias, muscle weakness, sudden gait changes or, perhaps, an insensitive foot with trophic ulcers.
Finally, in a study conducted by Simpson and colleagues it was found that 14.9% of postnatal neural tube defect cases include additional birth defects (19:285). Moreover, Hall and associates found that the probability of other anomalies in spina bifida was 10.1%. No differences, however, were reported with respect to ethnicity in these cases. Furthermore, of all the many different developmental abnormalities reported in Simpson et al., there was no mention of either situ
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