Spina Bifida


Spina bifida is a birth defect of the neural tube. The neural tube eventually develops to form the spine and nervous system. If it doesn’t form correctly damage to the spinal cord can occur, causing neurological dysfunctions, such as lower-limb paralysis, sensory impairment and incontinence.

The cause is unknown, however, lack of folic acid during early pregnancy can increase the risk of this birth defect occurring.


There are three different types of Spina Bifida: occulta, meningocele and myelomeningocele. Symptoms vary according to the type. In spina bifida occulta, there are rarely long-term health problems. Myelomeningocele is the most severe type and results in lower limb paralysis, sensory impairment and incontinence - Hydrocephalus is also common with these babies.

Tests and Diagnosis

Spina bifida is usually diagnosed prenatally during standard ultrasounds and blood tests that are carried out in pregnancy. To confirm the diagnosis, an MRI or CT scan may be carried out within three months of birth.

Orthotic Treatments

Again, treatment depends on the severity of the condition. With the more severe types, surgery is now indicated in infancy to protect the exposed spine and central nervous system. If detected early on in pregnancy, surgery can be carried out in the second trimester.

If lower limb paralysis is present, this is managed with physiotherapy to maintain good range at the hips, knee and ankle. Lower limb orthotics are used to provide stability and aid mobility.

Typically in spina bifida, orthotic intervention would be either ankle foot orthoses (AFO's) or knee ankle foot orthoses (KAFO's).

Initially, AFOs are used in young children to prevent contractures and provide stability to help children learn to stand. When children are learning to walk, fixed AFOs or ground reaction AFOs (GRAFO's) can be used to provide sufficient force for push-off in the stance phase and stabilise the knee joints.

As children grow and become more mobile, they may require additional control at the hip and knee and a KAFO may be indicated with locked knees to facilitate mobility.

Although permanent, this condition requires continued reassessment as each child grows, to ensure their orthotic prescription is optimal for their needs. At LOC, we work closely with the neuro team, such as physios, occupational therapists and parents to complement the therapy that they are receiving with advanced orthotic treatment for each child. As they grow so do the complexities of their gait with increased height and weight. The orthotist will adjust and redesign your orthotic prescription using our Gait Lab facility to optimise effectiveness.


We have the following facilities and amenities at our Kingston Upon Thames location:

  • Free parking
  • Wheelchair ramp
  • Disabled toilet
  • Baby changing facilities

We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.

We have the following facilities and amenities at our Cambridge location:

  • Free parking directly outside the clinic
  • Large Waiting Room
  • No Toys (Due to Health & Safety Requirements of the clinic)
  • Baby changing space (In clinic room)

For more information about The Beechwood Complementary Medical Practice, please visit The Beechwood Practice.

We have the following facilities and amenities at our Bristol location:

  • Free parking directly outside the clinic
  • Large Waiting Room
  • Free tea, coffee and water
  • No Toys (Due to Health & Safety Requirements of the clinic)
  • Baby changing space (In clinic room)
  • Fully wheelchair accessible
  • Short walk to Clifton Village centre for shops, restaurants & cafes

For more information, visit Litfield House Medical Centre.

LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.

It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.

Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton. 

508 Blackburn Rd,

Astley Bridge,




For more information, please visit The Good Health Centre 

An insole is a contoured orthotic device which alters the characteristics and biomechanics of the foot and ankle area. Biomechanics are concerned with mechanical laws and how they affect the living body, especially the musculoskeletal system.

They are removable devices, often made from plastic, that are designed to fit inside a shoe to provide additional support for your feet. As well as offering shock absorption, an insole can help distribute the weight of your body more effectively across the foot and can be made bespoke to cover a range of biomechanical conditions.

If you have symptoms in your feet, ankles, hips or your lower back that are intermittent or were not there to start with in early life, and have started to cause you pain over a period of time, bespoke orthotic insoles could be an excellent option.

If you have already tried rest, icing, compression and elevation and your feet have not recovered, we recommend a biomechanical assessment to consider the possibility of insoles. They are a non-invasive approach to treatment and in many cases, are a great option for symptoms that are not severe enough to warrant surgical intervention. Alternatively, they can be considered as an option prior to surgery.

We will send patients away when an insole is not appropriate, if a patient is suffering with iliotibial band syndrome for example, the problem can be helped with physiotherapy and a stretching programme. That’s what our biomechanical assessment is all about; determining whether there would be any benefit from altering the alignment of your feet.