Many people with spina bifida can walk, though the answer depends heavily on the type of spina bifida and where on the spine the defect occurs. Some walk independently with no aids at all, while others use braces or crutches, and some rely primarily on wheelchairs. The location of the spinal opening is the single biggest factor in determining mobility.
Why the Type of Spina Bifida Matters
Spina bifida exists on a spectrum, and the three main types have very different effects on mobility.
Spina bifida occulta is the mildest form. The spinal nerves aren’t involved, so most people never experience symptoms at all. Walking is unaffected, and many people don’t even know they have it.
Meningocele is rare. The protective membranes around the spinal cord push through the opening in the spine, but the cord itself stays in place. This can cause some minor functional issues with the bladder and bowels, but leg movement is usually preserved.
Myelomeningocele is the most severe and most common form that causes disability. The spinal cord and nerves push through the opening and are often damaged, leading to weakness or paralysis in the legs, along with bladder and bowel problems. When people ask whether you can walk with spina bifida, this is usually the type they’re asking about.
How Spinal Level Determines Walking Ability
The nerves that control your leg muscles branch off the spinal cord at specific points. The higher up the spine the defect occurs, the more leg function is lost. Think of it like a power outage: if the disruption happens high on the line, more of the system downstream goes dark.
People with a sacral-level defect (the lowest part of the spine) have the best outcomes. In one study, 93% of patients with sacral involvement relied on walking as their only method of getting around, and none of them needed crutches or a walker. At the low lumbar level (around L5), 91% walked most of the time, though some began needing a brace or crutch. At the L4 level (mid-lumbar), 57% still relied on walking most of the time, but 45% used crutches and 20% used a walker. With mid-to-high lumbar or thoracic-level defects, independent walking becomes much less likely, and wheelchairs become the primary mode of mobility.
The size of the opening in the neural tube also plays a role, as does the quality of care before and after birth. Two children with the same lesion level can have different outcomes based on surgical timing, therapy, and orthopedic management.
Braces and Devices That Help
For many people with spina bifida, walking isn’t an all-or-nothing situation. Orthotic devices bridge the gap between full leg function and no function at all.
Ankle-foot orthoses (AFOs) are the most commonly prescribed. These lightweight braces fit inside a shoe and support the ankle and foot. They help with foot drop (the inability to lift the front of the foot), stabilize the ankle, and improve the push-off motion during each step. Different designs exist depending on the specific weakness pattern, from flexible versions that allow some ankle movement to rigid ones that lock the joint in place.
Knee-ankle-foot orthoses (KAFOs) extend higher up the leg to also stabilize the knee. These are used when the muscles around the knee are too weak to support body weight on their own. They’re bulkier and require more energy to walk in, which is one reason some people transition to wheelchair use as they get older.
Many children also begin with standing frames, which hold them upright before they’re ready to take steps. This early weight-bearing is important for bone health and sets the foundation for later walking.
Walking Ability Changes Over Time
One of the most important things to understand is that walking ability in spina bifida often peaks in childhood and declines with age. A 50-year prospective study tracked this pattern closely. At age 9, about 51% of survivors could walk more than 50 meters. By age 18, that number was essentially the same at 50%. But by age 25, it had dropped to 33%, and by age 50, only 27% could still walk that distance.
Of the children who were walkers at age 9, more than half lost the ability to walk 50 meters as they got older. This decline happens for several reasons. Body weight increases while muscle strength stays the same or weakens. Orthopedic complications accumulate: hip deformities, scoliosis, and joint contractures all make walking progressively harder. The sheer energy cost of walking with braces and weakened muscles also becomes less sustainable as people age and face the demands of work and daily life.
The combination of hip deformity, pelvic tilt, and scoliosis is particularly damaging to walking ability. Any one of these conditions, if severe, can be enough on its own to end someone’s ability to walk. This is why orthopedic monitoring and early corrective surgeries (like procedures to prevent hip dislocation) play a major role in preserving mobility.
Transitioning to a wheelchair isn’t a failure. By age 50, over half of those living independently used wheelchairs. For many adults, a wheelchair provides faster, more efficient mobility and reduces the fatigue and joint damage that come with struggling to walk.
How Early Intervention Supports Mobility
Physical therapy starts early, ideally in the first months of life. For infants under one year, the focus is on trunk control and antigravity muscle activity. Tummy time (while awake) builds the back and core muscles that form the foundation for all later movement. Daily weight-bearing activities, even when supported, promote bone development in the legs.
Between ages one and five, children who aren’t pulling to stand on their own may use standing frames or mobility devices to get upright. Bracing starts during this period to protect weak legs from twisting forces and to support muscles that can’t do the job alone. Therapists and parents work together to explore all mobility options, including both walking and wheelchair skills, so the child has flexibility as they grow.
Parents should expect some delay in walking milestones even in children who will eventually walk well. A child with sacral-level spina bifida might walk independently but start later than peers. This is normal and doesn’t predict their long-term ability.
Prenatal Surgery and Walking Outcomes
Fetal surgery to repair myelomeningocele before birth has become an option at specialized centers. A systematic review of outcomes found that about 69% of children who had prenatal repair were able to walk, compared with 60% of those who had the traditional postnatal surgery. The difference is modest but meaningful, and prenatal repair also tends to reduce the need for a shunt to drain excess fluid from the brain. Not every pregnancy is a candidate for fetal surgery, and the procedure carries risks for both the mother and baby, but it represents a real shift in early outcomes for some families.