The windswept position in spina bifida is best described as which of the following?

• A. One leg ER and ABD; the other IR and ADD
• B. Both legs crossed
• C. Standing upright with knees locked
• D. Legs in equal neutral alignment

Answer: (A)

Windswept positioning reflects asymmetric hip deformities caused by muscle imbalances and postural patterns that commonly occur in spina bifida. When one leg ends up in a position of external rotation and abduction while the other leg is internally rotated and adducted, the legs are moving in opposite directions. This opposite rotation and direction is what defines the windswept posture, rather than simply having legs crossed, standing with knees locked, or both legs in neutral alignment.

This pattern arises from uneven strength and tightness around the hip joint: hip abductors and adductors, as well as the internal and external rotators, can develop imbalanced tone or contractures due to motor deficits and habitual positioning. Recognizing this helps guide management—emphasizing stretching and positioning to reduce contractures, targeted physical therapy to balance muscle forces, and orthopedic assessment if hip alignment worsens or impairs function.