Fibular Hemimelia in the Pediatric Patient

Children with fibular hemimelia (FH) present with a shortened lower leg of varying degrees of severity, often accompanied by a wide range of associated anomalies of the ipsilateral foot, ankle, and knee. Mild cases often need only appropriately timed contralateral epiphysiodesis. Moderate cases usually require tibial lengthening, with realignment of the ankle in selected cases. For severe cases, the choice comes down to amputation versus limb salvage. One of the biggest challenges in limb salvage is to obtain a plantigrade foot. For the stiff equinovalgus ankle (the most common severe manifestation of FH), special reconstruction techniques are recommended to achieve a plantigrade foot. Despite advancements in reconstruction of the fixed equinovalgus ankle, results may be a very stiff, small foot that holds up well in childhood but begins to fail in adulthood depending on patients’ demands and activity level. The knee may require anterior or posterior cruciate ligament reconstruction. Knee valgus is often treated by growth modulation. Associated congenital femoral deficiency should be addressed, either with lengthening or contralateral epiphysiodesis. In summary, treatment of FH must be individualized according to the needs and expectations of each family/child as well as the reconstructive options regionally available.