Fibular Hemimelia: Paley Type 3

Fibular hemimelia (FH) is the most common lower extremity congenital longitudinal deficiency. It is associated with a constellation of deformities including foot ray deficiencies, coalitions, ankle and hindfoot joint malorientation, diaphyseal deformity, and limb length discrepancy. Severe rigid and intractable equinovalgus deformity of the foot in combination with a limb length discrepancy has been the limiting factor for a successful outcome and the primary indication for ablative surgery. The Paley fibular hemimelia classification (Fig. 1) is based on the ankle joint morphology and stability and is helpful in planning surgical treatment. Reconstruction surgery for fibular hemimelia involves foot deformity correction and limb length equalization. The SuperAnkle is a combination of bone and soft tissue procedures that stabilizes the foot and addresses all deformities.