Tibial Hemimelia Paley Type 5a (Jones Type 1b) and Paley Type 5b (Jones Type 1a)

Tibial hemimelia (TH) often appears as a shortened leg with knee and ankle deformity. Most often, there are a varus deformity and knee flexion contracture, though multidirectional instability may also be present due to a lack of collateral ligaments. A patella and quadriceps mechanism may be present or absent and may have limited function if present. There may be cutaneous manifestations such as dimples. The tibia may be shortened, dysplastic, or absent; it may also present as an anlage invisible to radiographs. The fibula can be normal or dysplastic and often subluxated or dislocated proximally or distally. The ankle is often in varus and equinus, and the foot may be adducted and supinated. The medial side of the foot may be missing rays.