Fibular Hemimelia

Fibular hemimelia (FH) is a deformity of the lower leg, characterized by the absence of part or all of the fibula bone. Limb length discrepancy, foot deformities, and knee abnormalities oftentimes are associated with FH.

My Approach

Fibular hemimelia is one of the most common conditions that we treat at the Paley Institute. Between 18 and 36 months of age, we perform the initial surgery which entails placing the foot in the corrected position under the tibia. This operation has been termed a SUPERankle and is adjusted based on the deformity present and the type.

A first lengthening of the tibia often follows soon after the initial SUPERankle surgery. The need for knee surgery and/or femoral (thigh) lengthening all depends on the severity and presence of the knee ligament absence and/or femoral shortening. The number of necessary lengthenings is often predicted at the first visit.

Results have been outstanding leading to quite good function of the extremity.



Cause

Fibular Hemimelia has no known cause and is not hereditary.



Diagnosis Methods

A shortened deformed limb and foot is typically seen on one side or both, at birth. FH is diagnosed most commonly by physical examination and confirmed on plain radiographs. MRI is utilized to determine the exact nature of the specific hemimelia.



Treatments

Treatment requires a keen familiarity with FH as well as its different types and associated problems of the femur and knee. The SUPERankle, which includes releases, osteotomies of the heel and often the foot, shortening of the tibia, and freeing of nerves and blood vessels, may be quite complicated and difficult. Associated problems such as a knock knee deformity may be treated with a small procedure called guided growth. Complex limb lengthening with protection of the knee is often needed. Ligament reconstruction of the knee is commonly needed as well.

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