What is Fibular Hemimelia: Fibular hemimelia is a congenital (birth defect) limb deficiency, where part or whole of fibula bone is missing / not completely developed/ dysplastic and associated with hypoplasia/ dysplasia of tibia and foot. The phenotype has a broad spectrum of pathology varying from mild to severe limb length discrepancy, ankle/foot deformity with or without a subtalar coalition, midfoot coalition, and absent rays. A patient can have Limb length discrepancy, foot, and ankle deformities & deficiency, Tibial deformities, Genu Valgum & Knee instability.
Classification of Fibular Hemimelia: Many classification has been given for this problem but most common classification in use is given by Drohr P Paley classification is based on patho-anatomy deformities of ankle and subtalar joint. Each Paley classification type has its own surgical treatment plan.
Causes of Fibular Hemimelia: Fibular Hemimelia present since birth. It is congenital A Most of time causes are not known. But genetic factor is the most common cause for this problem.
Symptoms of Fibular Hemimelia: In fibular hemimelia, severity of fibular deficiency vary from mild shortening to complete deficiency of fibula. So symptom vary. Foot can be deformed, and on weight bearing foot goes ou Leg shortening, knee joint ligament deficiency can also be there. In some leg tibia will also be bend with skin puckering at anterior aspect.
How Fibular Hemimelia can be diagnosed: Fibular hemimelia can be diagnosed clinically even at the time of birth. Confirmation of diagnosis can be made after X-ray of leg & foot. Rarely we need MRI to see the status of foot and ankle.
How Fibular Hemimelia can be treated: Fibular hemimelia need surgical correction in most of the cases. But only in cases with minimal limb shortening, they may be managed with shoe raise & modified shoes.
Different Surgeries for the Treatment of Fibular Hemimelia: in fibular hemimelia, our surgical planning is based on deficiency of bony segment in foot & leg, shortening and deformity. Most of time, it is preferable to reconstruct the foot in place of amputation. Surgeries are being done in stages. Type of surgery is depend upon type of fibular hemimelia according to Paley classification.
Type of surgery in Tibial Hemimelia:
1-: shortening osteotomy, realignment distal tibia
2-: SUPER Ankle procedure (systemic utalarian procedure for extremity reconstruction).- in this procedure tendon lengthening, excision of fibular analogue, reconstruction of foot and ankle
3-: knee ligament reconstruction
4-: toe and metatarsal osteotomy
Complications of Fibular Hemimelia: Few of the toes and finger may also be absent congenitally. Limb shortening and sever deformity of foot and ankle if not managed, can cause pain, callosity & difficulty in walking.
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Dr. Jitendra Kumar Jain
Trishla Orthopedic Clinic & Rehab center, 182C / 350A, Tagore Town, Prayagraj (Allahabad) U.P-211002, India