Fibular hemimelia is a condition where part or all of the fibula bone is missing, causing a shorter limb and foot deformity. Treatment options range from special footwear to amputation and prosthetics, depending on severity. The cause is unknown, and it is more common in men. Classification systems exist to determine treatment plans.
Fibular hemimelia, sometimes known as paraxial fibular hemimelia or longitudinal fibular deficiency, is a condition in which a baby is born with part or all of the fibula missing. Along with the tibia, the fibula is a bone in the lower leg. While the thin fibula is on the outside of the leg, the thicker tibia is on the inside. Fibular hemimelia typically makes the affected limb shorter and causes the foot to bend inward and down. Various treatments are available depending on the severity of the deformity, ranging from special footwear to limb lengthening surgery, amputation, and the fitting of an artificial body part or prosthesis.
Although fibular hemimelia is the most common cause of leg bone deformation, its cause is unknown. The deformity often affects only one limb and the disorder is more common in men than in women. Sometimes there may be other associated deformities affecting the tibia, femur, or femur and foot. Several systems are used to classify fibular hemimelia, with classes ranging in severity from relatively mild to severely disabling. Each class is associated with a particular treatment plan and perspective.
In one classification system, what is called type IA fibular hemimelia refers to the condition in which only part of the fibula is missing. Type IB describes the state in which one third to one half of the fibula is missing and the amount of bone that remains is not enough to support the ankle. In type II, the most severe, there is no fibula at all.
Treatment of fibular hemimelia type IA does not always involve surgery because, in milder cases, walking is possible with the use of a heel lift. A heel lift is an extra piece added to a shoe to effectively even out leg lengths. Sometimes, with only a small difference in leg lengths, a technique known as contralateral epiphysiodesis may be used to shorten the opposite leg. This procedure, which prevents the bone from growing, is carefully timed to coincide with the final growth stage in adolescence, with the aim of leaving the normal leg slightly short. For a major difference in leg length and where the ankle and foot are not too misshapen, surgery that extends the shortened limb can be done.
Fibular hemimelia type IB is treated similarly to IA, although operations to correct the ankle angle and stabilize the foot may also be needed. For type II, several surgical procedures may be required. The foot is sometimes removed early in life and a prosthesis may be used to allow for efficient walking.
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