- With or without foot insufficiency
- If all rays on the foot – always femoral shortening
- If missing foot rays then – 50% have femoral shortening
Classification
Acherman & Kalmachi
| Type | Description |
|---|---|
| 1A | fibula is present, proximal physis is distal the tibial physis & the distal physis is proximal to the tibial physis |
| 1B | 30-50% short, distal does not support ankle |
| 2 | complete absence |
Associations
Complete absence
- Anterolateral bowing of the tibia
- Equinovalgus foot
- Talocalcaneal coalition
- Shortening of the leg
- Missing lateral rays
Partial absence
- Short femur
- Valgus knee
- ACL insufficiency, absent tibial spine
- Tarsal Coalition
- Ankle valgus, ball & socket ankle
Treatment
Complete
- Symes done when the child is pulling to stand ~ 10 months
- Symes prosthesis
- Generally no indication to keep foot
Partial Fibular Hemimelia
- typically associated with leg length discrepancy
- Lengthening & reconstruction with stabilization of the ankle may be feasible
- Watch for angular deformity at knee & correct with epiphysiodesis at appropriate time