I saw a really interesting 9 yr old boy in clinic today with Congenital Fibula Deficiency Type 1. He was referred by a Physio who had never seen a case and I had never heard of it but had time to quickly look it up before his appointment. I am not a Pediatric or even Biomechanics specialist and he just popped up as a new patient in a general clinic.
Members do not see these Ads. Sign Up.
His referral to Physio was for achilles tenonitis which he reported was improving with the exercises given but there was still some pain on palpation midway down the tendon. He has a 1cm leg length difference and the lateral malleoli on the affected leg is missing. He has a very mobile subtalar and midtarsal joint on the opposite foot but very limited ROM in the affected foot which is also in equinus. Both tibia are straight. The feet are very pronated in stance but he intoes during gait. He has bespoke ankle boots raised at the heel for the short leg but during the summer likes to wear normal trainers but understandably then suffers hip pain.
I am going to cast him for orthotics to wear in his trainers that will also accomodate the leg length but wondered if anyone has seen this before and has any suggestions. What also fascinates me is what happens to the muscle attachments where the fibula is missing. do they just attach in the same place but on the tibia? I have found some papers which I plan to read but a lot of it seems to deal with type 2 and surgery
:confused:
Tags:
-
-
Hi Hamilrob & :welcome: to Podiatry Arena.
Some potentially interesting reading: Oscar Pistorious
Congenital absence of the fibula
Google Scholar shows some interesting papers.
Hopefully one of our other members can answer your questions RE: your patient, more fully. I'm not suggesting your patient requires the radical treatment Mr Pistorious has undergone.
Kind regards,
Mandy.Last edited: Jun 24, 2011 -
Hi Hamilrob
I have tibial longitudinal deficiency ... I hope I can help?
Although the young lad has a unique foot pathology ('equinus' is usual, as are missing digits), a very mild form of fibular deficiency (such as this) is very much liveable with and most definitely shouldn't need an Oscar Pistorius treatment ;) ... they only tend to amputate if the foot is non-functional. Treatment is either orthotics or/and limb lengthening.
From what I've read and in my experience, if the bone doesn't form enough to provide a muscle attachment site, the muscle fibres either do not form or are significantly reduced in number.
Btw, in the UK the incidence of fibular deficiency is approx 1:50 000 live births, with many cases seemingly going undetected. When it is diagnosed, yes be interested but, at the same time, it's important not to make the person feel 'unusual'.
Just a couple of questions for you -
Do you know who prescribes his footwear?
and
Did you examine his hips and knees? -
Hi to you both and thank you for replying. I will read the papers you suggest but from the brief research I did yesterday it appeared that the type 2 where no fibula is present is most at risk of amputation. This young lad is very sporty but obviously concious of his footwear which is why he likes to wear normal trainers during school holidays. His shoes are made at the local hospital and have insoles with a soft valgus filler and poron medial rearfoot post for the affected foot. I think he would benefit from something more supportive but am also a bit cautious due to the limited STJ range of motion.
His lower leg muscles are poorly defined and in hindsight I probably should have checked his hips but as he had been to the Physio previously I assumed they would have checked all the leg muscles and given him exercise if appropriate. He also sees a consultant at Great Ormond Street and Mum made no mention of any hip involvement during the consultation and she was very informative.
Thinking about orthotics, his current footwear has a heel raise but apparantly the consultant wants the forefoot built up as well in his next pair so I was going to raise the entire orthotic however, I wonder if now if this is wise due to the equinus and problem with the achilles. Perhaps it should be done more gradually.
Looking forward to any advice you may have. -
Unilateral fibular longitudinal deficiency is often described as having a 'sporadic' aetiology. But, it can be associated with Proximal Femoral Focal Deficiency (PFFD) ... admittedly, full blown PFFD isn't easy to miss, but there are degrees of it, as there are with most things. :)
-
-
There are a few things that I've thought of since I lasted posted on this thread.
1. In the UK the NHS orthotics budget is being drastically cut; much worse than podiatry, believe it or not?! So there may be an increased likelihood of pods coming across people with more complex lower limb pathologies.
2. Some helpful papers on the condition are ~
Anteroposterior Instability of the Knee: A sign of Congenital Limb Deficiency Torode IP and Gillespie R; Journal of Pediatric Orthopaedics 3:467-470 © 1983 Raven Press, New York
Association of Fibular Hemimelia and Clubfoot Caskey PM, and Lester EL; Journal of Pediatric Orthopaedics 22:522-525 © 2002 Lippincott Williams & Wilkins, Inc., Philadelphia
Clinical Examination and Investigation of the Cruciate Ligaments in Children with Fibular Hemimelia Roux MO, Carlioz H; Journal of Pediatric Orthopaedics 19:247-251 © 1999
Fibular Hemimelia: A Preliminary Report on Management of the Severe Abnormality Gibbons PJ, Bradish CF; Journal of Pediatric Orthopaedics Part B 5:20-26 © 1996 Lippincott-Raven Publishers, Philadelphia
Management of Fibular Hemimelia - amputation or leg lengthening Naudie D, Hamdy RC, Fassier F, Morin B, Duhaime M; Journal of Bone & Joint Surgery (Br) 1997; 79-B:58-65
Talocalcaneal coalition in patients who have fibular hemimelia or proximal femoral focal deficiency (a comparison of the radiographic and pathological findings) Grogan DP, Holt GR, Ogden JA; J Bone Joint Surg Am 1994 Sep; 76-A: 1363-70
I'm sure there are some more recent papers?
3. I can't emphasise enough how important it is to liaise with the child/adult's rehabilitation consultant and/or orthopod. -
Congenital fibular deficiency: a review of thirty years' experience at one institution and a proposed classification system based on clinical deformity.
Birch JG, Lincoln TL, Mack PW, Birch CM.
J Bone Joint Surg Am. 2011 Jun 15;93(12):1144-51.
-
Outcome of limb lengthening in fibular hemimelia and a functional foot.
Changulani M, Ali F, Mulgrew E, Day JB, Zenios M.
J Child Orthop. 2010 Dec;4(6):519-24.
-
Congenital Fibular Deficiency
Reggie C. Hamdy, MD, MSc, FRCSC, Asim M. Makhdom, MD, MSc (C), Neil Saran, MD, MHSc (Clin Epi), FRCSC and John Birch, MD, FRCSC
J Am Acad Orthop Surg April 2014 vol. 22 no. 4 246-255
-
Prevention of recurrence of tibia and ankle deformities after bone lengthening in children with type II fibular hemimelia
Arnold Popkov, Anna Aranovich, Dmitry Popkov
International Orthopaedics; April 2015
-
Functional Assessment in Tibial Hemimelia (Can We Also Save the Foot in Reconstruction?).
Shahcheraghi GH, Javid M.
J Pediatr Orthop. 2015 May 14
-
Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children.
Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R.
J Pediatr Orthop B. 2015 Jun 5
-
The Nature of Foot Ray Deficiency in Congenital Fibular Deficiency.
Reyes, Bryan A. MD; Birch, John G. MD, FRS(C); Hootnick, David R. MD; Cherkashin, Alex M. MD; Samchukov, Mikhail L. MD
Journal of Pediatric Orthopaedics: September 9, 2015
-
Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia: A Report of Eight Cases.
Mishima K et al
Medicine (Baltimore). 2016 May;95(21):e3787.
-
Orthopedic treatment vs. surgery for longitudinal fibular deficiency.
Quintero-Prigent N et al
Ann Phys Rehabil Med. 2016 Sep;59S:e12-e13. doi: 10.1016/j.rehab.2016.07.030.
-
Classification of Cruciate Ligament Dysplasia and the Severity of Congenital Fibular Deficiency.
Walker JL, Milbrandt TA, Iwinski HJ, Talwalkar VR.
J Pediatr Orthop. 2016 Dec 22. doi: 10.1097/BPO.0000000000000910.
-
Ankle valgus following non-vascularized fibular grafts in children—an outcome evaluation minimum two years after fibular harvest
Agarwal, A., Kumar, D., Agrawal, N. et al.
International Orthopaedics (SICOT) (2017) 41: 949. doi:10.1007/s00264-017-3403-8
-
Ankle Reconstruction in Fibular Hemimelia: New Approach.
Hefny H etal
HSS J. 2017 Jul;13(2):178-185. doi: 10.1007/s11420-016-9524-6
-
Longitudinal Fibular Deficiency: A Cross-Sectional Study Comparing Lower Limb Function of Children and Young People with That of Unaffected Peers.
Pate JW et al
Children (Basel). 2019 Mar 15;6(3). pii: E45. doi: 10.3390/children6030045.
-
Longitudinal Fibular Deficiency: A Cross-Sectional Study Comparing Lower Limb Function of Children and Young People with That of Unaffected Peers
Joshua W. Pate et al
Children 2019, 6(3), 45; https://doi.org/10.3390/children6030045
-
Use of Paley Classification and SUPERankle Procedure in the Management of Fibular Hemimelia.
Kulkarni RM et al
J Pediatr Orthop. 2019 Oct;39(9):e708-e717
-
Amputation Versus Limb Reconstruction for Fibula Hemimelia
A Meta-Analysis
Elmherig, Aissam et al
Journal of Pediatric Orthopaedics: January 17, 2020
-
Correction of Genu Valgum in Patients With Congenital Fibular Deficiency
Westberry, David E et al
Journal of Pediatric Orthopaedics: February 28, 2020
-
Fibular hemimelia
Tiberiu Georgescu et al
J Med Life. 2022 Apr;15(4):587-588
-
A novel smoothed (SMO) point mutation in congenital tibial hemimelia: a case report
Xiaodong Yang et al
BMC Pediatr. 2023 Aug 25;23(1):424
Loading...
- Similar Threads - Congenital Fibula Deficiency
-
- Replies:
- 1
- Views:
- 1,742
-
- Replies:
- 1
- Views:
- 4,788
-
- Replies:
- 2
- Views:
- 4,358
-
- Replies:
- 0
- Views:
- 5,433
-
- Replies:
- 2
- Views:
- 5,915
-
- Replies:
- 3
- Views:
- 5,853
-
- Replies:
- 1
- Views:
- 5,860