Fibular Hemimelia

Fibular Hemimelia

Fibular Hemimelia is a congenital limb deficiency characterized by the partial or complete absence of the fibula, the smaller of the two bones in the lower leg. This condition can lead to various orthopaedic challenges, including limb length discrepancy, foot deformity, and knee deformity. Understanding these aspects is crucial for managing and treating the condition effectively. 

Limb Length Discrepancy 

One of the most common issues associated with Fibular Hemimelia is limb length discrepancy. The absence of the fibula often results in a shorter leg on the affected side. This discrepancy can cause several functional problems: 

  • Gait Abnormalities: A significant difference in leg length can affect walking patterns, leading to an uneven gait and potential difficulty in maintaining balance. 
  • Skeletal Imbalance: The absence of the fibula can disrupt standard growth patterns, potentially affecting the alignment and development of the tibia and the overall skeletal structure of the leg. 
  • Prosthetic Needs: In cases where the discrepancy is substantial, prosthetics or orthotics may be necessary to help balance the leg length and support proper mobility. 

Foot Deformity 

Fibular Hemimelia can also lead to various foot deformities due to the lack of support and stability provided by the fibula: 

  • Clubfoot: A joint deformity where the foot is turned inward and downward. This condition may require corrective measures such as casting or surgery to improve foot alignment. 
  • Equinus Deformity: Where the foot points downward, making it difficult to place the heel on the ground. This can lead to challenges in walking and maintaining a normal gait. 
  • Foot Drop: A condition where the foot cannot be lifted properly due to weak or paralyzed muscles, often requiring supportive devices to aid in walking. 

Knee Deformity 

The absence of the fibula can also impact the knee joint, leading to various deformities: 

  • Knee Instability: The lack of fibular support can lead to knee instability and misalignment, affecting overall leg function and mobility. 
  • Malalignment: As the tibia bears more stress without the fibula, it can cause malalignment of the knee joint, potentially leading to pain and reduced range of motion. 
  • Leg Length Discrepancy Impact: The knee deformity often exacerbates the limb length discrepancy, making it more challenging to achieve proper alignment and function. 

Extramedullary Internal Limb Lengthening 

Extramedullary Internal Limb Lengthening (EMILL) is a surgical procedure used to address limb length discrepancies, including those caused by Fibular Hemimelia. This technique involves: 

  • Surgical Procedure: EMILL consists of the implantation of an internal device that gradually lengthens the bone over time. This procedure is typically used when the discrepancy is significant and other non-surgical methods need to be revised. 
  • Rehabilitation: Post-surgery, patients undergo a rehabilitation process that includes physical therapy to strengthen the muscles, improve mobility, and ensure proper bone growth and alignment. 
  • Benefits: EMILL can effectively address limb length discrepancies, improve gait, and reduce the functional impact of Fibular Hemimelia. It offers a gradual and controlled method for lengthening the affected limb. 

Conclusion 

Fibular Hemimelia presents several challenges, including limb length discrepancy, foot deformity, and knee deformity. Understanding these issues and exploring effective treatment options, such as Extramedullary Internal Limb Lengthening, is crucial for managing the condition and improving the quality of life. Early diagnosis and intervention can significantly enhance outcomes, helping individuals with Fibular Hemimelia achieve better mobility and functionality. For comprehensive management and treatment, consulting with a specialized orthopaedic professional is essential. 

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