[Management of fibular hemimelia]

Fibular hemimelia is a congenital longitudinal deficiency that represents a spectrum of deformities. The management of this condition is controversial and our treatment options are changing with developments in limb reconstruction techniques. For the severely affected child with a predicted limb length discrepancy greater than 25 cm at maturity and with a poor foot and ankle amputation is generally agreed to be the best option. For less severely affected limbs, particularly those with a predicted limb discrepancy of 10 cm or less and with a foot with 3 or more rays which can be made plantigrade, limb reconstruction is recommended. Controversy remains about the best way to manage children with an intermediate deformity.