Congenital hypoplasia of the fibula: clinical manifestations

We describe five cases of congenital hypoplasia of the fibula and the clinical appearance of the patients. The more relevant clinical manifestation is leg length discrepancy, which is usually < 6 cm. The management of this problem has been approached with predictive tables and timing of the epiphyseodesis. Some cases have been treated with tibial lengthening to correct the associated valgus deformity simultaneously. The valgus deformity is secondary to the hypoplasia of the lateral femoral condyle, which can be treated with medial hemiepiphysiodesis of the distal femur. Anterior instability of the knee usually exists due to congenital absence of the anterior cruciate ligament and can complicate lengthening procedures. The hip joint is not involved, but mild shortening of the femur was observed in four cases. Ball and socket joint at the ankle and tarsal coalitions with absent lateral rays of the foot can occur. Management of the leg length discrepancy must be considered in light of all these possible associated defects.