Treatment
The therapy is based on the complexity of a disease. First step is to reduce the contractures in the knee and foot. This can be accomplished at an early age by cast. Later on it can be replaced by orthosis. Depending on the knee stability, it can be settled below or above a knee orthosis.
A patient of approximately 12 months should be equipped (elevated shoes or orthosis) in order to be able to start an independent movement.
If the leg length discrepancy is anticipated to be pronounced at puberty, there is a lengthening possibility with circular fixator. The decision about this operation should be made at the earliest possible age because of psychological advantages for both, patient and parents. The circular fixator also gives the possibility to correct complex deformities of the leg and foot that accompany fibula hemimelia. Depending on the severity of the disease, this operation probably has to be repeated at a later age. If the leg length discrepancy and the malalignment are not very marked, one could take into account the possibility of an epiphysiodesis (the surgical fixation of the epiphysis to the shaft of its bone).
At about the age of 6 the knee instability has to be dealt with, in order to avoid an early degenerative disease of the knee joint.
Although the operation with circular fixator has its psychological strain on both the parents and the child, it should be kept in mind that it is just a temporary condition, while the amputation is not.
Example therapy
| 0 - 10 months | counselling, swathe, if necessary X – rays films, intersection of fibular connective fibres |
| 7 months - 1 year | orthosis setting, MRI to determine pathological changes (fibular connective fibres on the place of a calf bone, bone deformation, interior of the knee) |
| 1 - 3 years | if necessary resection of fibular connective fibres / feet positioning / distal corrective osteotomy, osteosynthesis and fixation with Kirschner wires and thus first correction of the knee axis |
| 3 - 5 years | second correction of the knee axis and posibly lengthening by circular fixator, if necessary provisory epiphysiodesis after 5 years |
| from 7 years | if necessary plastic of anterior cruciate ligaments and provisory epiphysiodesis |
| 8 - 11 years | if necessary further correction of the knee axis, lengthening and provisory epiphysiodesis |
| 12 - 15 years | if necessary growth stopping on the opposite side |
| after growth ending (> 14-16 years): final correction of the knee axis and lengthening |
