Centralization of the foot in tibial and fibular hemimelia: preliminary results

Abstract

Purpose To assess the midterm results of acute centralization of the foot in cases of tibial and fibular hemimelia associated with severe foot deformity and ankle dislocation. Patients and methods We treated 11 limbs in 10 patients: eight patients with tibial hemimelia and two patients with fibular hemimelia. All cases were associated with severe foot deformity (equinovarus in tibial hemimelia and equinovalgus in fibular hemimelia), dislocated ankle, and tight tendoachilis. There were seven boys and three girls, with a mean age of 2.35 years. In tibial hemimelia, two limbs were type Ia, four limbs were type II, and three limbs were type IV according to Jones classification. In fibular hemimelia, all cases were type II according to Achterman and Kalamachi classification. The mean preoperative limb-length discrepancy was 5.4 cm (range, 4.5–7 cm). We had acute centralization of the foot by means of calcaneofibular or tibiocalcaneal arthrodesis in cases of tibial or fibular hemimelia, respectively, and talectomy, fibular shortening, and tibiofibular synostosis were done. Transcalcaneal fibular Kirschner wire was inserted to maintain the foot position. First-stage lengthening by Ilizarov fixator was done, with 5-cm gain of length in seven cases, and second-stage lengthening was done in two cases. Results The mean follow-up period was 50 months. We achieved foot correction and centralization of the foot, which was stable in all cases, except one with failed tibiofibular synostosis in Jones type IV. No neurovascular complications occurred. Wound dehiscence occurred in five limbs, unstable knee was seen in two cases, recurrent equinus of more than 20° was seen in three cases, and two cases had poor regenerate potential. All patients and families were satisfied with the foot procedure and were not satisfied with knee centralization procedure owing to knee instability. Conclusion Acute centralization of the severely deformed foot in cases of tibial and fibular hemimelia by calcaneofibular or tibiocalcaneal arthrodesis, respectively, can correct severe foot deformity, achieve plantigrade foot, and preserve the patient but was associated with many secondary procedures. Level of evidence Level IV.