Lateral malleolus reconstruction for fibular hemimelia as a prevention of foot deformity recurrence following tibial lengthening—A long-term analysis

Purpose: Management of ankle deformity and instability remains a challenge in patients with severe fibular hemimelia (FH). This study aims to evaluate the long-term effectiveness of lateral malleus reconstruction using the fibular anlage in correcting ankle malalignment and preventing the recurrence of deformity following leg lengthening. Methods: Ten patients (age: 3.3 years, 0.8-7.7) with a severe FH, equino-valgus foot deformity, ankle instability, and tibial bowing underwent tibia and ankle realignment and lateral malleolus reconstruction. Afterward, all patients underwent tibial lengthening, and the mean lengthening was 9.9 cm (5.0-16.5). Foot and ankle alignment was evaluated clinically and radiographically before surgery, postoperatively, and at a follow-up (10.0 years, 9.2-11.7). Recurrences, additional procedures, and complications were analyzed. Quality of life was assessed using the Limb Deformity-Scoliosis Research Society (LD-SRS) questionnaire. Results: At the last follow-up, all patients present neutral heel position or slight valgus (three patients 5° and one patient 10°). No additional procedures were performed except medial malleus temporary epiphysiodesis in two patients. The foot was plantigrade in six patients, presented equinus 10° in two and 20° in two, due to equinus, supra-malleolar osteotomy was performed in three patients. Significant improvement of radiological alignment was found and maintained in all parameters. The mean LD-SRS score was 3.78 at follow-up. Conclusion: Lateral malleolus reconstruction provided good clinical, radiological, and functional outcomes. Due to the tendency for recurrence, additional procedures may be necessary. Level of Evidence: IV.