Tibial Hemimellia Jones type IV. Reconstruction and Follow-up from Birth to Maturity (18 years Follow-up)

Treatment of Tibial Hemimellia (TH) is a challenging task. Amputation option remains the mainstay of treatment in Jones 1-3 types, but no consensus exists about treatment options for type IV (ankle diastasis).

Method: A boy was born with severe clubfoot, ankle diastasis, and a projected 19 cm of lengthening.

Result: Clubfoot correction was performed closely using the Ilizarov method of soft tissue distraction. Staged 14 cm external and internal lengthening was performed three times, contralateral distal femoral and proximal tibial epiphysiodesis was done at age 11. After skeletal maturity, the patient has active 30 degrees of ankle motion, a functional foot and normal life, with no significant leg length discrepancy.

Conclusion: After reaching skeletal maturity, the patient has a functional foot and ankle and equal limb length.

Significance: Salvage option with functional foot and ankle in patients with TH type IV is possible and should be considered