Congenital longitudinal deficiency of the fibula presented two major
problems in management: severe shortening of the limb and equinovalgus
deformity of the ankle and foot. When the deformity was severe, our
attempts at reducing the deformities of the foot and ankle with soft-tissue
procedures and our attempts at achieving limb-length equality with various
lengthening procedures were unsuccessful. Our best results in these
patients were achieved with an early Syme amputation. The pattern of the
deformity and the determination of the growth inhibition factor in the
involved limb now enable us to make an early estimate of the deformity and
plan appropriately. Syme amputation is definitive and allows the patient to
have nearly normal function of the limb and a prosthesis of excellent
appearance.