Paraxial Fibular Hemimelia: Comparison of Foot Ablation to Retention in Long-Term Follow-Up
ROBIN C. CRANDALL, MD*
Foot ablation is frequently recommended for the typical types of fibular hemimelia. Even with relatively normal feet, shortening can be severe, eventually leading to ablation and conventional fitting. Less frequently recommended is retention of the foot with "nonconventional" fitting. Foot ablation is compared to retention in long-term follow-up. Factors studied were patient satisfaction, prosthetic cost, clinic visits per year, skin ulcerations or limb breakdown, and overall patient function. The group studied included all patients with paraxial fibular hemimelia seen at the Minneapolis Shriners Hospital available for follow-up. Fifteen patients were rejected because of insufficient follow-up, leaving 38 patients with 42 affected limbs. With an average follow-up of 9.4 years involving 26 male and 12 female patients, it was found that all who underwent foot ablation were satisfied. Syme-type amputation was recommended for unilateral cases in females. Non-conventional fitting with foot retention was acceptable and often the preferred alternative in males. Comparable prosthetic cost and patient satisfaction were found. Increased visits per year were noted in non-conventional fittings. If foot ablation is selected, the Syme-type amputation should be done.
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