Staged Reconstruction for Type IV Tibial Deficiency (Distal Tibiofibular Diastasis): A Report of 2 Cases

Case:Congenital tibiofibular diastasis is a relatively rare form of limb deficiency, characterized by distal tibial tapering, absent ankle mortise, equinovarus foot deformity, and variable lower leg shortening. Treatment described has ranged from various forms of foot centralization with or without leg lengthening to amputation. We describe 2 cases treated in childhood by staged foot centralization by soft-tissue distraction, distal tibiotalar fusion, tibial lengthening, and subsequent limb length discrepancy equalization. At skeletal maturity, both patients ambulated independently without aid.Conclusions:Staged reconstruction with foot centralization and distal tibiotalar fusion is an option for carefully selected patients with tibiofibular diastasis who refuse foot ablation.