Lower Limb Differences Clinic

A child with tibial hemimelia is born with a short or missing bone (tibia) of their lower leg. This makes it difficult to put weight on the leg and walk normally.

In fibular hemimelia, a child is born with a short or missing bone (fibula) on the outside of their lower leg. The foot may not form correctly, and the tibia may be curved.

The shaft of the thighbone (femur) is shorter than normal in children with congenital short femur. In most children with this condition, only one femur is short. Sometimes the condition affects both legs.

In PFFD, the hip joint can be affected along with the top of the thighbone (proximal femur) in varying degrees. The length of the femur is always shorter, or in severe cases the femur is absent.

Many complex conditions have limb differences as one of their features. The team in the Limb Differences Clinic works with children who have these conditions, such as amniotic band syndrome, Apert syndrome and VACTRL. VACTRL stands for vertebral problems (V), imperforate anus (A), cardiac problems (C), tracheoesophageal fistula (T), renal problems (R) and limb differences (L).

To make a bone longer, surgeons make a cut in the bone and attach a frame (fixator or distractor) above and below the cut. After surgery, the frame is used to slowly open the gap between the two sections of the bone, about 1 millimeter each day. Bone grows to fill in this gap. The process takes three months to lengthen the bone an inch.

Surgery to rebuild the lower limb may correct or improve some limb differences. There are several methods that may be helpful, based on your child’s condition. They include cutting the bone to change the shape, using implants in place of bone, using metal plates and rods to hold bone in place and doing surgery to move muscles and tendons.

For some conditions, removing part of a limb may provide the best results for your child.

Physical therapy helps improve your child’s strength and ability to move, sometimes using custom mobility devices. Our physical therapists work with babies, children and teens to improve their gross motor skills, such as walking, running and playing.

Braces, artificial limbs or both can support or replace body parts. Orthotics and prosthetics improve your child’s function and appearance. Our experts assess your child’s needs and build their devices. Then they make sure the devices fit and function properly now and as your child grows.

Read Radhika's story.

If you are pregnant and an ultrasound shows your baby may have a lower limb difference, our team can meet with you. We can talk with you about what the ultrasound means, what to expect and what the treatment options may be.