Tibial Hemimelia explained
Tibial Hemimelia is a partial or total absence of the tibia and is the rarest form of lower limb deficiency present at birth. There are two long bones in the lower leg, the thicker one is called the tibia and the thinner one is the fibula. With Tibial Hemimelia the fibula is present but the tibia is either missing or misshapen. There is a foot deformity and the foot may have additional toes
The knee may also be twisted inwards.
Most legs affected by Tibial Hemimelia will look ‘unusual’. It can occur either in one leg or both legs – thirty percent have both legs affected. The fibula may be deformed or unaffected.
Severe cases are likely to be seen at scans during pregnancy. Milder cases may not be noticed straight away and only become apparent when the shortening of the leg becomes more noticeable and the leg is X-rayed. Most cases are thought to occur for no reason.
Steps have produced a downloadable publication, Leg Length Difference for parents who have been told of a possible problem with their baby’s legs.
How can it be treated?
Treatment depends on the exact form of the condition.
For the mildest form the Ilizarov apparatus may be used to lengthen the leg and improve the position of the foot. Steps are producing a publication on ‘Leg Equalisation’, explaining the process of leg lengthening and shortening and covers aspects of caring for a child during this process.
In more severe cases amputation is often the best option with the provision of a prosthetic limb which may be above or below the knee depending on the condition of the knee joint and the presence or absence of certain other parts of the upper leg. Steps have produced a Parent’s Guide to Planned Amputation to help parents and carers prepare themselves and their child for a lower limb amputation.
Some attempts at reconstruction using the fibula have been made but rarely provide a well functioning limb due to instability at the knee and problems with the quadriceps (thigh) musculature. Steps have also produced a guide – Preparing For Your Child’s Surgery to help parents and carers prepare themselves and their child for a hospital admission.
Steps have produced a Fact Sheet about Tibial Hemimelia to help parents understand the condition and its treatment.
Children’s sports prostheses funding in England
The Department of Health and Social Care is making £1 million available (£500,000 per financial year) to fund prostheses in England. The fund is for children who have suffered limb loss or were born with a limb deficiency, to enable them to take part in physical activity and sports. The funding is available until the end of March 2020.
NHS limb centres in England may request funds for individual prostheses they have prescribed up to the value of £5,000 per limb (not per child). This includes all the associated costs of fitting the new limb, such as a new socket or liner.
For an individual prosthesis of greater value, they must apply for approval from an advisory group.
Steps is a member of the advisory group and if you have any questions on funding for sports prostheses please contact us on firstname.lastname@example.org.