Affects of MHE on the Ankles

  • Valgus deformity of the ankle is also common in patients with MHE and is observed in 45-54% of patients in most series.  This valgus deformity can be attributed to multiple factors including shortening of the fibula relative to the tibia.  A resulting obliquity of the distal tibial epiphysis and medial subluxation of the talus can also be associated with this deformity, while developmental obliquity of the superior talar articular surface may provide partial compensation. 


Diagnostic Procedures

  • The orthopaedist will probably manually feel for exostoses along the leg, and check range of motion (“ROM”) by manipulating (moving) the leg in different directions. The orthopaedist will also check measurements on each leg to see if there is a difference. X-rays or other imaging tests may be ordered.


Possible Treatment Options 

  • Minor length discrepancies can sometimes be effectively treated with the use of orthotics (specially made shoes or lifts that will equalize leg length).

  • Bowing and some limb length discrepancies and be treated with a surgical procedure called “stapling,” where surgical staples are inserted into the growth plate of the leg bone growing faster than the other. This will hopefully give the slower growing bone the chance to “catch up” and the limb will straighten over time.

  • In more advanced cases, excision of exostoses with early medial hemiepiphyseal stapling of the tibia in conjuction with exostosis excision can correct a valgus deformity at the ankle of 15° or greater associated with limited shortening of the fibula. 

  • Fibular lengthening has been used effectively for severe valgus deformity with more significant fibular shortening, (i.e. when the distal fibular physis is located proximal to the distal tibial physis). 

  • Supramalleolar osteotomy of the tibia has also been used effectively to treat severe valgus ankle deformity.

  • Growth of exostoses can also result in tibiofibular diastasis that can be treated with early excision of the lesions.


What Parents Should Watch Out For:


  • Limping, pain when walking

  • Recurrent falls and instability while walking on uneven surfaces.

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