Congenital diastasis of distal tibiofibular joint. A case report and treatment presentation

Abstract

Congenital distal tibiofibular diastasis is a rare disorder of unknown etiology, first described in 1972. Purpose of our study is to present a rare case and the treatment plan. A fifteen days old infant female patient was presented to the paediatric-orthopaedic clinic in order to be examined for congenital clubfoot deformity of her left lower extremity. There was an obvious talipes equinovarus foot deformity, hypoplasia of the ipsilateral great toe and deformation of the ankle. X-rays were diagnostic for a profound diastasis of the distal tibiofibular joint. The patient underwent a Ponseti serial casting treatment for the equinovarus deformity in order to obtain a plantigrade foot. At the age of 2, an Achilles tendon and posterior tibialis lengthening was performed. One year post-op, the child had a bipedal gait pattern without support, a plantigrade foot, active 10 ° dorsiflexion and was enjoying all activities of daily living. Plain radiographs demonstrated a shortening of 0.6 cm in the left tibia compared to the contralateral side. Distal tibiofibular joint diastasis is associated with tibia hemimelia. Basic treatment goals include: a plantigrade foot, limb length equalization and ankle joint stability. In our case, serial casting and soft tissues procedures lead to satisfactory clinical outcome.

Keywords

• Congenital distal tibiofibular diastasis
• Ponseti
• Tibia hemimelia
• Paediatric
• Talipes equinovarus