Some patients with fibular hemimelia have fusion of two metatarsals (toes). This requires a specialized surgery to realign the toes and two metatarsals, and particularly when the first and second toes are fused together. The big toe may be in a varus (pointing) position. Sometimes the big toe is fused to the second toe. This requires surgery to release some of the muscles and tendons and decompress nerves in the foot in order to realign the toe and possibly to straighten the double metatarsal.
This is a very complex surgery and may need to be performed prior to one year of age. Separation of the toes, such as for Syndactyly, can also be combined with this surgery or when they occur in isolation—usually prior to one year of age. This procedure may require a skin graft from the groin, to be performed at the same time. In some cases, patients with FH have a Y-shaped metatarsal where two separate toes come off from one metatarsal. At the end of the metatarsal are two separate heads in the shape of the letter Y. This also requires a special reconstruction. One toe issue we cannot address is to add toes that are missing. Despite aesthetic considerations, it does not produce any mechanical problems for the child except modification of shoe wear or the need for specialized orthotics.