ABSTRACT
Problems of disproportionate length relationships between tibia and fibula can manifest as deformity of the knee or ankle joint. If the deformity is moderate or cannot be compensated for by the subtalar joint, it can lead to fibula impingement, recurrent medial or lateral ligament sprains. Clinical instability must be demonstrated and treatment not simply directed at radiograph measurements– note it is normal to have some degree of valgus at the ankle prior to the age of ten. Correction of the tilt of the ankle mortise should be done after considering the range of movement in the subtalar joint. A mobile subtalar joint tolerates some abnormalities of ankle tilt and allows the forefoot to be placed flat on the ground. The other strategies of treatment are described to provide solutions when epiphyseodesis is not feasible, when one or other physis is closed or for an adolescent near or after skeletal maturity.
