File:PMC2915398 cios-2-179-g001.jpg

English: F1: (A) Radiographs of the lower leg at 3 years of age show a large segmental fibular defect by chronic osteomyelitis. (B, C) Four years later, serial radiographs show a valgus deformity of the ankle due to upward migration of the distal fibula and partial epiphyseal closure of the lateral part of the distal tibia, and a supramalleolar corrective osteotomy and Langenskiold's distal tibio-fibular synostosis was performed to correct the deformity. (D) At age 18, 11 years after the Langenskiold's operation, the radiographs show solid fusion between the distal tibia and fibula, but the valgus deformity had progressed by 23° and his leg was shortened by 1.2 cm. (E) Second supramalleolar corrective osteotomy: 8° of varus ankle position is shown to prevent the recurrence of the valgus deformity during skeletal growth. (F) At age 24, 6 years after the second supramalleolar osteotomy, the joint line between the ankle and knee was relatively parallel but the limb length discrepancy remained.