Limb Deficiency in Children

Limb deficiency means that one limb is smaller than the other.  It is usually detectable at birth.  There are number of reasons why a child can have a deficient limb, and there are a number of types of limb deficiencies including the following:

Types of Limb Deficiency

Limb deficiencies can affect the whole limb, or just a portion of the limb.  For example, in one of the more common deficiencies, known as fibula hemimelia (see x-ray below), the small bone on the outside of the leg (fibula) is smaller than expected, and sometimes the bone is absent altogether.  The portion of the limb below the knee may be very short compared to the other side, or there may be only minimal differences in limb lengths. There may be five toes on the foot, but there may also be four, three, two or even one toe.  In addition, in about half the cases, children born with a fibula hemimelia will have a short thigh bone (femur) as well.

The example to the right is of a young girl with a fibula hemimelia. Notice how the small bone (fibula) is absent on the right side, the lower leg is small, and the femur (thigh) bone is also smaller on the right side compared to the left. This girl is standing on a 3 cm (approx 1 ¼” lift) to even out her limb lengths.

Limb Deficiency Causes

The cause for most limb deficiencies is unknown.  Some deficiencies are known to occur due to prenatal drug exposure, such as the well-known thalidomide tragedy when 10,000 children were born with limb deficiencies.  Other deficiencies may be inherited, although this is rare.

Prognosis and Treatment

Prognosis and treatment for the limb deficiency depends on which limb is smaller, and how much smaller is it.  No matter how big or small the limb deficiency may be, the goal is always the same – maximize function. 

For example, a child born with an absent little toe technically has a limb deficiency. But functionally, the child should not have any problems as a result, so no treatment is required.  In some children, the limb is so short, that amputation will allow for the best function but other children may go through bone lengthening surgery to allow the limbs to be of equal length.  Although limb deficiencies may be associated with other deficiencies, it is rare to have other problems, such as heart or kidney damage, brain damage, etc.


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