{"id":11878,"date":"2024-05-10T04:05:40","date_gmt":"2024-05-10T04:05:40","guid":{"rendered":"https:\/\/paleyinstitute.org\/?page_id=11878"},"modified":"2025-06-16T16:50:00","modified_gmt":"2025-06-16T16:50:00","slug":"fibularhemimelia-treatment-strategies","status":"publish","type":"page","link":"https:\/\/paleyinstitute.org\/fibularhemimelia-treatment-strategies\/","title":{"rendered":"Fibularhemimelia Treatment Strategies"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"11878\" class=\"elementor elementor-11878\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9e99fa8 elementor-section-full_width elementor-section-height-min-height elementor-section-height-default elementor-section-items-middle wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"9e99fa8\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0ab646d\" data-id=\"0ab646d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-12fa910 elementor-widget elementor-widget-heading\" data-id=\"12fa910\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Treatment Strategies<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b70e571 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b70e571\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a8ed8e6\" data-id=\"a8ed8e6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-99426b7 elementor-widget elementor-widget-text-editor\" data-id=\"99426b7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Children born with fibular hemimelia have a spectrum of deformity, deficiency, or instability (DDI). The surgical treatment for fibular hemimelia is designed to address all of the deformities, deficiencies, and length discrepancies, specific to each type and the individual patient\u2019s needs. At the Paley Institute, we start with a reconstructive life plan. This involves evaluating all of the surgical deformities, deficiencies, and predicting the limb length discrepancy at maturity and then coming up with a surgical plan to correct these in the fewest number of surgeries, spread apart as much as possible throughout the child\u2019s growing years.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-614ba6e elementor-hidden-mobile\" data-id=\"614ba6e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-81d816f elementor-widget elementor-widget-heading\" data-id=\"81d816f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Fibular Hemimelia<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-55a2ff6 elementor-align-left elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"55a2ff6\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Overview<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-limb-lengthening\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Limb Lengthening for Fibular Hemimelia<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-reconstruction-vs-amputation\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Reconstruction vs. Amputation<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibularhemimelia-treatment-strategies\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Treatment Strategies<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f1d0a84 elementor-align-left elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"f1d0a84\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-knee-reconstruction\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Knee Reconstruction<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/super-ankel\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">SUPERankle<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-toe-reconstruction\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Toe Reconstruction<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7516f35 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"7516f35\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-62d1ee7\" data-id=\"62d1ee7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-11aa5c0 elementor-widget elementor-widget-text-editor\" data-id=\"11aa5c0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The goals of treatment are to achieve the following by skeletal maturity<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-50529a2 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"50529a2\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Equalized limb length<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">A functional foot in the plantigrade position (flat on the ground)<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Alignment of the hip, knee, and ankle joints<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Knee stability.<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2b3cb80 elementor-widget elementor-widget-text-editor\" data-id=\"2b3cb80\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>For more details on treatment, see Dr. Paley&#8217;s article in Journal of Children&#8217;s Orthopedics: Surgical Reconstruction for Fibular Hemimelia<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8a6e595 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"8a6e595\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bef365e\" data-id=\"bef365e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0350717 elementor-widget elementor-widget-heading\" data-id=\"0350717\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Reconstructive Life Plan<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cd479bf elementor-widget elementor-widget-text-editor\" data-id=\"cd479bf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>A reconstructive life plan for fibular hemimelia may look like this<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ee767f5 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ee767f5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-e35b2ed\" data-id=\"e35b2ed\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7375167 elementor-widget elementor-widget-heading\" data-id=\"7375167\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SUPERankle Surgery and First Lengthening<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b01964e elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"b01964e\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">5 cm of length gained<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Performed age 18 - 24 months<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-5bd4fe4\" data-id=\"5bd4fe4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-898af47 elementor-widget elementor-widget-heading\" data-id=\"898af47\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Second Lengthening<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dcedb99 elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"dcedb99\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">5 - 8 cm of length gained<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Performed age 7 - 10<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-0080c9a\" data-id=\"0080c9a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7f86bf9 elementor-widget elementor-widget-heading\" data-id=\"7f86bf9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Third Lengthening<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9c76875 elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"9c76875\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">5 cm of length gained<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Performed age 12 - 14<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-730c0f6\" data-id=\"730c0f6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bcdaeca elementor-widget elementor-widget-heading\" data-id=\"bcdaeca\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Epiphysiodesis (\"8 plate\")<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c525bb1 elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"c525bb1\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">5 cm of length gained<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Performed around age 9 for girls and age 13 for boys<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-57f43ef elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"57f43ef\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-50413c1\" data-id=\"50413c1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-86e5a50 elementor-widget elementor-widget-heading\" data-id=\"86e5a50\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Total length gained: 15 - 30 cm (6 - 12 inches)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b77aa6c elementor-widget elementor-widget-text-editor\" data-id=\"b77aa6c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The first step for treatment is to predict the limb length discrepancy at skeletal maturity. During the initial visit with Dr. Paley, he will obtain x-rays of both lower limbs and measure the lengths of both femurs, both tibias, and the heights of both feet. By comparing the sum of the femur, tibia, and feet height on the short leg with that on the long leg, we can determine the limb length discrepancy at the time of the x-ray. Using the multiplier method for limb length discrepancy prediction (a formula developed by Dr. Paley in 2000), we can calculate the limb length discrepancy at skeletal maturity. Additional measurements throughout the patient\u2019s life will improve the accuracy of the prediction.<\/p><p>Once the predicted limb length discrepancy at skeletal maturity has been calculated, a determination on the number of limb length equalization surgeries can be made. Under the age of four, it is safe to lengthen up to 5 cm (~2 in.). As the patient ages, subsequent lengthening&#8217;s can be as high as 8 cm.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-be2fae8\" data-id=\"be2fae8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c078273 glow-line elementor-widget-tablet__width-initial elementor-widget-mobile__width-inherit elementor-widget elementor-widget-image\" data-id=\"c078273\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"300\" height=\"200\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-waiting-room-300x200-1.jpg\" class=\"attachment-large size-large wp-image-11892\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4c95426 elementor-widget elementor-widget-text-editor\" data-id=\"4c95426\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Playing games during follow up appointment<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-14d4ef3 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"14d4ef3\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-caca914\" data-id=\"caca914\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7af83fb elementor-widget elementor-widget-text-editor\" data-id=\"7af83fb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>If additional equalization is required, one can also consider a limb growth-slowing procedure, called an epiphysiodesis. The epiphysiodesis involves slowing the growth of the long leg to allow the growth of the short leg to catch up and equalize. While limb lengthening can be performed at any age, an epiphysiodesis has to be performed at a very specific age in order to achieve a specific amount of growth slowing. We rarely use epiphysiodesis to achieve more than 5 cm (~2 in.) of limb length equalization. This covers the majority of cases of fibular hemimelia. In rare cases with larger discrepancies shortening of the femur or simultaneous lengthening of the femur and tibia may be preferred.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-beaf68c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"beaf68c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6b39d0e\" data-id=\"6b39d0e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3c4eefd elementor-widget elementor-widget-heading\" data-id=\"3c4eefd\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Fibular Hemimelia Classification<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ace70df elementor-widget elementor-widget-text-editor\" data-id=\"ace70df\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The next step will be to determine the type of fibular hemimelia. At the initial consultation, it is determined whether the patient has a fixed foot deformity (or even a dynamic foot deformity) that will require surgical treatment. Fibular hemimelia is classified into different groups dependent on treatment strategies according to the degree of severity. Many different classification systems have for FH have been proposed, but these systems have historically prioritized amputation treatment.<\/p><p>In 1995, Dr. Paley developed a classification for fibular hemimelia that takes reconstruction into account. The Paley classification divides fibular hemimelia into four groups: types 1, 2, 3, and 4. It further subdivides Type 3 into four subtypes: 3A, 3B, 3C, and 3D. The method of treatment is specific to each type and subtype<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-33d6b0a elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"33d6b0a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c6217a5\" data-id=\"c6217a5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-db29291 elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"db29291\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Type 1 \u2013 stable ankle joint<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Type 2 \u2013 valgus deformity of the foot<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Type 3 \u2013 equinovalgus deformity of the foot<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-833200d elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"833200d\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">3A \u2013 equinovalgus due to malorientation of the ankle joint<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">3B \u2013 equinovalgus due to malunited subtalar coalition<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">3C\u2013 equinovalgus due to combination of malorientation of ankle joint and malunited subtalar coalition<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">3D \u2013 subtalar deformity other than a subtalar coalition<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c6b90a elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"1c6b90a\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Type 4 \u2013 equinovarus deformity of the foot (also known as \u201cclubfoot type\u201d)<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1a1fce7 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"1a1fce7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6d653c3\" data-id=\"6d653c3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5535284 elementor-widget elementor-widget-bdt-tabs\" data-id=\"5535284\" data-element_type=\"widget\" data-widget_type=\"bdt-tabs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n        <div class=\"bdt-tabs-area\">\n\n            <div id=\"bdt-tabs-5535284-7352\" class=\"bdt-tabs  bdt-tabs-default\" data-settings=\"{&quot;id&quot;:&quot;bdt-tabs-5535284-7352&quot;,&quot;hashTopOffset&quot;:70,&quot;hashScrollspyTime&quot;:1500,&quot;navStickyOffset&quot;:1,&quot;activeItem&quot;:1,&quot;linkWidgetId&quot;:&quot;5535284-7352&quot;}\">\n                \n                \n                        <div class=\"bdt-tab-wrapper \">\n            <div >\n                <div class=\"bdt-tab bdt-tab-default  \" data-bdt-tab=\"connect: #bdt-tab-content-5535284-7352; swiping: false;\" data-bdt-height-match=\"target: &gt; .bdt-tabs-item &gt; .bdt-tabs-item-title; row: false;\">\n                                            <div class=\"bdt-tabs-item bdt-active\">\n                            <a data-title=\"Type-1\" class=\"bdt-tabs-item-title\" id=\"bdt-tab-Type-1\" data-tab-index=\"0\" href=\"#\">\n                                <div class=\"bdt-tab-text-wrapper bdt-flex-column\">\n\n                                    <div class=\"bdt-tab-title-icon-wrapper\">\n\n                                        \n                                                                                    <span class=\"bdt-tab-text\">\n                                                Type 1                                            <\/span>\n                                        \n                                        \n                                    <\/div>\n\n                                    \n                                <\/div>\n                            <\/a>\n                        <\/div>\n                                            <div class=\"bdt-tabs-item\">\n                            <a data-title=\"Type-2\" class=\"bdt-tabs-item-title\" id=\"bdt-tab-Type-2\" data-tab-index=\"1\" href=\"#\">\n                                <div class=\"bdt-tab-text-wrapper bdt-flex-column\">\n\n                                    <div class=\"bdt-tab-title-icon-wrapper\">\n\n                                        \n                                                                                    <span class=\"bdt-tab-text\">\n                                                Type 2                                            <\/span>\n                                        \n                                        \n                                    <\/div>\n\n                                    \n                                <\/div>\n                            <\/a>\n                        <\/div>\n                                            <div class=\"bdt-tabs-item\">\n                            <a data-title=\"Type-3\" class=\"bdt-tabs-item-title\" id=\"bdt-tab-Type-3\" data-tab-index=\"2\" href=\"#\">\n                                <div class=\"bdt-tab-text-wrapper bdt-flex-column\">\n\n                                    <div class=\"bdt-tab-title-icon-wrapper\">\n\n                                        \n                                                                                    <span class=\"bdt-tab-text\">\n                                                Type 3                                            <\/span>\n                                        \n                                        \n                                    <\/div>\n\n                                    \n                                <\/div>\n                            <\/a>\n                        <\/div>\n                                            <div class=\"bdt-tabs-item\">\n                            <a data-title=\"Type-4\" class=\"bdt-tabs-item-title\" id=\"bdt-tab-Type-4\" data-tab-index=\"3\" href=\"#\">\n                                <div class=\"bdt-tab-text-wrapper bdt-flex-column\">\n\n                                    <div class=\"bdt-tab-title-icon-wrapper\">\n\n                                        \n                                                                                    <span class=\"bdt-tab-text\">\n                                                Type 4                                            <\/span>\n                                        \n                                        \n                                    <\/div>\n\n                                    \n                                <\/div>\n                            <\/a>\n                        <\/div>\n                                    <\/div>\n            <\/div>\n        <\/div>\n\n\n                                    \n        <div class=\"bdt-switcher-wrapper\">\n            <div id=\"bdt-tab-content-5535284-7352\" class=\"bdt-switcher bdt-switcher-item-content\">\n                                                        <div class=\"bdt-tab-content-item bdt-active\" \n                    data-content-id=\"type-1\">\n                        <div>\n                            \t\t<div data-elementor-type=\"section\" data-elementor-id=\"14070\" class=\"elementor elementor-14070\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9bde2a2 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"9bde2a2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-5bc6623\" data-id=\"5bc6623\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-778f8d5 elementor-widget elementor-widget-text-editor\" data-id=\"778f8d5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Paley Type 1 is a congenitally short tibia and fibula with a stable ankle joint. In many cases, the ankle of Type 1 cases appears completely normal and the fibula is only slightly shorter at its upper end compared to the opposite side. The predicted limb length discrepancy in Type 1 cases is typically less than 7 centimeters (3 inches). Type 1 FH is also referred to as the Stable type due to the stable ankle joint. Most patients with Type 1 do not require any foot surgery. In many of these cases, lengthening of the tibia and fibula will address the deformity.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-42a90bd\" data-id=\"42a90bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e374d64 elementor-widget elementor-widget-image\" data-id=\"e374d64\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"300\" height=\"225\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-1-300x225-2.jpg\" class=\"attachment-full size-full wp-image-14071\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-82af09c elementor-widget elementor-widget-text-editor\" data-id=\"82af09c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 1 Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t                        <\/div>\n                    <\/div>\n                                                        <div class=\"bdt-tab-content-item \" \n                    data-content-id=\"type-2\">\n                        <div>\n                            \t\t<div data-elementor-type=\"section\" data-elementor-id=\"14074\" class=\"elementor elementor-14074\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fd4c367 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"fd4c367\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a4a4920\" data-id=\"a4a4920\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3f24f2c elementor-widget elementor-widget-text-editor\" data-id=\"3f24f2c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tPaley Type 2 cases have a short tibia and fibula with a foot that stands flat to the ground but often goes into a valgus position (pointing outward). The foot can come into a normal position, but as the child gets older or more tired, the foot goes into valgus such that the heel is pointing outwards and the ankle is pointing inwards. Patients with Type 2 often have a tight Achilles tendon and a ball-and-socket ankle joint as well. Type 2 FH is also referred to as the Dynamic Valgus type due to the nature of the ankle deformity. Most patients with Type 2 will require realignment of the ankle, combined with lengthening of the gastrocsoleus muscles (the two muscles connected to the Achilles tendon). This should be planned and included as part of the lengthening procedure.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-38da354\" data-id=\"38da354\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-37cb7e6 glow-line elementor-widget elementor-widget-image\" data-id=\"37cb7e6\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"272\" height=\"300\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-2-272x300-1.jpg\" class=\"attachment-full size-full wp-image-14076\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e43da9d elementor-widget elementor-widget-text-editor\" data-id=\"e43da9d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 2 Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t                        <\/div>\n                    <\/div>\n                                                        <div class=\"bdt-tab-content-item \" \n                    data-content-id=\"type-3\">\n                        <div>\n                            \t\t<div data-elementor-type=\"page\" data-elementor-id=\"14087\" class=\"elementor elementor-14087\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-aa04e4d elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"aa04e4d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7fd48ce\" data-id=\"7fd48ce\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e207be6 elementor-widget elementor-widget-text-editor\" data-id=\"e207be6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tPaley Type 3 cases demonstrate a fixed foot deformity, also known as a fixed equinovalgus deformity, with the foot pointing down and to the side. The foot has limited mobility and cannot be brought into a plantigrade (flat on the ground) position relative to the lower leg. While the more common foot deformity known as clubfoot has the foot pointing down and in, Type 3 fibular hemimelia is the opposite, with the foot pointing down and out. Type 3 is the type of deformity that has malorientation of the ankle joint and\/or malunited subtalar coalition.\n\nType 3 has fixed deformities that must be corrected early to allow the patient to walk with the foot flat on the ground and to be able to wear a shoe properly. Type 3 FH is treated by the SUPERankle procedure (SUPER is an acronym for Systematic Utilitarian Procedure for Extremity Reconstruction). The SUPERankle was developed by Dr. Paley in 1996. It is the most successful method to correct the fixed equinovalgus of Type 3 (or fixed equinovarus of Type 4) fibular hemimelia. The SUPERankle procedure is the most revolutionary advancement in the treatment of fibular hemimelia. Prior to the advent of this surgery, the biggest cause of failure of surgical reconstruction was recurrent foot deformity.\n\nThe SUPERankle is the first and only procedure that has reduced and almost eliminated recurrent foot and ankle deformity following treatment of fibular hemimelia. The previous surgeries, such as soft tissue releases or joint distraction, had very high failure rates and led to increased or permanent stiffness. The SUPERankle procedure combines extra-articular soft tissue releases with intra-articular reshaping of the ankle joint with extra-articular osteotomy bony alignment of the ankle and subtalar joints. It is a very technically demanding surgery. At first consultation, a determination if the SUPERankle procedure is required will be made. If the procedure is to be performed on its own, it can be done as early as 12 months of age. If it is to be performed in combination with lengthening, it is preferable to wait until 18 months of age. The SUPERankle can be performed at an older age if necessary.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-11c8405 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"11c8405\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6f8242c\" data-id=\"6f8242c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6b727d8 elementor-widget elementor-widget-text-editor\" data-id=\"6b727d8\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3 cases are further subdivided into four types. In Type 3A, the fixed equinovalgus deformity is due to a malorientation of the ankle joint. For that reason, Type 3A FH is also referred to as Ankle Type.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b599f0b glow-line elementor-widget elementor-widget-image\" data-id=\"b599f0b\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"590\" height=\"371\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1.jpg\" class=\"attachment-full size-full wp-image-14092\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1.jpg 590w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1-300x189.jpg 300w\" sizes=\"(max-width: 590px) 100vw, 590px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-21f2f91 elementor-widget elementor-widget-text-editor\" data-id=\"21f2f91\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3A Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-a41f7d5\" data-id=\"a41f7d5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-90561fa elementor-widget elementor-widget-text-editor\" data-id=\"90561fa\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3 cases are further subdivided into four types. In Type 3A, the fixed equinovalgus deformity is due to a malorientation of the ankle joint. For that reason, Type 3A FH is also referred to as Ankle Type.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a8c2015 glow-line elementor-widget elementor-widget-image\" data-id=\"a8c2015\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"590\" height=\"371\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1.jpg\" class=\"attachment-full size-full wp-image-14092\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1.jpg 590w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3a-300x226-1-300x189.jpg 300w\" sizes=\"(max-width: 590px) 100vw, 590px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cd240a0 elementor-widget elementor-widget-text-editor\" data-id=\"cd240a0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3B Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-45c450e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"45c450e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-5e5369c\" data-id=\"5e5369c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6e3c00e elementor-widget elementor-widget-text-editor\" data-id=\"6e3c00e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tIn Type 3C, it is due to a combination of maloriented ankle joint and a malunited subtalar coalition. Type 3C is also referred to as Combined Ankle and Subtalar Type.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-06f80c6 glow-line elementor-widget elementor-widget-image\" data-id=\"06f80c6\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"590\" height=\"371\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3c-300x226-1.jpg\" class=\"attachment-full size-full wp-image-14093\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3c-300x226-1.jpg 590w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3c-300x226-1-300x189.jpg 300w\" sizes=\"(max-width: 590px) 100vw, 590px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de64496 elementor-widget elementor-widget-text-editor\" data-id=\"de64496\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3C Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-bb9af2c\" data-id=\"bb9af2c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b2b963a elementor-widget elementor-widget-text-editor\" data-id=\"b2b963a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tIn Type 3D, the subtalar joint is not fused and does not have the coalition but is nonetheless maloriented. In fact, in this condition, there is hypermobility of the subtalar joint. Type 3D FH is also referred to as Talar Type.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d0257db glow-line elementor-widget elementor-widget-image\" data-id=\"d0257db\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"590\" height=\"371\" src=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3d-300x190-1.jpg\" class=\"attachment-full size-full wp-image-14094\" alt=\"\" srcset=\"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3d-300x190-1.jpg 590w, https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/05\/FH-type-3d-300x190-1-300x189.jpg 300w\" sizes=\"(max-width: 590px) 100vw, 590px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-80aa5bc elementor-widget elementor-widget-text-editor\" data-id=\"80aa5bc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tType 3D Fibular Hemimelia\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-60892b6 elementor-widget elementor-widget-text-editor\" data-id=\"60892b6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tThe differences in anatomy of the different subtypes for Type 3 FH require different variations of the SUPERankle procedure.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t                        <\/div>\n                    <\/div>\n                                                        <div class=\"bdt-tab-content-item \" \n                    data-content-id=\"type-4\">\n                        <div>\n                            <p>Paley Type 4, also known as the clubfoot-type of fibular hemimelia, has a subtalar coalition maloriented into varus (foot turned inwards) and appears more like a clubfoot deformity instead of the equinovalgus deformity typical of fibular hemimelia. This equinovarus, or clubfoot deformity, can often be mistaken for true clubfoot. The treatment for true clubfoot is by manipulation and Ponsetti casting, typically followed by an Achilles tendon lengthening. A fibular hemimelia case mistakenly treated by this method would fail to correct. Furthermore, such manipulation in the presence of a subtalar coalition can damage the ankle joint and growth plate of the lower tibia. Therefore, correct diagnosis is crucial to prevent incorrectly treating fibular hemimelia as clubfoot.<\/p><p>Type 4 FH is treated with the SUPERankle procedure.<\/p>                        <\/div>\n                    <\/div>\n                            <\/div>\n        <\/div>\n                    \n                                <a href=\"#\" id=\"bottom-anchor-5535284-7352\" data-bdt-hidden><\/a>\n            <\/div>\n        <\/div>\n    \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c9622ac elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c9622ac\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6be0ce2\" data-id=\"6be0ce2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d372a4e elementor-widget elementor-widget-heading\" data-id=\"d372a4e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Initial Consultation<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a149a6 elementor-widget elementor-widget-text-editor\" data-id=\"6a149a6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>In summary, at the first consultation, the following steps are performed<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a3a0024 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a3a0024\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6d32988\" data-id=\"6d32988\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2446c4b elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2446c4b\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">An evaluation made of the type of foot deformity and the classification type<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Predicted limb length discrepancy at skeletal maturity calculated<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Reconstructive life plan developed, including number of lengthenings and\/or epiphysiodesis surgeries required<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Determiniation of valgus knee and knee correction surgery planning<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Assessment of patient toes and toe correction surgery planning<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-161e835 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"161e835\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-849ce3b\" data-id=\"849ce3b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-17456cb elementor-widget elementor-widget-text-editor\" data-id=\"17456cb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Since no treatment is required prior to walking age, there is no urgency in the timing of the first consultation. Dr. Paley usually recommends coming in when your child is around six months of age and to treat the child normally until that time, with no specialized braces, shoes, or physical therapy. It is a common misconception to perform physical therpay prior to surgery. Physical therapy, if performed inappropriately, can actually be harmful to the foot. Dr. Paley highly recommends against any manipulation therapy of the foot and ankle, including casting or bracing prior to surgery.<\/p><p>The first intervention is the use of a shoe lift at the time of walking. Children with fibular hemimelia learn to walk either at normal age or slightly delayed. All of them will walk and can walk with FH even in very extreme cases. There is no neurologic obstruction to learning to walk in children with FH. Once the child demonstrates that they are \u201ccruising the furniture,\u201d it is then appropriate to obtain a shoe lift. In most cases, an ankle foot orthotic (AFO), which is custom-molded to the foot, is recommended. Then a shoe lift is added to the bottom of the shoe to equalize the limb length discrepancy. After that, the child should be booked for the first surgery\u2014typically a SUPERankle procedure between age 12 and 18 months. No other treatment is required prior to the first surgery.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b43f2da elementor-hidden-desktop elementor-hidden-laptop elementor-hidden-tablet elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b43f2da\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5c499c6 elementor-hidden-desktop elementor-hidden-tablet\" data-id=\"5c499c6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a022e64 elementor-widget elementor-widget-heading\" data-id=\"a022e64\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Fibular Hemimelia<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c75c4c7 elementor-align-left elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"c75c4c7\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Overview<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-limb-lengthening\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Limb Lengthening for Fibular Hemimelia<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-reconstruction-vs-amputation\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Reconstruction vs. Amputation<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibularhemimelia-treatment-strategies\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Treatment Strategies<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0da3f4d elementor-align-left elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"0da3f4d\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-knee-reconstruction\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Knee Reconstruction<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/super-ankel\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">SUPERankle<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/paleyinstitute.org\/fibular-hemimelia-toe-reconstruction\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Toe Reconstruction<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Treatment Strategies Children born with fibular hemimelia have a spectrum of deformity, deficiency, or instability (DDI). The surgical treatment for fibular hemimelia is designed to address all of the deformities, deficiencies, and length discrepancies, specific to each type and the individual patient\u2019s needs. At the Paley Institute, we start with a reconstructive life plan. This involves evaluating all of the surgical deformities, deficiencies, and predicting the limb length discrepancy at maturity and then coming up with a surgical plan to correct these in the fewest number of surgeries, spread apart as much as possible throughout the child\u2019s growing years. Fibular Hemimelia Overview Limb Lengthening for Fibular Hemimelia Reconstruction vs. Amputation Treatment Strategies Knee Reconstruction SUPERankle Toe Reconstruction The goals of treatment are to achieve the following by skeletal maturity Equalized limb length A functional foot in the plantigrade position (flat on the ground) Alignment of the hip, knee, and ankle joints Knee stability. For more details on treatment, see Dr. Paley&#8217;s article in Journal of Children&#8217;s Orthopedics: Surgical Reconstruction for Fibular Hemimelia Reconstructive Life Plan A reconstructive life plan for fibular hemimelia may look like this SUPERankle Surgery and First Lengthening 5 cm of length gained Performed age 18 &#8211; 24 months Second Lengthening 5 &#8211; 8 cm of length gained Performed age 7 &#8211; 10 Third Lengthening 5 cm of length gained Performed age 12 &#8211; 14 Epiphysiodesis (&#8220;8 plate&#8221;) 5 cm of length gained Performed around age 9 for girls and age 13 for boys Total length gained: 15 &#8211; 30 cm (6 &#8211; 12 inches) The first step for treatment is to predict the limb length discrepancy at skeletal maturity. During the initial visit with Dr. Paley, he will obtain x-rays of both lower limbs and measure the lengths of both femurs, both tibias, and the heights of both feet. By comparing the sum of the femur, tibia, and feet height on the short leg with that on the long leg, we can determine the limb length discrepancy at the time of the x-ray. Using the multiplier method for limb length discrepancy prediction (a formula developed by Dr. Paley in 2000), we can calculate the limb length discrepancy at skeletal maturity. Additional measurements throughout the patient\u2019s life will improve the accuracy of the prediction. Once the predicted limb length discrepancy at skeletal maturity has been calculated, a determination on the number of limb length equalization surgeries can be made. Under the age of four, it is safe to lengthen up to 5 cm (~2 in.). As the patient ages, subsequent lengthening&#8217;s can be as high as 8 cm. Playing games during follow up appointment If additional equalization is required, one can also consider a limb growth-slowing procedure, called an epiphysiodesis. The epiphysiodesis involves slowing the growth of the long leg to allow the growth of the short leg to catch up and equalize. While limb lengthening can be performed at any age, an epiphysiodesis has to be performed at a very specific age in order to achieve a specific amount of growth slowing. We rarely use epiphysiodesis to achieve more than 5 cm (~2 in.) of limb length equalization. This covers the majority of cases of fibular hemimelia. In rare cases with larger discrepancies shortening of the femur or simultaneous lengthening of the femur and tibia may be preferred. Fibular Hemimelia Classification The next step will be to determine the type of fibular hemimelia. At the initial consultation, it is determined whether the patient has a fixed foot deformity (or even a dynamic foot deformity) that will require surgical treatment. Fibular hemimelia is classified into different groups dependent on treatment strategies according to the degree of severity. Many different classification systems have for FH have been proposed, but these systems have historically prioritized amputation treatment. In 1995, Dr. Paley developed a classification for fibular hemimelia that takes reconstruction into account. The Paley classification divides fibular hemimelia into four groups: types 1, 2, 3, and 4. It further subdivides Type 3 into four subtypes: 3A, 3B, 3C, and 3D. The method of treatment is specific to each type and subtype Type 1 \u2013 stable ankle joint Type 2 \u2013 valgus deformity of the foot Type 3 \u2013 equinovalgus deformity of the foot 3A \u2013 equinovalgus due to malorientation of the ankle joint 3B \u2013 equinovalgus due to malunited subtalar coalition 3C\u2013 equinovalgus due to combination of malorientation of ankle joint and malunited subtalar coalition 3D \u2013 subtalar deformity other than a subtalar coalition Type 4 \u2013 equinovarus deformity of the foot (also known as \u201cclubfoot type\u201d) Type 1 Type 2 Type 3 Type 4 Paley Type 1 is a congenitally short tibia and fibula with a stable ankle joint. In many cases, the ankle of Type 1 cases appears completely normal and the fibula is only slightly shorter at its upper end compared to the opposite side. The predicted limb length discrepancy in Type 1 cases is typically less than 7 centimeters (3 inches). Type 1 FH is also referred to as the Stable type due to the stable ankle joint. Most patients with Type 1 do not require any foot surgery. In many of these cases, lengthening of the tibia and fibula will address the deformity. Type 1 Fibular Hemimelia Paley Type 2 cases have a short tibia and fibula with a foot that stands flat to the ground but often goes into a valgus position (pointing outward). The foot can come into a normal position, but as the child gets older or more tired, the foot goes into valgus such that the heel is pointing outwards and the ankle is pointing inwards. Patients with Type 2 often have a tight Achilles tendon and a ball-and-socket ankle joint as well. Type 2 FH is also referred to as the Dynamic Valgus type due to the nature of the ankle deformity. Most patients with Type 2 will require realignment of the ankle, combined with lengthening of the gastrocsoleus muscles (the two muscles connected to the Achilles tendon).<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-11878","page","type-page","status-publish","hentry"],"acf":[],"rankMath":{"parentDomain":"paleyinstitute.org","noFollowDomains":[],"noFollowExcludeDomains":[],"noFollowExternalLinks":false,"featuredImageNotice":"The featured image should be at least 200 by 200 pixels to be picked up by Facebook and other social media sites.","pluginReviewed":false,"postSettings":{"linkSuggestions":true,"useFocusKeyword":false},"frontEndScore":false,"postName":"fibularhemimelia-treatment-strategies","permalinkFormat":"https:\/\/paleyinstitute.org\/%pagename%\/","showLockModifiedDate":true,"assessor":{"focusKeywordLink":"https:\/\/paleyinstitute.org\/wp-admin\/edit.php?focus_keyword=%focus_keyword%&post_type=%post_type%","hasTOCPlugin":true,"primaryTaxonomy":false,"serpData":{"title":"","description":"","focusKeywords":"","pillarContent":false,"canonicalUrl":"","breadcrumbTitle":"","advancedRobots":{"max-snippet":"-1","max-video-preview":"-1","max-image-preview":"large"},"facebookTitle":"","facebookDescription":"","facebookImage":"","facebookImageID":"","facebookHasOverlay":false,"facebookImageOverlay":"","facebookAuthor":"","twitterCardType":"","twitterUseFacebook":true,"twitterTitle":"","twitterDescription":"","twitterImage":"","twitterImageID":"","twitterHasOverlay":false,"twitterImageOverlay":"","twitterPlayerUrl":"","twitterPlayerSize":"","twitterPlayerStream":"","twitterPlayerStreamCtype":"","twitterAppDescription":"","twitterAppIphoneName":"","twitterAppIphoneID":"","twitterAppIphoneUrl":"","twitterAppIpadName":"","twitterAppIpadID":"","twitterAppIpadUrl":"","twitterAppGoogleplayName":"","twitterAppGoogleplayID":"","twitterAppGoogleplayUrl":"","twitterAppCountry":"","robots":{"index":true},"twitterAuthor":"username","primaryTerm":0,"authorName":"admin","titleTemplate":"%title% %sep% %sitename%","descriptionTemplate":"%excerpt%","showScoreFrontend":true,"lockModifiedDate":false},"powerWords":["a cut above","absolute","absolutely","absolutely lowest","absurd","abuse","accurate","accuse","achieve","actionable","adaptable","adequate","admit","adorable","advantage","advice","affordable","aggravate","aggressive","agitated","agonizing","agony","alarmed","alarming","alienated","aligned","alive","all-inclusive","alluring","always","amazing","amp","animated","annihilate","announcing","anonymous","antagonistic","anxious","apocalypse","appalled","approved","approving","argumentative","armageddon","arrogant","ass kicking","assault","assured","astonishing","astounded","astounding","at ease","atrocious","attack","attractive","audacity","authentic","authoritative","authority","avoid","aware","awe-inspiring","awesome","awkward","backbone","backdoor","backed","backlash","backstabbing","badass","balanced","banned","bargain","barrage","basic","battle","beaming","beat down","beating","beautiful","beauty","begging","behind the scenes","belief","belong","best","best-selling","better","beware","big","billion","black market","blacklisted","blast","blessed","blinded","blissful","blood","bloodbath","bloodcurdling","bloody","blunder","blushing","bold","bomb","bona","bona fide","bonanza","bonus","bootleg","bottom line","bountiful","brave","bravery","brazen","break","breaking","breakthrough","breathtaking","bright","brilliant","broke","brutal","budget","buffoon","bullshit","bully","bumbling","buy","cadaver","calm","cancel anytime","capable","captivate","captivating","carefree","case study","cash","cataclysmic","catapult","catastrophe","caution","censored","centered","certain","certainly","certified","challenge","charming","cheap","cheat","cheat-sheet","cheer","cheerful","child-like","clarity","classified","clear","clueless","collapse","colorful","colossal","comfortable","compare","competitive","complete","completely","completeness","comprehensive","compromise","compulsive","concealed","conclusive","condemning","condescending","confess","confession","confessions","confident","confidential","conquer","conscientious","constructive","content","contrary","controlling","controversial","convenient","convert","cool","cooperative","copy","corpse","corrupt","corrupting","courage","courageous","cover-up","covert","coward","cowardly","crammed","crave","crazy","create","creative","cringeworthy","cripple","crisis","critical","crooked","crush","crushing","damaging","danger","dangerous","daring","dazzling","dead","deadline","deadly","death","decadent","deceived","deceptive","deep","defiance","definitely","definitive","defying","dejected","delicious","delight","delighted","delightful","delirious","delivered","demoralizing","deplorable","depraved","desire","desperate","despicable","destiny","destroy","detailed","devastating","devoted","diagnosed","direct","dirty","disadvantages","disastrous","discount","discover","disdainful","disempowered","disgusted","disgusting","dishonest","disillusioned","disoriented","distracted","distraught","distressed","distrustful","divulge","document","dollar","dominate","doomed","double","doubtful","download","dreadful","dreamy","drive","drowning","dumb","dynamic","eager","earnest","easily","easy","economical","ecstatic","edge","effective","efficient","effortless","elated","eliminate","elite","embarrass","embarrassed","embarrassing","emergency","emerging","emphasize","empowered","enchant","encouraged","endorsed","energetic","energy","enormous","enraged","enthusiastic","envy","epic","epidemic","essential","ethical","euphoric","evil","exactly","exasperated","excellent","excited","excitement","exciting","exclusive","exclusivity","excruciating","exhilarated","expensive","expert","explode","exploit","explosive","exposed","exquisite","extra","extraordinary","extremely","exuberant","eye-opening","fail","fail-proof","failure","faith","famous","fantasy","fascinating","fatigued","faux","faux pas","fearless","feast","feeble","festive","fide","fierce","fight","final","fine","fired","first","first ever","flirt","fluid","focus","focused","fool","fooled","foolish","forbidden","force-fed","forever","forgiving","forgotten","formula","fortune","foul","frantic","free","freebie","freedom","frenzied","frenzy","frightening","frisky","frugal","frustrated","fulfill","fulfilled","full","fully","fun","fun-loving","fundamentals","funniest","funny","furious","gambling","gargantuan","genius","genuine","gift","gigantic","giveaway","glamorous","gleeful","glorious","glowing","goddamn","gorgeous","graceful","grateful","gratified","gravity","great","greatest","greatness","greed","greedy","gripping","grit","grounded","growth","guaranteed","guilt","guilt-free","gullible","guts","hack","happiness","happy","harmful","harsh","hate","have you heard","havoc","hazardous","healthy","heart","heartbreaking","heartwarming","heavenly","hell","helpful","helplessness","hero","hesitant","hidden","high tech","highest","highly effective","hilarious","hoak","hoax","honest","honored","hope","hopeful","horribly","horrific","horrifying","horror","hostile","how to","huge","humility","humor","hurricane","hurry","hypnotic","idiot","ignite","illegal","illusive","imagination","immediately","imminently","impatience","impatient","impenetrable","important","impressive","improved","in the zone","incapable","incapacitated","incompetent","inconsiderate","increase","incredible","indecisive","indulgence","indulgent","inexpensive","inferior","informative","infuriated","ingredients","innocent","innovative","insane","insecure","insider","insidious","inspired","inspiring","instant savings","instantly","instructive","insult","intel","intelligent","intense","interesting","intriguing","introducing","invasion","investment","iron-clad","ironclad","irresistible","irs","is here","jackpot","jail","jaw-dropping","jealous","jeopardy","jittery","jovial","joyous","jubilant","judgmental","jumpstart","just arrived","keen","kickass","kickstart","kill","killed","killing","kills","know it all","lame","largest","lascivious","last","last chance","last minute","latest","laugh","laughing","launch","launching","lavishly","lawsuit","lazy","left behind","legendary","legitimate","liberal","liberated","lick","lies","life-changing","lifetime","light","lighthearted","likely","limited","literally","little-known","loathsome","lonely","looming","loser","lost","love","lucrative","lunatic","lurking","lust","luxurious","luxury","lying","magic","magical","magnificent","mainstream","malicious","mammoth","manipulative","marked down","massive","master","masterclass","maul","mediocre","meditative","meltdown","memorability","memorable","menacing","mesmerizing","meticulous","mind-blowing","minimalist","miracle","mired","mischievous","misgiving","missing out","mistake","monetize","money","moneyback","moneygrubbing","monumental","most important","motivated","mouth-watering","murder","mystery","nail","naked","natural","naughty","nazi","nest egg","never","new","nightmare","no good","no obligation","no one talks about","no questions asked","no risk","no strings attached","non-controlling","noted","novelty","now","obnoxious","obsessed","obsession","obvious","odd","off-kilter","off-limits","off-the record","offensive","official","okay","on-demand","open-minded","opportunities","optimistic","ordeal","outlawed","outrageousness","outstanding","overcome","overjoyed","overnight","overwhelmed","packed","painful","painless","painstaking","pale","panic","panicked","paralyzed","pas","passionate","pathetic","pay zero","payback","perfect","peril","perplexed","perspective","pessimistic","pioneering","piranha","pitfall","pitiful","placid","plague","played","playful","pleased","pluck","plummet","plunge","poison","poisonous","polarizing","poor","popular","portfolio","pound","powerful","powerless","practical","preposterous","prestige","price","priceless","pride","prison","privacy","private","privileged","prize","problem","productive","professional","profit","profitable","profound","promiscuous","promising","promote","protect","protected","proven","provocative","provoke","psychological","pummel","punch","punish","pus","quadruple","quality","quarrelsome","quick","quick-start","quickly","quiet","radiant","rare","ravenous","rebellious","recession-proof","reckoning","recognized","recommend","recreate","reduced","reflective","refugee","refund","refundable","reject","relaxed","release","relentless","reliable","remarkable","replicate","report","reprimanding","repulsed","repulsive","research","resentful","resourceful","responsible","responsive","rested","restricted","results","retaliating","reveal","revealing","revenge","revengeful","revisited","revolting","revolutionary","reward","rich","ridiculous","risky","riveting","rookie","rowdy","ruin","rules","ruthless","sabotaging","sacred","sadistic","sadly","sadness","safe","safety","sale","sampler","sarcastic","satisfied","savage","savagery","save","savings","savvy","scam","scandal","scandalous","scarce","scared","scary","scornful","scream","searing","secret","secret agenda","secret plot","secrets","secure","security","seductive","seething","seize","selected","self-hating","self-sufficient","sensational","senseless","sensual","serene","seriously","severe","sex","sexy","shaking","shameful","shameless","shaming","shatter","shellacking","shocking","should","shrewd","sick and tired","signs","silly","simple","simplicity","simplified","simplistic","sincere","sinful","sins","six-figure","sizable","sizzle","sizzled","sizzles","sizzling","sizzlingly","skill","skyrocket","slaughter","slave","sleazy","sleeping","sly","smash","smiling","smug","smuggle","smuggled","sneak-peek","sneaky","sniveling","snob","snooty","snotty","soar","soaring","solid","solution","spank","special","spectacular","speedy","spell-binding","spine","spirit","spirited","spiteful","spoiler","spontaneous","spotlight","spunky","squirming","stable","staggering","startling","steady","steal","stealthy","steamy","step-by-step","still","stoic","stop","strange","strangle","strategy","stressed","strong","strongly suggest","struggle","stuck up","studies","stunning","stupid","stupid-simple","sturdy","sublime","succeed","success","successful","suck","suddenly","suffer","sunny","super","super-human","superb","supercharge","superior","supported","supportive","sure","sure fire","surefire","surge","surging","surprise","surprised","surprising","survival","survive","suspicious","sweaty","swoon","swoon-worthy","tailspin","tank","tantalizing","targeted","tawdry","tease","technology","teetering","tempting","tenacious","tense","terrible","terrific","terrified","terrifying","terror","terrorist","tested","thankful","the truth","threaten","threatened","thrilled","thrilling","thug","ticked off","tickled","timely","today","torture","toxic","track record","trade secret","tragedy","tragic","transform","transparency","trap","trapped","trauma","traumatized","treacherous","treasure","tremendous","trend","tricks","triggers","triple","triumph","truly","trusting","trustworthy","truth","truthful","turbo-charge","turbocharges","tweaks","twitching","ultimate","unadulterated","unassuming","unauthorized","unbelievable","unburdened","uncaring","uncensored","uncertain","uncomfortable","unconditional","uncontrollable","unconventional","uncovered","undeniable","under priced","undercover","underground","underhanded","underused","unexpected","unforgettable","unheard of","unhurried","uninterested","unique","unjustified","unknowingly","unleashed","unlimited","unlock","unparalleled","unpopular","unreliable","unresponsive","unseen","unstable","unstoppable","unsure","unsurpassed","untapped","unusual","up-sell","upbeat","uplifted","uplifting","urge","urgent","useful","useless","validate","valor","valuable","value","vanquish","vaporize","venomous","verify","vibrant","vicious","victim","victory","vigorous","vilified","vindictive","violated","violent","volatile","vulnerable","waiting","wanted","wanton","warning","waste","weak","wealth","weird","what no one tells you","whip","whopping","wicked","wild","willpower","withheld","wonderful","wondrous","woozy","world","worry","worst","worthwhile","wounded","wreaking","youthful","zen","zinger"],"diacritics":{"A":"[\\u0041\\u24B6\\uFF21\\u00C0\\u00C1\\u00C2\\u1EA6\\u1EA4\\u1EAA\\u1EA8\\u00C3\\u0100\\u0102\\u1EB0\\u1EAE\\u1EB4\\u1EB2\\u0226\\u01E0\\u00C4\\u01DE\\u1EA2\\u00C5\\u01FA\\u01CD\\u0200\\u0202\\u1EA0\\u1EAC\\u1EB6\\u1E00\\u0104\\u023A\\u2C6F]","AA":"[\\uA732]","AE":"[\\u00C6\\u01FC\\u01E2]","AO":"[\\uA734]","AU":"[\\uA736]","AV":"[\\uA738\\uA73A]","AY":"[\\uA73C]","B":"[\\u0042\\u24B7\\uFF22\\u1E02\\u1E04\\u1E06\\u0243\\u0182\\u0181]","C":"[\\u0043\\u24B8\\uFF23\\u0106\\u0108\\u010A\\u010C\\u00C7\\u1E08\\u0187\\u023B\\uA73E]","D":"[\\u0044\\u24B9\\uFF24\\u1E0A\\u010E\\u1E0C\\u1E10\\u1E12\\u1E0E\\u0110\\u018B\\u018A\\u0189\\uA779]","DZ":"[\\u01F1\\u01C4]","Dz":"[\\u01F2\\u01C5]","E":"[\\u0045\\u24BA\\uFF25\\u00C8\\u00C9\\u00CA\\u1EC0\\u1EBE\\u1EC4\\u1EC2\\u1EBC\\u0112\\u1E14\\u1E16\\u0114\\u0116\\u00CB\\u1EBA\\u011A\\u0204\\u0206\\u1EB8\\u1EC6\\u0228\\u1E1C\\u0118\\u1E18\\u1E1A\\u0190\\u018E]","F":"[\\u0046\\u24BB\\uFF26\\u1E1E\\u0191\\uA77B]","G":"[\\u0047\\u24BC\\uFF27\\u01F4\\u011C\\u1E20\\u011E\\u0120\\u01E6\\u0122\\u01E4\\u0193\\uA7A0\\uA77D\\uA77E]","H":"[\\u0048\\u24BD\\uFF28\\u0124\\u1E22\\u1E26\\u021E\\u1E24\\u1E28\\u1E2A\\u0126\\u2C67\\u2C75\\uA78D]","I":"[\\u0049\\u24BE\\uFF29\\u00CC\\u00CD\\u00CE\\u0128\\u012A\\u012C\\u0130\\u00CF\\u1E2E\\u1EC8\\u01CF\\u0208\\u020A\\u1ECA\\u012E\\u1E2C\\u0197]","J":"[\\u004A\\u24BF\\uFF2A\\u0134\\u0248]","K":"[\\u004B\\u24C0\\uFF2B\\u1E30\\u01E8\\u1E32\\u0136\\u1E34\\u0198\\u2C69\\uA740\\uA742\\uA744\\uA7A2]","L":"[\\u004C\\u24C1\\uFF2C\\u013F\\u0139\\u013D\\u1E36\\u1E38\\u013B\\u1E3C\\u1E3A\\u0141\\u023D\\u2C62\\u2C60\\uA748\\uA746\\uA780]","LJ":"[\\u01C7]","Lj":"[\\u01C8]","M":"[\\u004D\\u24C2\\uFF2D\\u1E3E\\u1E40\\u1E42\\u2C6E\\u019C]","N":"[\\u004E\\u24C3\\uFF2E\\u01F8\\u0143\\u00D1\\u1E44\\u0147\\u1E46\\u0145\\u1E4A\\u1E48\\u0220\\u019D\\uA790\\uA7A4]","NJ":"[\\u01CA]","Nj":"[\\u01CB]","O":"[\\u004F\\u24C4\\uFF2F\\u00D2\\u00D3\\u00D4\\u1ED2\\u1ED0\\u1ED6\\u1ED4\\u00D5\\u1E4C\\u022C\\u1E4E\\u014C\\u1E50\\u1E52\\u014E\\u022E\\u0230\\u00D6\\u022A\\u1ECE\\u0150\\u01D1\\u020C\\u020E\\u01A0\\u1EDC\\u1EDA\\u1EE0\\u1EDE\\u1EE2\\u1ECC\\u1ED8\\u01EA\\u01EC\\u00D8\\u01FE\\u0186\\u019F\\uA74A\\uA74C]","OI":"[\\u01A2]","OO":"[\\uA74E]","OU":"[\\u0222]","P":"[\\u0050\\u24C5\\uFF30\\u1E54\\u1E56\\u01A4\\u2C63\\uA750\\uA752\\uA754]","Q":"[\\u0051\\u24C6\\uFF31\\uA756\\uA758\\u024A]","R":"[\\u0052\\u24C7\\uFF32\\u0154\\u1E58\\u0158\\u0210\\u0212\\u1E5A\\u1E5C\\u0156\\u1E5E\\u024C\\u2C64\\uA75A\\uA7A6\\uA782]","S":"[\\u0053\\u24C8\\uFF33\\u1E9E\\u015A\\u1E64\\u015C\\u1E60\\u0160\\u1E66\\u1E62\\u1E68\\u0218\\u015E\\u2C7E\\uA7A8\\uA784]","T":"[\\u0054\\u24C9\\uFF34\\u1E6A\\u0164\\u1E6C\\u021A\\u0162\\u1E70\\u1E6E\\u0166\\u01AC\\u01AE\\u023E\\uA786]","TZ":"[\\uA728]","U":"[\\u0055\\u24CA\\uFF35\\u00D9\\u00DA\\u00DB\\u0168\\u1E78\\u016A\\u1E7A\\u016C\\u00DC\\u01DB\\u01D7\\u01D5\\u01D9\\u1EE6\\u016E\\u0170\\u01D3\\u0214\\u0216\\u01AF\\u1EEA\\u1EE8\\u1EEE\\u1EEC\\u1EF0\\u1EE4\\u1E72\\u0172\\u1E76\\u1E74\\u0244]","V":"[\\u0056\\u24CB\\uFF36\\u1E7C\\u1E7E\\u01B2\\uA75E\\u0245]","VY":"[\\uA760]","W":"[\\u0057\\u24CC\\uFF37\\u1E80\\u1E82\\u0174\\u1E86\\u1E84\\u1E88\\u2C72]","X":"[\\u0058\\u24CD\\uFF38\\u1E8A\\u1E8C]","Y":"[\\u0059\\u24CE\\uFF39\\u1EF2\\u00DD\\u0176\\u1EF8\\u0232\\u1E8E\\u0178\\u1EF6\\u1EF4\\u01B3\\u024E\\u1EFE]","Z":"[\\u005A\\u24CF\\uFF3A\\u0179\\u1E90\\u017B\\u017D\\u1E92\\u1E94\\u01B5\\u0224\\u2C7F\\u2C6B\\uA762]","a":"[\\u0061\\u24D0\\uFF41\\u1E9A\\u00E0\\u00E1\\u00E2\\u1EA7\\u1EA5\\u1EAB\\u1EA9\\u00E3\\u0101\\u0103\\u1EB1\\u1EAF\\u1EB5\\u1EB3\\u0227\\u01E1\\u00E4\\u01DF\\u1EA3\\u00E5\\u01FB\\u01CE\\u0201\\u0203\\u1EA1\\u1EAD\\u1EB7\\u1E01\\u0105\\u2C65\\u0250]","aa":"[\\uA733]","ae":"[\\u00E6\\u01FD\\u01E3]","ao":"[\\uA735]","au":"[\\uA737]","av":"[\\uA739\\uA73B]","ay":"[\\uA73D]","b":"[\\u0062\\u24D1\\uFF42\\u1E03\\u1E05\\u1E07\\u0180\\u0183\\u0253]","c":"[\\u0063\\u24D2\\uFF43\\u0107\\u0109\\u010B\\u010D\\u00E7\\u1E09\\u0188\\u023C\\uA73F\\u2184]","d":"[\\u0064\\u24D3\\uFF44\\u1E0B\\u010F\\u1E0D\\u1E11\\u1E13\\u1E0F\\u0111\\u018C\\u0256\\u0257\\uA77A]","dz":"[\\u01F3\\u01C6]","e":"[\\u0065\\u24D4\\uFF45\\u00E8\\u00E9\\u00EA\\u1EC1\\u1EBF\\u1EC5\\u1EC3\\u1EBD\\u0113\\u1E15\\u1E17\\u0115\\u0117\\u00EB\\u1EBB\\u011B\\u0205\\u0207\\u1EB9\\u1EC7\\u0229\\u1E1D\\u0119\\u1E19\\u1E1B\\u0247\\u025B\\u01DD]","f":"[\\u0066\\u24D5\\uFF46\\u1E1F\\u0192\\uA77C]","g":"[\\u0067\\u24D6\\uFF47\\u01F5\\u011D\\u1E21\\u011F\\u0121\\u01E7\\u0123\\u01E5\\u0260\\uA7A1\\u1D79\\uA77F]","h":"[\\u0068\\u24D7\\uFF48\\u0125\\u1E23\\u1E27\\u021F\\u1E25\\u1E29\\u1E2B\\u1E96\\u0127\\u2C68\\u2C76\\u0265]","hv":"[\\u0195]","i":"[\\u0069\\u24D8\\uFF49\\u00EC\\u00ED\\u00EE\\u0129\\u012B\\u012D\\u00EF\\u1E2F\\u1EC9\\u01D0\\u0209\\u020B\\u1ECB\\u012F\\u1E2D\\u0268\\u0131]","j":"[\\u006A\\u24D9\\uFF4A\\u0135\\u01F0\\u0249]","k":"[\\u006B\\u24DA\\uFF4B\\u1E31\\u01E9\\u1E33\\u0137\\u1E35\\u0199\\u2C6A\\uA741\\uA743\\uA745\\uA7A3]","l":"[\\u006C\\u24DB\\uFF4C\\u0140\\u013A\\u013E\\u1E37\\u1E39\\u013C\\u1E3D\\u1E3B\\u017F\\u0142\\u019A\\u026B\\u2C61\\uA749\\uA781\\uA747]","lj":"[\\u01C9]","m":"[\\u006D\\u24DC\\uFF4D\\u1E3F\\u1E41\\u1E43\\u0271\\u026F]","n":"[\\u006E\\u24DD\\uFF4E\\u01F9\\u0144\\u00F1\\u1E45\\u0148\\u1E47\\u0146\\u1E4B\\u1E49\\u019E\\u0272\\u0149\\uA791\\uA7A5]","nj":"[\\u01CC]","o":"[\\u006F\\u24DE\\uFF4F\\u00F2\\u00F3\\u00F4\\u1ED3\\u1ED1\\u1ED7\\u1ED5\\u00F5\\u1E4D\\u022D\\u1E4F\\u014D\\u1E51\\u1E53\\u014F\\u022F\\u0231\\u00F6\\u022B\\u1ECF\\u0151\\u01D2\\u020D\\u020F\\u01A1\\u1EDD\\u1EDB\\u1EE1\\u1EDF\\u1EE3\\u1ECD\\u1ED9\\u01EB\\u01ED\\u00F8\\u01FF\\u0254\\uA74B\\uA74D\\u0275]","oi":"[\\u01A3]","ou":"[\\u0223]","oo":"[\\uA74F]","p":"[\\u0070\\u24DF\\uFF50\\u1E55\\u1E57\\u01A5\\u1D7D\\uA751\\uA753\\uA755]","q":"[\\u0071\\u24E0\\uFF51\\u024B\\uA757\\uA759]","r":"[\\u0072\\u24E1\\uFF52\\u0155\\u1E59\\u0159\\u0211\\u0213\\u1E5B\\u1E5D\\u0157\\u1E5F\\u024D\\u027D\\uA75B\\uA7A7\\uA783]","s":"[\\u0073\\u24E2\\uFF53\\u015B\\u1E65\\u015D\\u1E61\\u0161\\u1E67\\u1E63\\u1E69\\u0219\\u015F\\u023F\\uA7A9\\uA785\\u1E9B]","ss":"[\\u00DF]","t":"[\\u0074\\u24E3\\uFF54\\u1E6B\\u1E97\\u0165\\u1E6D\\u021B\\u0163\\u1E71\\u1E6F\\u0167\\u01AD\\u0288\\u2C66\\uA787]","tz":"[\\uA729]","u":"[\\u0075\\u24E4\\uFF55\\u00F9\\u00FA\\u00FB\\u0169\\u1E79\\u016B\\u1E7B\\u016D\\u00FC\\u01DC\\u01D8\\u01D6\\u01DA\\u1EE7\\u016F\\u0171\\u01D4\\u0215\\u0217\\u01B0\\u1EEB\\u1EE9\\u1EEF\\u1EED\\u1EF1\\u1EE5\\u1E73\\u0173\\u1E77\\u1E75\\u0289]","v":"[\\u0076\\u24E5\\uFF56\\u1E7D\\u1E7F\\u028B\\uA75F\\u028C]","vy":"[\\uA761]","w":"[\\u0077\\u24E6\\uFF57\\u1E81\\u1E83\\u0175\\u1E87\\u1E85\\u1E98\\u1E89\\u2C73]","x":"[\\u0078\\u24E7\\uFF58\\u1E8B\\u1E8D]","y":"[\\u0079\\u24E8\\uFF59\\u1EF3\\u00FD\\u0177\\u1EF9\\u0233\\u1E8F\\u00FF\\u1EF7\\u1E99\\u1EF5\\u01B4\\u024F\\u1EFF]","z":"[\\u007A\\u24E9\\uFF5A\\u017A\\u1E91\\u017C\\u017E\\u1E93\\u1E95\\u01B6\\u0225\\u0240\\u2C6C\\uA763]"},"researchesTests":["contentHasTOC","contentHasShortParagraphs","contentHasAssets","keywordInTitle","keywordInMetaDescription","keywordInPermalink","keywordIn10Percent","keywordInContent","keywordInSubheadings","keywordInImageAlt","keywordDensity","keywordNotUsed","lengthContent","lengthPermalink","linksHasInternal","linksHasExternals","linksNotAllExternals","titleStartWithKeyword","titleSentiment","titleHasPowerWords","titleHasNumber","hasContentAI"],"hasRedirection":true,"hasBreadcrumb":true},"homeUrl":"https:\/\/paleyinstitute.org","objectID":11878,"objectType":"post","locale":"en","localeFull":"en_US","overlayImages":{"play":{"name":"Play icon","url":"https:\/\/paleyinstitute.org\/wp-content\/plugins\/seo-by-rank-math\/assets\/admin\/img\/icon-play.png","path":"\/home\/540807.cloudwaysapps.com\/cagyqbkvyn\/public_html\/wp-content\/plugins\/seo-by-rank-math\/assets\/admin\/img\/icon-play.png","position":"middle_center"},"gif":{"name":"GIF icon","url":"https:\/\/paleyinstitute.org\/wp-content\/plugins\/seo-by-rank-math\/assets\/admin\/img\/icon-gif.png","path":"\/home\/540807.cloudwaysapps.com\/cagyqbkvyn\/public_html\/wp-content\/plugins\/seo-by-rank-math\/assets\/admin\/img\/icon-gif.png","position":"middle_center"}},"defautOgImage":"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/11\/unnamed-1-1.jpg","customPermalinks":true,"isUserRegistered":false,"autoSuggestKeywords":false,"connectSiteUrl":"https:\/\/rankmath.com\/auth?site=https%3A%2F%2Fpaleyinstitute.org&r=https%3A%2F%2Fpaleyinstitute.org%2Fwp-json%2Fwp%2Fv2%2Fpages%2F11878%3Fnonce%3Dd675d97d12&pro=1","maxTags":100,"trendsIcon":"<svg width=\"100%\" height=\"100%\" viewBox=\"0 0 36 36\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" fit=\"\" preserveAspectRatio=\"xMidYMid meet\" focusable=\"false\">\n\t\t<g id=\"Page-1\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n\t\t\t<g id=\"Trends-Arrow\">\n\t\t\t\t<g id=\"TrendsArrow\">\n\t\t\t\t\t<path d=\"M1.11227159,26.3181534 L10.2875029,17.1429221 L13.7152617,20.5706809 L4.5400304,29.7459122 C4.20518633,30.0807563 3.66229681,30.0807562 3.32745277,29.7459122 L1.11136262,27.529822 C0.776518575,27.194978 0.776518548,26.6520885 1.11136262,26.3172444 L1.11227159,26.3181534 Z\" id=\"Shape\" fill=\"#4285F4\" fill-rule=\"nonzero\"><\/path>\n\t\t\t\t\t<path d=\"M14.3201543,14.3211528 L22.283717,22.2847155 L19.4658829,25.1025495 C19.1310388,25.4373936 18.5881494,25.4373937 18.2533053,25.1025495 L10.2906516,17.1398959 L13.1084857,14.3220618 C13.4429747,13.987572 13.9851638,13.9871653 14.3201543,14.3211528 Z\" id=\"Shape\" fill=\"#EA4335\" fill-rule=\"nonzero\"><\/path>\n\t\t\t\t\t<polygon id=\"Rectangle-path\" fill=\"#FABB05\" fill-rule=\"nonzero\" points=\"18.8573051 18.8577571 28.2843236 9.43073862 31.7120824 12.8584974 22.2850639 22.2855159\"><\/polygon>\n\t\t\t\t\t<path d=\"M35.0711567,15.5054713 L35.0711567,7 L35.0711567,7 C35.0711567,6.44771525 34.6234415,6 34.0711567,6 L25.5656854,6 L25.5656854,6 C25.0134007,6 24.5656854,6.44771525 24.5656854,7 C24.5656854,7.26521649 24.6710423,7.5195704 24.8585786,7.70710678 L33.3640499,16.2125781 L33.3640499,16.2125781 C33.7545742,16.6031024 34.3877392,16.6031024 34.7782635,16.2125781 C34.9657999,16.0250417 35.0711567,15.7706878 35.0711567,15.5054713 Z\" id=\"Shape\" fill=\"#34A853\" fill-rule=\"nonzero\"><\/path>\n\t\t\t\t\t<rect id=\"Rectangle-path\" x=\"0\" y=\"0\" width=\"36\" height=\"36\"><\/rect>\n\t\t\t\t<\/g>\n\t\t\t<\/g>\n\t\t<\/g>\n\t<\/svg>","showScore":true,"siteFavIcon":"https:\/\/paleyinstitute.org\/wp-content\/uploads\/2024\/01\/cropped-favicon-32x32.png","canUser":{"general":false,"advanced":false,"snippet":false,"social":false,"analysis":false,"analytics":false,"content_ai":false},"isPro":true,"is_front_page":false,"trendsUpgradeLink":"https:\/\/paleyinstitute.org\/wp-admin\/admin.php?page=rank-math&view=help","trendsUpgradeLabel":"Activate now","trendsPreviewImage":"https:\/\/paleyinstitute.org\/wp-content\/plugins\/seo-by-rank-math\/assets\/admin\/img\/trends-preview.jpg","currentEditor":false,"homepageData":{"assessor":{"powerWords":["a cut above","absolute","absolutely","absolutely lowest","absurd","abuse","accurate","accuse","achieve","actionable","adaptable","adequate","admit","adorable","advantage","advice","affordable","aggravate","aggressive","agitated","agonizing","agony","alarmed","alarming","alienated","aligned","alive","all-inclusive","alluring","always","amazing","amp","animated","annihilate","announcing","anonymous","antagonistic","anxious","apocalypse","appalled","approved","approving","argumentative","armageddon","arrogant","ass kicking","assault","assured","astonishing","astounded","astounding","at ease","atrocious","attack","attractive","audacity","authentic","authoritative","authority","avoid","aware","awe-inspiring","awesome","awkward","backbone","backdoor","backed","backlash","backstabbing","badass","balanced","banned","bargain","barrage","basic","battle","beaming","beat down","beating","beautiful","beauty","begging","behind the scenes","belief","belong","best","best-selling","better","beware","big","billion","black market","blacklisted","blast","blessed","blinded","blissful","blood","bloodbath","bloodcurdling","bloody","blunder","blushing","bold","bomb","bona","bona fide","bonanza","bonus","bootleg","bottom line","bountiful","brave","bravery","brazen","break","breaking","breakthrough","breathtaking","bright","brilliant","broke","brutal","budget","buffoon","bullshit","bully","bumbling","buy","cadaver","calm","cancel anytime","capable","captivate","captivating","carefree","case study","cash","cataclysmic","catapult","catastrophe","caution","censored","centered","certain","certainly","certified","challenge","charming","cheap","cheat","cheat-sheet","cheer","cheerful","child-like","clarity","classified","clear","clueless","collapse","colorful","colossal","comfortable","compare","competitive","complete","completely","completeness","comprehensive","compromise","compulsive","concealed","conclusive","condemning","condescending","confess","confession","confessions","confident","confidential","conquer","conscientious","constructive","content","contrary","controlling","controversial","convenient","convert","cool","cooperative","copy","corpse","corrupt","corrupting","courage","courageous","cover-up","covert","coward","cowardly","crammed","crave","crazy","create","creative","cringeworthy","cripple","crisis","critical","crooked","crush","crushing","damaging","danger","dangerous","daring","dazzling","dead","deadline","deadly","death","decadent","deceived","deceptive","deep","defiance","definitely","definitive","defying","dejected","delicious","delight","delighted","delightful","delirious","delivered","demoralizing","deplorable","depraved","desire","desperate","despicable","destiny","destroy","detailed","devastating","devoted","diagnosed","direct","dirty","disadvantages","disastrous","discount","discover","disdainful","disempowered","disgusted","disgusting","dishonest","disillusioned","disoriented","distracted","distraught","distressed","distrustful","divulge","document","dollar","dominate","doomed","double","doubtful","download","dreadful","dreamy","drive","drowning","dumb","dynamic","eager","earnest","easily","easy","economical","ecstatic","edge","effective","efficient","effortless","elated","eliminate","elite","embarrass","embarrassed","embarrassing","emergency","emerging","emphasize","empowered","enchant","encouraged","endorsed","energetic","energy","enormous","enraged","enthusiastic","envy","epic","epidemic","essential","ethical","euphoric","evil","exactly","exasperated","excellent","excited","excitement","exciting","exclusive","exclusivity","excruciating","exhilarated","expensive","expert","explode","exploit","explosive","exposed","exquisite","extra","extraordinary","extremely","exuberant","eye-opening","fail","fail-proof","failure","faith","famous","fantasy","fascinating","fatigued","faux","faux pas","fearless","feast","feeble","festive","fide","fierce","fight","final","fine","fired","first","first ever","flirt","fluid","focus","focused","fool","fooled","foolish","forbidden","force-fed","forever","forgiving","forgotten","formula","fortune","foul","frantic","free","freebie","freedom","frenzied","frenzy","frightening","frisky","frugal","frustrated","fulfill","fulfilled","full","fully","fun","fun-loving","fundamentals","funniest","funny","furious","gambling","gargantuan","genius","genuine","gift","gigantic","giveaway","glamorous","gleeful","glorious","glowing","goddamn","gorgeous","graceful","grateful","gratified","gravity","great","greatest","greatness","greed","greedy","gripping","grit","grounded","growth","guaranteed","guilt","guilt-free","gullible","guts","hack","happiness","happy","harmful","harsh","hate","have you heard","havoc","hazardous","healthy","heart","heartbreaking","heartwarming","heavenly","hell","helpful","helplessness","hero","hesitant","hidden","high tech","highest","highly effective","hilarious","hoak","hoax","honest","honored","hope","hopeful","horribly","horrific","horrifying","horror","hostile","how to","huge","humility","humor","hurricane","hurry","hypnotic","idiot","ignite","illegal","illusive","imagination","immediately","imminently","impatience","impatient","impenetrable","important","impressive","improved","in the zone","incapable","incapacitated","incompetent","inconsiderate","increase","incredible","indecisive","indulgence","indulgent","inexpensive","inferior","informative","infuriated","ingredients","innocent","innovative","insane","insecure","insider","insidious","inspired","inspiring","instant savings","instantly","instructive","insult","intel","intelligent","intense","interesting","intriguing","introducing","invasion","investment","iron-clad","ironclad","irresistible","irs","is here","jackpot","jail","jaw-dropping","jealous","jeopardy","jittery","jovial","joyous","jubilant","judgmental","jumpstart","just arrived","keen","kickass","kickstart","kill","killed","killing","kills","know it all","lame","largest","lascivious","last","last chance","last minute","latest","laugh","laughing","launch","launching","lavishly","lawsuit","lazy","left behind","legendary","legitimate","liberal","liberated","lick","lies","life-changing","lifetime","light","lighthearted","likely","limited","literally","little-known","loathsome","lonely","looming","loser","lost","love","lucrative","lunatic","lurking","lust","luxurious","luxury","lying","magic","magical","magnificent","mainstream","malicious","mammoth","manipulative","marked down","massive","master","masterclass","maul","mediocre","meditative","meltdown","memorability","memorable","menacing","mesmerizing","meticulous","mind-blowing","minimalist","miracle","mired","mischievous","misgiving","missing out","mistake","monetize","money","moneyback","moneygrubbing","monumental","most important","motivated","mouth-watering","murder","mystery","nail","naked","natural","naughty","nazi","nest egg","never","new","nightmare","no good","no obligation","no one talks about","no questions asked","no risk","no strings attached","non-controlling","noted","novelty","now","obnoxious","obsessed","obsession","obvious","odd","off-kilter","off-limits","off-the record","offensive","official","okay","on-demand","open-minded","opportunities","optimistic","ordeal","outlawed","outrageousness","outstanding","overcome","overjoyed","overnight","overwhelmed","packed","painful","painless","painstaking","pale","panic","panicked","paralyzed","pas","passionate","pathetic","pay zero","payback","perfect","peril","perplexed","perspective","pessimistic","pioneering","piranha","pitfall","pitiful","placid","plague","played","playful","pleased","pluck","plummet","plunge","poison","poisonous","polarizing","poor","popular","portfolio","pound","powerful","powerless","practical","preposterous","prestige","price","priceless","pride","prison","privacy","private","privileged","prize","problem","productive","professional","profit","profitable","profound","promiscuous","promising","promote","protect","protected","proven","provocative","provoke","psychological","pummel","punch","punish","pus","quadruple","quality","quarrelsome","quick","quick-start","quickly","quiet","radiant","rare","ravenous","rebellious","recession-proof","reckoning","recognized","recommend","recreate","reduced","reflective","refugee","refund","refundable","reject","relaxed","release","relentless","reliable","remarkable","replicate","report","reprimanding","repulsed","repulsive","research","resentful","resourceful","responsible","responsive","rested","restricted","results","retaliating","reveal","revealing","revenge","revengeful","revisited","revolting","revolutionary","reward","rich","ridiculous","risky","riveting","rookie","rowdy","ruin","rules","ruthless","sabotaging","sacred","sadistic","sadly","sadness","safe","safety","sale","sampler","sarcastic","satisfied","savage","savagery","save","savings","savvy","scam","scandal","scandalous","scarce","scared","scary","scornful","scream","searing","secret","secret agenda","secret plot","secrets","secure","security","seductive","seething","seize","selected","self-hating","self-sufficient","sensational","senseless","sensual","serene","seriously","severe","sex","sexy","shaking","shameful","shameless","shaming","shatter","shellacking","shocking","should","shrewd","sick and tired","signs","silly","simple","simplicity","simplified","simplistic","sincere","sinful","sins","six-figure","sizable","sizzle","sizzled","sizzles","sizzling","sizzlingly","skill","skyrocket","slaughter","slave","sleazy","sleeping","sly","smash","smiling","smug","smuggle","smuggled","sneak-peek","sneaky","sniveling","snob","snooty","snotty","soar","soaring","solid","solution","spank","special","spectacular","speedy","spell-binding","spine","spirit","spirited","spiteful","spoiler","spontaneous","spotlight","spunky","squirming","stable","staggering","startling","steady","steal","stealthy","steamy","step-by-step","still","stoic","stop","strange","strangle","strategy","stressed","strong","strongly suggest","struggle","stuck up","studies","stunning","stupid","stupid-simple","sturdy","sublime","succeed","success","successful","suck","suddenly","suffer","sunny","super","super-human","superb","supercharge","superior","supported","supportive","sure","sure fire","surefire","surge","surging","surprise","surprised","surprising","survival","survive","suspicious","sweaty","swoon","swoon-worthy","tailspin","tank","tantalizing","targeted","tawdry","tease","technology","teetering","tempting","tenacious","tense","terrible","terrific","terrified","terrifying","terror","terrorist","tested","thankful","the truth","threaten","threatened","thrilled","thrilling","thug","ticked off","tickled","timely","today","torture","toxic","track record","trade secret","tragedy","tragic","transform","transparency","trap","trapped","trauma","traumatized","treacherous","treasure","tremendous","trend","tricks","triggers","triple","triumph","truly","trusting","trustworthy","truth","truthful","turbo-charge","turbocharges","tweaks","twitching","ultimate","unadulterated","unassuming","unauthorized","unbelievable","unburdened","uncaring","uncensored","uncertain","uncomfortable","unconditional","uncontrollable","unconventional","uncovered","undeniable","under priced","undercover","underground","underhanded","underused","unexpected","unforgettable","unheard of","unhurried","uninterested","unique","unjustified","unknowingly","unleashed","unlimited","unlock","unparalleled","unpopular","unreliable","unresponsive","unseen","unstable","unstoppable","unsure","unsurpassed","untapped","unusual","up-sell","upbeat","uplifted","uplifting","urge","urgent","useful","useless","validate","valor","valuable","value","vanquish","vaporize","venomous","verify","vibrant","vicious","victim","victory","vigorous","vilified","vindictive","violated","violent","volatile","vulnerable","waiting","wanted","wanton","warning","waste","weak","wealth","weird","what no one tells you","whip","whopping","wicked","wild","willpower","withheld","wonderful","wondrous","woozy","world","worry","worst","worthwhile","wounded","wreaking","youthful","zen","zinger"],"diacritics":true,"researchesTests":["contentHasTOC","contentHasShortParagraphs","contentHasAssets","keywordInTitle","keywordInMetaDescription","keywordInPermalink","keywordIn10Percent","keywordInContent","keywordInSubheadings","keywordInImageAlt","keywordDensity","keywordNotUsed","lengthContent","lengthPermalink","linksHasInternal","linksHasExternals","linksNotAllExternals","titleStartWithKeyword","titleSentiment","titleHasPowerWords","titleHasNumber","hasContentAI"],"hasBreadcrumb":true,"serpData":{"title":"%sitename% %page% %sep% %sitedesc%","description":"","titleTemplate":"%sitename% %page% %sep% %sitedesc%","descriptionTemplate":"","focusKeywords":"","breadcrumbTitle":"Home","robots":{"index":true},"advancedRobots":{"max-snippet":"-1","max-video-preview":"-1","max-image-preview":"large"},"facebookTitle":"","facebookDescription":"","facebookImage":"","facebookImageID":""}}},"tocTitle":"Table of Contents","tocExcludeHeadings":[],"listStyle":"ul","localBusiness":{"limit":0,"mapStyle":"hybrid","routeLabel":"My Route"}},"_links":{"self":[{"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/pages\/11878","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/comments?post=11878"}],"version-history":[{"count":15,"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/pages\/11878\/revisions"}],"predecessor-version":[{"id":48826,"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/pages\/11878\/revisions\/48826"}],"wp:attachment":[{"href":"https:\/\/paleyinstitute.org\/wp-json\/wp\/v2\/media?parent=11878"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}