Lower Limb Differences Clinic

The Lower Limb Differences Clinic provides care for children from before birth to age 21 who are missing part or all of a lower limb. Many of our patients were born with their limb difference. Some had their limb shortened or removed due to an injury or disease.

We offer a full range of treatment options, both with and without surgery. Members of the clinic team work with each child and family to design a treatment plan that is right for them. Our goal is to help your child have the best function they can and be as active as possible. Our patients are active in many ways, including in sports. It is our pleasure to assist and encourage them.

The clinic team includes an orthopedic surgeon, orthopedic nurse, medical assistant, physical therapist and orthotist/prosthetist. Consultation with a social worker or child life specialist is provided on an as-needed basis. Together we help you make your way through the healthcare system and get your child’s healthcare needs met. For added support, we can connect you with other children and families with limb differences.

Conditions We Treat

In our Lower Limb Differences Clinic, we see children with many conditions, including:

  • Tibia deficiency/tibial hemimelia

    A child with tibial hemimelia is born with a short or missing bone (tibia) of their lower leg. This makes it difficult to put weight on the leg and walk normally.

  • Fibular deficiency/fibular hemimelia

    In fibular hemimelia, a child is born with a short or missing bone (fibula) on the outside of their lower leg. The foot may not form correctly, and the tibia may be curved.

  • Congenital short femur

    The shaft of the thighbone (femur) is shorter than normal in children with congenital short femur. In most children with this condition, only one femur is short. Sometimes the condition affects both legs.

  • Proximal femoral focal deformity (PFFD)

    In PFFD, the hip joint can be affected along with the top of the thighbone (proximal femur) in varying degrees. The length of the femur is always shorter, or in severe cases the femur is absent.

  • Limb differences linked with syndromes

    Many complex conditions have limb differences as one of their features. The team in the Limb Differences Clinic works with children who have these conditions, such as amniotic band syndrome, Apert syndrome and VACTRL. VACTRL stands for vertebral problems (V), imperforate anus (A), cardiac problems (C), tracheoesophageal fistula (T), renal problems (R) and limb differences (L).

Services We Offer

  • Limb lengthening

    To make a bone longer, surgeons make a cut in the bone and attach a frame (fixator or distractor) above and below the cut. After surgery, the frame is used to slowly open the gap between the two sections of the bone, about 1 millimeter each day. Bone grows to fill in this gap. The process takes three months to lengthen the bone an inch.

  • Reconstructive surgery

    Surgery to rebuild the lower limb may correct or improve some limb differences. There are several methods that may be helpful, based on your child’s condition. They include cutting the bone to change the shape, using implants in place of bone, using metal plates and rods to hold bone in place and doing surgery to move muscles and tendons.

  • Amputation

    For some conditions, removing part of a limb may provide the best results for your child.

  • Physical therapy

    Physical therapy helps improve your child’s strength and ability to move, sometimes using custom mobility devices. Our physical therapists work with babies, children and teens to improve their gross motor skills, such as walking, running and playing.

  • Orthotics and prosthetics

    Braces, artificial limbs or both can support or replace body parts. Orthotics and prosthetics improve your child’s function and appearance. Our experts assess your child’s needs and build their devices. Then they make sure the devices fit and function properly now and as your child grows.

  • Prenatal consult

    If you are pregnant and an ultrasound shows your baby may have a lower limb difference, our team can meet with you. We can talk with you about what the ultrasound means, what to expect and what the treatment options may be.

Telemedicine at Seattle Children’s

You may be offered a telehealth (virtual) appointment. Learn more.

Paying for Care

Learn about paying for care at Seattle Children’s, including insurance coverage, billing and financial assistance.

Access Additional Resources

Get resources for patients and families, including information on food, housing, transportation, financial assistance, mental health and more.