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Augmentation of the Lower Leg: A New Combined Calf-Tibial Implant

Background: The underdeveloped lower leg can be a source of embarrassment. Underdevelopment or atrophy may be associated with asymmetry, congenital deformity (tibial torsion, pes planus, genu valgus), traumatic nerve damage, or disease (polio). In some people, muscular development simply fails to respond to exercise. Augmentation of the calves with subfascial silicone implants has been practiced for 25 years and is a reliable procedure. The implant is placed through a transverse popliteal incision in a plane dissected between the gastrocnemius fascia and muscle. One or both heads of the gastrocnemius are augmented—a larger size is usually used medially. When the lower portion of the leg is also thin, and especially when there is tibial torsion, augmentation of the calf alone may exaggerate the deformity. Methods: A new one-piece combined medial calf–medial leg implant has been developed and used in 15 patients (n = 30 implants). Results: Augmentation/correction has met with complete patient approval (except for one patient who wished to have a larger size). Conclusion: A new and effective implant to correct various deformities or lack of development of the lower leg is presented.