Leg length discrepancy (LLD) projected to be greater than 2.5 cm at the end of growth

 An anteroposterior (AP) hips-to-ankles radiograph (Fig. 1) and/or scanograms should be obtained, as well as AP and lateral views of the knee.

 Bone age of the wrist should be determined.

 For proximal fibular epiphysiodesis, the peroneal nerve is coming from posterolateral to anteromedial over the fibular neck (Fig. 2). Avoid it by approaching the fibular physis under direct vision anteriorly over the fibular head.

 The patient is placed supine on a radiolucent table with a bump under the greater trochanter to place the patella anteriorly.

 An unsterile thigh tourniquet is placed.

 Identify the distal femur and proximal tibial and fibular physes with fluoroscopy and mark on the skin.

 Make a 2.0-cm longitudinal incision directly anterior over the proximal fibular physis.

 Spread longitudinally through the subcutaneous tissue and open the lateral edge of the tibialis anterior fascia.

 The muscle is bluntly cleared off the overlying periosteum. Position over the physis is verified with fluoroscopy.

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