Fig. 4A–C.

A 57-year-old man had ankle fusion for a right distal tibia nonunion with bone loss which resulted in 3.6 cm shortening. This was addressed by proximal tibia lengthening using the LAP protocol. The external fixator was removed at 4.8 months and the patient was advised to be toe-touch weightbearing. However, (A) progressive regenerate collapse into varus that eventually resulted in plate breakage was observed on a followup radiograph. The proximal hardware was removed, the external fixator was reapplied, and a proximal tibia osteotomy was performed. (B) The deformity was gradually corrected and alignment was fully restored. (C) The external fixator was removed in 4 months after reliable healing of the osteotomy was confirmed. The alignment remained unchanged at subsequent followups.