Sixty-two instances of congenital absence of the fibula occurring in forty-eight patients are reported. The transition of treatment from the conservative approach of correction of deformity, using plaster casts, bracing, platform braces, and built-up shoes, to the more radical approach of amputation and prosthesis is presented. End-bearing stumps are recommended for both boys and girls because of the utility of the stump, with or without the prosthesis; the more stable prosthetic gait with end-bearing; and the minimum prosthetic upkeep of these prostheses with few moving parts. Absence of complications in the stump is an important feature in these end-bearing amputations, with no revisions reported to date. The procedure of earlier amputation and fitting of a prosthesis is recommended.