Shriners Children’s physicians are known for their expertise in treating children with complex and rare orthopedic issues. As medical care has advanced, our orthopedic focus has expanded to meet new and greater demands. Many locations are now the local leaders in fractures, sports injuries and follow-up care for childhood orthopedic conditions — including the occasions when an amputation is required.
In 2013, Owen, then 3, was airlifted to a level-one trauma center in suburban Chicago after he sustained a traumatic amputation of part of his foot in a lawn mower accident. The serious injury required surgery within the first 24 hours to stabilize the limb and preserve as much healthy tissue as possible.
Owen’s surgeon, Dr. Jeffrey Ackman, left, is one of the leading specialists on pediatric amputation in the area.
Owen was immediately seen by pediatric orthopedic surgeon Terri Cappello, M.D., who said that in trauma situations, training and instinct work together to determine the best course of action. Dr. Cappello performed a rare ankle disarticulation — known as a Syme amputation — which removes the foot at the ankle while preserving the heel pad to create a weight-bearing limb for a specialized prosthesis. She has performed this procedure only twice in her 25-year career.
“I had to move the tissues that were no longer going to be useful. In doing so, I removed all the bones of his foot but was able to save some skin and soft tissue on the bottom to close the traumatic wound,” Dr. Cappello recalled. “The damage to the skin is important, because you have to have skin to cover the amputation. You can’t walk on a skin graft; you need to walk and bear weight on normal skin.”
Because Owen would require long-term specialized orthopedic and prosthetic care as he grew, Dr. Cappello knew right away she would be referring this young boy to Shriners Children’s for follow-up care.
Change of venue
As Owen recovered, Dr. Cappello recommended the family see Jeffrey Ackman, M.D., at Shriners Children’s Chicago. “I knew that the orthopedic surgeon, as well as the orthotist and prosthetist had the most experience in the city, and that’s what I wanted for Owen. Nowhere except Shriners Children’s, in my opinion, had the ability to care for this patient postoperatively.” Owen’s family followed that advice and brought him to Dr. Ackman, who has the busiest pediatric amputee clinic in a six-county area.
Owen paid a visit to Dr. Terri Cappello to say thanks and update her on his progress.
Over the years, Owen has received 11 prosthetic legs that allowed him to play, jump and keep up with his classmates. Today, Owen is thriving as a happy, confident young man — a ninth grader who recently made the high school golf team.
Joining a winning team
Dr. Cappello now practices at Shriners Children’s Chicago. She joined the institution to expand the location’s general orthopedic practice and fracture clinic and to provide specialized education to referring pediatricians.
When Owen, his mom, Carrie, and the family learned Dr. Cappello now works at Shriners Children’s, they came into the hospital for a reunion. Dr. Cappello enjoyed their gift of a beautiful flower bouquet, but the true highlight was seeing this confident young man.
“It was just so good to hear that he’s physically and emotionally doing well. Seeing how well Owen is doing supported my instinct that Shriners Children’s was the right place to send him. Dr. Ackman’s expertise has helped him reach all of his goals,” Dr. Cappello remarked.
Independence Day for Mariah
Mariah was born with a severe leg length difference resulting from an underdeveloped lower leg. As a young child, she required three different foot surgeries because of the way her movement was impacted. Following the care plan of her orthopedic doctor near their home in New York, Mariah’s parents, Cassandra and Charles, were prepared for her to undergo a leg-lengthening procedure during adolescence. However, when that provider retired, Mariah’s new doctor no longer advised the same treatment. The family didn’t know where to turn.
Shriners Children’s New England physiatrist Jennifer Miller, M.D., treats children with a wide range of conditions that affect mobility.
By this time, Mariah was 11, and her condition significantly limited her activity level. “She couldn’t play sports and had back and hip pain. If she walked long distances, she would get very tired and had to take frequent breaks,” said Cassandra. “Mariah started losing her confidence because she couldn’t keep up with her friends.”
Concerned and seeking a second opinion, Cassandra found the Shriners Children’s website and called immediately. She and Charles were happy to get an appointment right away at Shriners Children’s New England in Springfield, Massachusetts, with orthopedic surgeon and medical director Lael Luedtke, M.D.
At the conclusion of Mariah’s exam, Dr. Luedtke delivered some unexpected news: She determined the best course of action was to amputate Mariah’s foot and then fit her with a prosthesis, evening her leg length and improving her mobility. Mariah and her parents were shocked.
The family took several months to consider their next step, but with the help of her parents, Mariah weighed all the pros and cons and decided to move ahead with the amputation.
The care team at Shriners Children’s provided Mariah with support and reassurance every step of the way. “When Dr. Luedtke walked into the room on the day of the surgery, she knew we were nervous,” recalls Cassandra. “She told us to think of it as ‘Independence Day,’ because that was what Mariah would gain from the amputation. That just changed our perspective on everything.”
Shriners Children’s New England prosthetist Eunice Wong makes final adjustments to Mariah’s custom prosthesis.
Once Mariah healed from surgery, she saw Eunice Wong, MSOP, CPO, a prosthetist with Shriners Children’s New England’s Pediatric Orthotic and Prosthetic Services (POPS), to be fitted for a prosthesis. When Mariah walked with it for the first time, she immediately felt a difference. “It was life changing,” described Mariah. “I never realized I had that much pain until I started walking again and noticed my hips didn’t hurt.”
Having their entire orthopedic care team assembled in one place has given Mariah’s family peace of mind. “Mariah walks into Shriners Children’s and everyone knows her,” said Cassandra. “They make it a point to remember each individual family, something you don’t see elsewhere. Everyone involved in her care makes us feel like our decision was the right one every time we’re there.”
The function specialist
Mariah also received care from an additional specialist, Shriners Children’s New England physiatrist Jennifer Earle Miller, M.D. Dr. Miller works alongside her colleagues in orthopedics, POPS, and physical therapy to help enhance the functional ability and quality of life for patients with physical impairments and disabilities. She has expertise in the rehabilitation of individuals with amputations and limb differences, as well as cerebral palsy, spasticity, low muscle tone and other gait abnormalities.
Unlike other specialties that focus on one organ or body system, physiatry (or physical medicine and rehabilitation) is a philosophy of care that relates to the whole person. “Physiatry takes a step back from traditional diagnostics,” explained Dr. Miller. “For a patient like Mariah,
I look at their day-to-day function and assess how I can eliminate any barriers that might have a medical root to them.”
Dr. Miller’s residency training at Harvard Medical School and Spaulding Rehabilitation Hospital in Boston coincided with the Boston Marathon bombing in 2013, an experience that helped shape her career. She provided acute amputee care for survivors and helped them acclimate to the use of prosthetic devices. “It was a once-in-a-lifetime experience to have as a resident,” explained Dr. Miller. “There was no question I wanted to treat amputees in the future.”
Mariah is a huge fan of the Buffalo Bills and is overjoyed that her prosthesis is emblazoned with the team’s logo.
Dr. Miller went on to work with amputees of all ages at Albany Medical Center in Albany, New York. She also created and led a multidisciplinary clinic there for children with cerebral palsy. Through this work, Dr. Miller discovered that caring for pediatric patients brought her great joy. “When I thought about taking my career to a new setting, the thing I couldn’t live without was treating children,” she said. “Shriners Children’s was the only place I envisioned starting my next chapter.”
According to Dr. Miller, physiatrists focus on optimizing function rather than finding cures. They provide nonsurgical solutions that support patients at every age and stage of life. “What a patient needs today might not be the right thing for them six months or six years down the road,” she explained. “For a new prosthetic user like Mariah, I make sure the device fits her goals, is comfortable and doesn’t cause mobility issues. As she gains confidence, we continue to meet her changing needs.”
Dr. Miller also helps amputees manage symptoms like phantom limb syndrome. She prescribes adaptive seating, wheelchairs and other assistive devices, as well as nerve blocks for spasticity. “I talk with my patients about their symptoms and educate them on available options,” said Dr. Miller. “My goal is to help families live more effectively with mastery of the information surrounding their child’s condition.”
Game-changing personalized care
Drawn to the patient-centered environment at Shriners Children’s, Dr. Miller values collaborating with other specialists. “I love having the ability to walk down the hall and ask a colleague a question,” she said. “It helps us provide the best care for patients like Mariah.”
This personalized care was evident in every stage of Mariah’s treatment, including her prosthesis. A huge Buffalo Bills fan, she worked with Eunice to create a design featuring the team’s logo. On the day her customized prosthesis arrived, Mariah celebrated both her favorite NFL team and her newfound mobility. Two months later, she attended her first-ever Bills game, an experience she’ll never forget.
Mariah, now 12, is also a huge fan of her Shriners Children’s New England team, knowing that at each visit she’ll be heard by providers who put her first. “I’m always excited to go because I’m going to see people that know me,” she said. “They don’t just talk to my parents like I’m not in the room. They ask me how I feel and that makes me happy.”
