Pediatrics
Deanna Jewell, DO
Assistant Professor
University of Wisconsin Madison
Madison, Wisconsin, United States
Deanna Jewell, DO
University of Wisconsin Madison
Madison, Wisconsin, United States
A 7-year-old with a history of lipomyelomeningocele was seen in multidisciplinary clinic. Neurologic exam revealed at least 4/5 strength in bilateral lower extremities, except for trace dorsiflexion and plantarflexion in the right ankle, with decreased sensation distally. Previously active and athletic, he was nonweightbearing on the right distal lower extremity, to manage wounds on the lateral ankle and foot. His surgical history included clubfoot correction and subsequent tibialis tendon transfers years later, which failed to correct persistent forefoot supination. This led to ambulation on the lateral aspect of his foot and pressure wound development in his AFO. He required wound care for years and unfortunately developed osteomyelitis which was treated with incision and drainage, bony resection, and prolonged courses of antibiotics. Despite aggressive management, he developed wound dehiscence. After multidisciplinary evaluation and shared decision-making, the family elected to proceed with Syme amputation.
Discussions:
This patient experienced over two years of weightbearing restrictions, requiring intensive wound management and frequent clinical follow-up. These limitations significantly impacted his participation in age-appropriate activities, including sports and play, contributing to reduced psychosocial well-being. Despite multiple surgical interventions and prolonged antimicrobial therapy, wound healing remained incomplete. After comprehensive interdisciplinary evaluation and shared decision-making, the family elected to proceed with Syme amputation to optimize function and quality of life. At follow-up several months post-op, the patient had successfully completed prosthetic training and re-engaged in meaningful activities at home and school. His ability to rejoin play with peers and siblings brought visible joy and marked a meaningful restoration of his quality of life.
Conclusions:
This case highlights the importance of individualized, goal-directed care and demonstrates how amputation, though a difficult decision for families, can be a restorative intervention that enhances mobility, independence, and participation in children with complex neuromuscular conditions.
