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SALT LAKE CITY — Five years ago, Enya Lund's leg was growing rapidly.
She was born with a condition called gigantism, where overstimulated growth plates push the length of one leg inches longer than the other.
At age 5, the one leg was already 1¾ inches longer than the normal leg and was projected to grow another several inches by age 14.
“My hips would be so uneven that I would have pain in my hips, my legs, my feet, my back, and it hurt really bad,” Enya said.
My hips would be so uneven that I would have pain in my hips, my legs, my feet, my back, and it hurt really bad.
–Enya Lund
The traditional treatment for leg length discrepancy, as it’s called, is to fit the patient with an elevated shoe on the normal leg and wait until age 14 to do major invasive and often risky surgery.
At that time, surgeons remove bone from the normal leg and then gradually stretch that leg with a brace until it nears equal length to the longer abnormal leg. Infection, cracks in the bone, broken hardware, unstable joints and multiple scars are all potential complications.
But five years ago, when he met Enya, University of Utah orthopedic surgeon Peter Stevens tried something different and much less expensive.
“My goal was to render her equal by age 14 without any hospitalization or cast, brace, frame or therapy,” Stevens explained.
At Primary Children’s Medical Center, Stevens attached small plates with metal screws to the bone and growth plates in Enya’s longer growing leg. The incisions were small, only 4 millimeters.
The restraints were attached to her tibia first at age 5 and then added to the femur at age 7. The bone below the knee doesn’t grow as quickly and that’s where most of Enya’s length discrepancy was occurring.
The projection was to adjust up to 5/8th of an inch per year of normal growth.
While the restraints slowed down the overstimulated growth plates, the bottom screws were removed periodically through the same small incisions to allow the plates to resume growth.
“What is novel is starting at a very young age to do this and respecting the growth plate — not damaging the growth plate and recognizing that treated properly it will provide enough growth to avoid major surgery,” Stevens said.
My goal was to render her equal by age 14 without any hospitalization or cast, brace, frame or therapy.
–Dr. Peter Stevens
Restraining then backing off, restraining then backing off — over time this procedure paid off. When it began on Enya five years ago, she was among the first in the world to undergo the procedure.
Now at age 9, Enya is walking normally. The hips are straight, and there’s only a quarter of an inch difference between the two legs.
“I think we would have regretted it if we had gone with the traditional way,” said Enya’s mother, Annie Prince. “I think this is the perfect solution for Enya. I just knew it was going to work. I just didn’t think it was going to work this fast.”
Nobody has absolute equal length legs, so with only a quarter of an inch difference, Enya is doing pretty much what she wants to do now. She walks, runs, swims and plays with her friends — something her father, Jacob Lund, feared she would never do comfortably when the legs were growing disproportionately.
“She likes to do those things, but with the difference in the lengths of the leg, I worried about her being able to do that. It’s pretty obvious the surgeries are working,” Lund said.
Stevens said orthopedic surgeons may be good carpenters in the operating room, but they can be patient gardeners as well by just gently pruning things.
In Enya’s case, he said, “when you add it all up it was worth the wait.”
Email:eyeates@desnews.com
