ATLANTA, GA (Ivanhoe Newswire) - He's overcome a developmental disorder to compete on the ice, but a physical abnormality almost forced him to give up his passion.
For 11-year-old Harrison Sokol, skating is everything.
"I've been skating since I was four, and I pretty much like everything about it," Harrison said.
Harrison has an autism spectrum disorder, but when he puts on a pair of skates, there's no stopping him.
"There's no telling him what he can or can't do," Laura Sokol, Harrison's mom, told Ivanhoe.
Autism isn't Harrison's only challenge. He was born with a painful abnormality of calf muscle and bone that made him more and more unstable
"His feet started rolling in and it just got worse and worse," Laura said.
To get Harrison back on track, Doctor Mark Gorman performed his own spin on a procedure called gastrocnemius recession, to lengthen Harrison's Achilles tendons.
"We stretch the calf muscle, the gastrocnemius muscle where the tendon and muscle come together right at that area without damaging the tendon," Mark R. Gorman, DPM, diplomate abfas, explained.
Then, a custom-fit conical titanium implant was placed between the heel bone and ankle bone in each foot, to restore normal stability and mobility.
A year after surgery, Harrison is back on the ice solo skating, ice dancing and winning gold. A tough competitor heading toward his biggest challenge yet, the 2013 International Special Olympics.
Now that Harrison's stability and motion problem has been surgically repaired, doctors say it's likely to be a permanent solution. Though future complications are unlikely, the conical implants in his feet can easily be removed or replaced if necessary.
RESEARCH SUMMARY
BONE AND MUSCLE DEFECT: Birth defects can occur in any bone or muscle, although the bones and muscles of the skull, face, spine, hips, legs, and feet are affected most often. Bones and muscles may develop incompletely. Also, structures that normally align together may be separated or misaligned. Usually, bone and muscle defects result in abnormal appearance and function of the affected part of the body. Most of these defects are repaired surgically if symptoms are troublesome. Often, the surgery is complex and involves reconstructing deformed or absent body parts. ( Source: Home Health handbook)
ABNORMALITIES OF THE FEET: Clubfoot (talipes equinovarus) is a defect in which the foot and ankle are twisted out of shape or position. The usual clubfoot is a down and inward turning of the hind foot and ankle, with twisting inward of the forefoot. Sometimes the foot only appears abnormal because it was held in an unusual position in the uterus (positional clubfoot). In contrast, true clubfoot is a structurally abnormal foot. With true clubfoot, the bones of the leg or foot or the muscles of the calf are often underdeveloped.
FIXING IT: Gastrocnemius recession is commonly performed to correct an equinus contracture of the ankle that may accompany foot and ankle pathology in adults. The equinus deformity leads to excessive pressure and pain that manifests as plantar fasciitis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers. The procedure is also performed on individuals who have limited ankle dorsiflexion. ( Source: American Academy of Orthopedic Surgeons)
A NEW SPIN: Doctor Mark R. Gorman is changing the game. He's using a custom-fit conical titanium implant placed between the heel bone and ankle bone in each foot, to restore normal stability and mobility. "We used to actually cut a piece of bone either from the hip or from the tibia and put it in there and rough up the bones on the calcaneus heel bone and the ankle bone the talus, rough that up and put that in and put somebody in a cast for two to three months and that would become a solid piece of bone." Dr. Gorman said. "No foot pain, no leg pain, no pathology."
INTERVIEW
Dr. Mark Gorman, Podiatrist, explains the use of an innovative implant that is used for children with disabilities and have trouble walking.
What was going on with Harrison's feet?
Dr. Gorman: Harrison has been a patient of ours since 2007, he is an autistic child which causes some abnormalities in the walking pattern. Harrison has really been very cooperative, his family, he was somewhat not totally balanced. His feet rolled in, what we call pronated they rolled in and along with that he had a very tight calf muscle. The muscle in the back of his leg was very tight. When Harrison walked his feet turned in and he pronated. Also associated with that and part of that cause was a very tight muscle in the back of his leg, the Achilles tendon muscle which is called the gastrocnemius muscle belly. So we treated him conservatively from 2007 to 2009 when we did the first surgical procedure. We put foot orthotics on him, we gave him exercises, we had some physical therapy and he had been doing very well but continued to have some discomfort, some instability, some abnormality in his walking pattern. His family being very interested, particularly his mother, and he was a very active special olympic ice skater. Fairly well trained, very well trained actually and this was limiting him slightly in what he was able to do. So at that point we elected to discuss with the family, his mother, and to consider a surgical procedure. The surgical procedure included two things, Number one; the first surgical procedure was to lengthen the Achilles tendon area but the older type of Achilles tendon lengthening was very disabling you had to actually cut in to the tendon. We did a procedure that's been around for a while but been modified where we stretch the calf muscle, that gastrocnemius muscle at where the tendon and the muscle come together, right at that area and without damaging the tendon. So that initially allows the foot to go a little bit more up, we call it dorsiflexion and as a result that would then allow his foot not to pronate as much. Because of his autistic pathology, the ambulation, the second we discussed and we put it in was a little implant in his subtalar joint, in the sinus tarsi area and that's called a subtalar joint arthroereisis. This procedure has been around a few years but its been modified, the technology, the type of equipment that's being used has made it a much simpler procedure to do. A much more effective procedure to do and the patients respond better. Many, many years ago what they would do instead of doing this implant that we put in there they would actually fuse, they would take a piece of bone from the hip put it down there and they would fuse that joint so that joint had little or no motion. Then they modified that by going in and trying to take a little piece of bone out of the calcaneus, that's the heel bone, and try to place that in to the joint. And then through technology and research they designed various types of little implants which went in to the sinus tarsi area subtalar joint and stabilized it. So that's the procedure that we performed on Harrison.
What does the implant do and what is it made of?
Dr. Gorman: The implant is made of titanium that one, initially it was made of other products but now it's made of titanium and it slows down the ability to what we call pronate. The heel bone is here the ankle bone is called the talus, the calcaneus is called the talus and right between them there is a joint, the body is put together with a little joint, all we've done we've done with that implant is place that conical implant in that joint which stabilizes the amount of mobility that he has in one direction form of pronation allowing that foot to function in a more average mechanical status. The nice thing about this procedure although Harrison did marvelous, if there's any complications that little implant can be taken out and the patient and the patient can be right back to where they were before. So we've done no permanent damage.
So you used to cut the tendon and take the bone?
Dr. Gorman: We used to actually cut a piece of bone either from the hip or from the tibia and put it in there and rough up the bones on the calcaneus heel bone and the ankle bone the talus, rough that up and put that in and put somebody in a cast for two to three months and that would become a solid piece of bone. There would be no motion at all. So instead of just restricting the motion slightly and still having it mechanically correct that would fuse that solid and the patient would have no problems, down the road that patient would have all kind of problems because their body wouldn't be able to function with that joint. That joint would stop their motion.
So why is this a good thing, the Achilles tendon and the implant for the patient?
Dr. Gorman: Well that was a good thing for a kid like Harrison because he was able to maintain his mobility, maintain his motion in that joint without fusing it. Give him that length that he needed in that tendon that the average person would have and allow him to function without any secondary complications. No foot pain, no leg pain, no pathology. And more important as he became older the problem with some of the pathology that Harrison had initially as he would get older these things become a larger problem. They don't stabilize they continue to become worse. So we have reversed it back to what the average person has and the patient should do very well and he's been doing very well every since.
What is the recovery time with this new procedure versus the way they used to do it?
Dr. Gorman: Those were probably about three to six months Harrison was back on skates in about two months I think.
This is a game changer for him.
Dr. Gorman: He's thrilled, as is his family and his mother. And I actually talked with his coach here in Scottsdale right shortly afterward and he functioned well, he did great.
This is not a real routine procedure, how many kids are born with these kinds of abnormalities?
Dr. Gorman: A lot of children are built with pronation, a roll in, but only a certain number of them. Many times we can stretch that calf muscle out physically, physical therapy with exercises we can get it back to normal. You can also by using a foot orthotic, not an arch support but a foot orthotic we can control the mechanics in the foot and they don't need any surgical procedure. I would say that I personally probably do eight to ten of these a year.
With the way the technology and the procedure has advanced it's a breakthrough for kids.
Dr. Gorman: I have yet to have a child and tomorrow something could change but I have yet to have a family or a child who hasn't been pleased and thrilled with the results.
Tell me what you did.
Dr. Gorman: Here the Achilles tendon or the gastrocnemius muscle attaches right here and goes up to above the knee. About this area right here we stretched it, we do what we call a tongue and grove we don't just cut it. We go in there and we let Mother Nature because it's so tight it will stretch on its own. Very similar to an accordion, it's stretched out and we've got the motion we needed. That's the secret to starting. Right here this heel bone is the calcaneus this ankle bone is called the talus, right here where I'm using this little forcep is where that little hole in our foot, we all have it is. Years ago they would take a piece of bone either from the tibia or the hip and they would put it in here, rough up the joint cartilage, rough up that and create a solid block. That in turn would stop the motion but it was permanent there was no motion at all. What has been designed over a period of years is a little conical implant device, this is a sample. Pronation is when this foot rolls in like this. Putting this little conical device right here, that stops that motion and we've designed, as I use the word conical, that it fits right in there without doing any damage to the surrounding tissue. The body has given us this area to work with and we've taken advantage of it.
Will his bone grow around that to keep it in place?
Dr. Gorman: It stays in place, I like to wait until a child has begun to be fairly well mature before we do it because their feet won't change a lot. But this builds a little fibrous union around it and it won't slide out. The other secret is because you have to put this in at a certain position and that way once it's in there it stabilizes itself. Get this in about half way across the talus bone, get in about half way across.
And you did this on both feet?
Dr. Gorman: Both feet, we did one at a time.
How many surgeries did he have all together?
Dr. Gorman: He had two surgeries one on each foot, but four procedures two procedures on each foot.
FOR MORE INFORMATION, PLEASE CONTACT:
Mark R. Gorman, DPM, Diplomate ABFAS
(480) 998-6079
drmgorman@gmail.com
