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Chloe's Smile Matches Her Bright Future

Chloe returns to Shriners Children's St. Louis from her home country of St. Lucia for a second leg lengthening surgery.

When Chloe and her mother, Magdaleine, touched down in St. Louis in mid-January, they were greeted by cold weather.

They walked out of St. Louis Lambert International Airport into a midwestern winter. Snowflakes and icicles are a far cry from the weather they’re used to in their home country of St. Lucia. However, it’s not their first visit to Missouri or Shriners Children’s St. Louis.

17-year-old Chloe was born with bow leggedness of the left tibia and leg length differences due to Blount’s disease.

“Blount’s disease is associated with leg deformity. Chloe’s type is infantile Blount’s. It was present when she was between 18 months and two years old,” explained Mark Miller, M.D., a Shriners Children’s St. Louis surgeon.

Magdaleine said Chloe was bullied at school because of her deformity. She was left out and ostracized. Verbal abuse led Chloe to have a deflated sense of self-worth and self-esteem.

Chloe's legs

“We, in my home country, are not sensitizing our kids enough to appreciate the kids who are differently abled,” said Magdaleine.

Magdaleine would do anything to take this pain away from her child, she'd even fly 2,500 miles to a foreign country.

Thanks to a partnership with World Pediatric Project, Chloe was brought to Shriners Children’s St. Louis in 2018. At that point, Miller used an external fixator to correct the deformity and gain length in her left leg.

X-ray of fixator and Chloe wearing the fixator

Eight months later, when Chloe and Magdaleine finally returned to St. Lucia, they were hopeful for a different experience at school and in her community.

“I was happy to see that she’d be accepted like everyone else,” said Magdaleine.

For the most part, she was accepted. However, as her teenage years marched on, Chloe continued to grow taller. She began to have new pains; a new problem.

How bowed her leg was hid her knock knee deformity. This was mild but it bothered her. It needed to be corrected so it didn’t cause her pain.
Mark Miller, M.D.

So, Chloe sought help again through World Pediatric Project in 2021. The Shriners Children’s team decided to bring her back to St. Louis for a second highly skilled surgery/treatment plan to lengthen her leg again and correct a slight deformity.

“How bowed her leg was hid her knock knee deformity. This was mild but it bothered her. It needed to be corrected so it didn’t cause her pain,” explained Miller.

Miller used an internal nail to correct her knock knee and inserted a magnetic rod, called an Ellipse nail, into her femur.

“This is a nail that has a magnet inside the rod that’s attached to a series of rotors that aid in the lengthening process. An external magnet (outside the body) communicates with the internal magnet (inside the nail). If you run it for seven minutes, it will lengthen the nail by one millimeter. If our goal is 30 centimeters of length, we’d continue the process for 30 days,” said Miller.

Ellipse nail X-ray

Several days after the surgery, Chloe and Magdaleine started the lengthening process – just as Shriners Children’s staff members taught them to do.

“We educate our patients and families to do the lengthening process on their own. After you understand the process, it’s really very simple,” said Miller.

“This time, it’s not painful. We allow the machine to do its thing,” said Magdaleine.

As Magdaleine and Chloe report, lengthening sessions are typically not painful for the patient. However, as the body adjusts, aches and pains can pop up.

“The cumulative effects of lengthening can be painful because it stresses joints above and below. Physical therapy is a very important part of this procedure, in order to stretch muscles and joints,” said Miller.

During this type of leg lengthening treatment plan, Chloe isn’t permitted to put weight on her left leg. She has been prescribed exercises to do at home and in-person physical therapy three times a week.

“We need the bone she’s making to be strong enough to support her weight bearing,” Miller said.

I hope that she achieves her dreams. That’s why I do everything in my power to help her.
Magdaleine, Chloe's mother

So, what is the science behind the surgery and treatment plan?

When Dr. Miller inserted the nail, he also cut Chloe’s femur. It’s in that break that the team is encouraging her body to create new bone – giving her length and strength.

“Periosteum is the bone covering. In children, periosteum has a lot of blood vessels and bone nutrients. What we’re doing is, as the periosteum gets stretched, it stimulates the body to build new bone. It becomes calcified. That new bone is called ‘regenerate’,” said Miller.

Current Ellipse nails can lengthen a bone up to three inches. In some cases, children require several lengthening treatment plans that can last more than six months each.

“The team has a lot of experience with limb deformity, making this the ideal place to have this type of surgery done. There’s so much that happens outside the operating room to achieve these goals. Everyone works on behalf of these children: nurses, physical therapists, occupational therapists, prosthetists,” Miller said.

“We’ve taken care of kids who’ve had deformities where they wouldn’t even be able to go to school. We’ve given them the independence to go to school and play sports, things they wouldn’t have been able to do previously,” said Miller.

That’s certainly the case for Chloe. She’s gained mobility, independence and confidence. When she grows up, Chloe wants to be a “baby doctor,” a pediatrician.

Chloe with her mother


“I hope that she achieves her dreams. That’s why I do everything in my power to help her,” Magdaleine said.

Everything in her power – including traveling 2,500 miles to live in a foreign country for eight months.

A mother’s love knows no bounds.

“You are special. You are beautifully and wonderfully made. God knew what he was doing when he created you,” said Magdaleine.

If your child has a leg deformity or leg length discrepancy, Miller recommends making an appointment with Shriners Children's so the team can evaluate your child. From there, the team will draw up a treatment plan. Then, the child and family get the chance to know the broader team for preparation and education ahead of surgery. These types of treatment plans require much of the care team and the family. Setting expectations ahead of time ensures successful outcomes.

Chloe Travels to Shriners Children's St. Louis for Second Leg Lengthening Surgery

Chloe is 2,500 miles from her home country of St. Lucia. She last visited Shriners Children's St. Louis in 2018. Chloe is working hard to strengthen her leg ahead of a big surgery next week. Shriners Children's surgeons straightened and lengthened Chloe's left leg several years ago. However, as her body continues to grow, her legs have become uneven again. This causes her to experience a lot of pain. So, Chloe prepares for another surgery. INFO on limb lengthening program: (Thanks to the World Pediatric Project for collaborating with us to bring Chloe and others to St. Louis for lifechanging treatment.)
View Transcript

Chloe: Hey, I'm Chloe. Came all the way from Saint Lucia.

Jody Barlow: She's a joy to be around. She's always very upbeat and happy. She doesn't always enjoy all of the things that we have to do, like any kid, but she makes the best of it. She's a good sport. She's a lot of fun to have around./p>

Chloe: Because they're amazing. They torture me sometimes. You heard that, Jody?/p>

Jody Barlow: Good job. Keep going. Bring your leg back towards me just a bit. So, right now, we're doing some pre-op strengthening for Chloe. She's having surgery next week on her leg to help with her lower extremity deformity in her left leg. So, she got into the country a week or so earlier than her surgery was scheduled. So, she's coming to us three days a week to work on some strengthening of her legs so she is nice and strong before she goes into surgery./p>

Chloe: Not scared, but just nervous. It's different, totally different procedure. I like the snow. It's nice. I can drink coffee, hot cocoa./p>

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