Radhika Poppy Ennis is an energetic 4-year-old who loves to laugh, play and dance. But until recently, she was unable to stand or walk on her own.
When Leslie and Jeremy Ennis adopted Radhika from India last year, she had extensive burns on her lower body. She could not straighten or use her left knee and moved around with her arms, dragging her left leg. The family was referred to Dr. Vincent Mosca, an orthopedic surgeon and chief of foot and limb deformities within the Orthopedics and Sports Medicine department at Seattle Children’s. The only option was to amputate Radhika’s lower leg, so that she could get a prosthesis.
In the past year, Radhika has not only learned a new language and way of life. She also underwent surgery and received a shiny blue prosthetic leg.
“Radhika is really determined and resilient,” said Leslie. “She has been through a lot, but from the very beginning she’s been really happy and up for adventure. We were excited for her to be able to run, dance, play with other kids and just to be off the floor and be seen. She loves people and wants to be in the mix so badly.”
The best option
Leslie said they first saw a picture of Radhika when their adoption agency presented her file to the family. The couple worked with a physician at the University of Washington to review Radhika’s medical files.
“We were most concerned about her having mobility,” said Leslie. “We were told that the worst case scenario would be that she would need an amputation and the use of a prosthetic. I knew that even if that was the case, we would be in good hands because Dr. Mosca has a lot of experience and we felt lucky about being close to Seattle Children’s. We moved forward with the process to match with her.”
They returned home with Radhika in July 2018, and were surprised at how efficiently and quickly she moved around with her arms and right leg. Soon, the family had an appointment with Mosca.
Radhika’s left knee and left ankle were severely contracted, or unable to be straightened, with her knee permanently bent.
“When a burn is really deep, it can burn the skin, fat, muscle and even the bone, as it did with Radhika. She could not straighten her leg because it had no functioning muscle,” said Mosca. “When the knee is flexed for a long period of time, the nerve, artery and vein below the knee become shortened. Straightening the knee would stretch them beyond their capacity.”
Mosca did X-rays of Radhika’s leg and talked to the Ennises about knee disarticulation, or an amputation through the knee. Since her knee could not be made into a functional, comfortable knee with good blood supply, her leg was unable to be reconstructed. A prosthetic would give her knee the most natural range in motion.
Though worried at first about the amputation, Leslie said they knew it was the best decision for Radhika.
“I was still hoping that she would have the use of her knee because that would make things so much easier for her,” said Leslie. “Dr. Mosca was really great at making us comfortable about the amputation. He said that with kids that get prosthetics, it becomes part of their bodies. I was able to realize that we were doing the best thing for her.”
Seattle Children’s also connected Leslie and Jeremy with a family who has a son with a similar kind of amputation, which further dispelled their concerns about the amputation.
One step closer to a new leg
To help prepare Radhika for surgery, Leslie said they showed Radhika videos of kids with prosthetics and introduced the words “prosthetic leg.”
“She understood right away when we told her, ‘You’re going to get a prosthetic leg’ and ‘You’re going to walk and run,’” said Leslie. “She was so happy, and would clap and squeal in excitement. Then we started talking to her about surgery, and we showed on her leg where the amputation would be. We tried to focus on getting the prosthetic. It helps that she really respects doctors.”
Mosca removed Radhika’s lower left leg and foot, leaving her entire thigh bone and soft tissues that fit into the prosthetic. The prosthetic consists of her knee joint, lower leg segment, ankle joint and foot.
“The surgery went really well,” said Mosca. “Radhika did great with the operation, and it looked exactly how I hoped it would look.”
Radhika was a “trooper” in the hospital, said Leslie. Once she was home and on the last day of her pain medication, she started to move around in her cast, dancing and spinning around. Soon, Radhika was back to being her bubbly, happy-go-lucky self.
“I rave about Seattle Children’s,” said Leslie. “Dr. Mosca was wonderful. He was reassuring and knew exactly the right surgery for her. It was great to trust that he knew how to take care of her and get her mobile. He really spent time with us and we never felt rushed.”
After surgery, Radhika was motivated to get stronger during physical therapy as she waited to get her prosthetic leg.
“Radhika hasn’t shown any signs of being upset about the actual amputation,” said Leslie. “We speculated that it must because the leg wasn’t serving her. She wasn’t using it.”
A new prosthesis for the New Year
In the month leading up to getting her leg, Radhika had appointments at Seattle Children’s for measuring and testing a prosthetic between her physical therapy appointments.
Prosthetist Peter Yukawa, a member of Seattle Children’s Orthotics and Prosthetics team, made a cast mold of Radhika’s leg and then made a socket for the artificial leg he created for her with prosthetic components. As Radhika grows throughout the years, Yukawa will need to make a new socket eventually.
Mosca said most of his patients opt for unique prostheses adorned with princesses, butterflies, flames, exposed components and more. For her prosthetic, Radhika chose a bright, shiny blue.
At her prosthetics fitting in mid-December, Radhika was able to walk with assistance for the first time. She put on a second shoe for the first time and immediately wanted to stand. She shifted back and forth on both legs, holding onto Leslie’s hands.
When the day to get her leg finally came, Radhika beamed with excitement. She received her prosthetic at Seattle Children’s on Dec. 31, just in time for the new year and starting school in January.
“No more scooting!” she proclaimed. “I’m going to walk.”
After Yukawa fitted her prosthesis, Radhika practiced walking with assistance. Mosca dropped by to see the family and said that Radhika looked comfortable in her new leg.
“Eventually, the knees will line up,” said Mosca. “Her ability to control her prosthetic leg will come with maturity. She has to know how to walk before she can make her knee work.”
Yukawa predicted that Radhika would be walking on her own within the next month.
Determined to walk
After the first week, Radhika took unassisted steps. By the second week, she walked while holding onto the wall. It only took her about three weeks to walk independently.
“The first time that she took her first unassisted steps between me and Jeremy, I felt how parents feel when their kid walks for the first time,” said Leslie. “I was so happy for her and she wanted to keep walking between us. We helped build her confidence by showing her that she doesn’t always need us to hold her and that it’s okay to fall. She can always get up and try again.”
Radhika now attends physical therapy at Seattle Children’s South Clinic, where she will continue to practice walking. Mosca will have follow-up appointments with Radhika, and Yukawa will adjust her prosthetics as she grows, change the knee to be free swinging and eventually add higher activity parts.
“Radhika is doing awesome, and has progressed so quickly,” said Yukawa. “She started independently walking just a couple of weeks after her fitting, which is pretty quick. It really shows how resilient she is and how much she is thriving in her new home situation.”
Mosca agreed that Radhika’s potential for a full life is “excellent.”
“With her intelligence and the help of her parents, Radhika is going to go far,” said Mosca.
A whole new world
Radhika is comfortable wearing her new leg most of the time, whether she’s at school, the park or the children’s museum.
“Her prosthesis has definitely improved her life overall,” said Leslie. “She saw a friend at the museum and they were holding hands and walking together. It’s next level seeing her be able to live her full life as a kid, alongside her peers.”
Another change has been Radhika’s new friendship with the family’s dog Charlie. Since she has been able to stand on two legs, she feels more confident around Charlie.
“I am glad we were able to be there for her during this experience,” said Leslie. “I think it helped us bond and understand her better. She’s really proud of herself and we’re really proud of her. It’s been a long road from seeing Dr. Mosca for the first time to learning how to walk.”
Radhika is still navigating stairs and how walking feels different on the pavement, grass and indoors, but she’s starting to walk faster, suggesting that her next step will be running. Recently, Radhika hiked almost a mile with Leslie.
“Her relationship with the environment around her has changed, and she notices so many things that she didn’t notice while in a stroller,” said Leslie. “When she takes walks now, she interacts with trees and birds. It’s kind of a whole new world.”