Foot and Ankle Reconstruction and Tendon Transfer - Brenna Schettler-Pinkley

It is often a father’s dream to walk his daughter down the aisle on her wedding day. For Brenna Schettler-Pinkley’s father, though, that moment was more than he had hoped and prayed for — his daughter was actually walking freely on her very special day.

“He was just so overcome with emotion and he started crying,” Brenna recalls with a smile. “It was overwhelming for him, my mother and me because there was a time when we thought I’d never walk on my own again.”

The wedding in May 2016 came almost six years to the day that Brenna, a high school student at the time, suffered a traumatic foot injury after falling more than 10 feet from a fence.

“It was a spontaneous thing to climb the fence and when I fell, I landed on my left ankle,” she recalls. “I first thought I hurt my back and I had to be taken by ambulance to a hospital.”

At home, with her mother upstairs and her father downstairs, both received emergency calls. “It was a surreal phone call,” says Deb Schettler, Brenna’s mother. “When we got to the hospital, we were just so grateful she was alive. She could have broken her neck or back. We didn’t realize the extent of her foot and ankle damage until we talked with the doctors.”

Brenna suffered several broken bones in her foot and above her ankle. The worst was a pilon fracture that occurred at the bottom of her shinbone. Because it impacted the weight-bearing surface of her ankle, the repair had to be perfect. Compounding her problems was a series of secondary complications that rapidly compromised blood circulation in the foot.

“My bones were basically shattered. We were told that with this type of injury there was a high risk of amputation,” Brenna says. “It was so scary.”

With extensive damage to the soft tissue around her ankle, doctors couldn’t repair the damage with traditional plates and screws. They first had to put an external fixator to hold the bones together. They also did a surgical procedure to try and pinpoint the origin of Brenna’s circulation problems. That surgical wound, however, never healed. After more than a month in the hospital, Brenna was discharged. “She wasn’t walking at all,” says Deb Schettler. “Not only was her injury skeletal, it was also vascular. We had specialized equipment to try and get the wound to close. Home healthcare and occupational and physical therapists came to our house to assist in the recovery, however muscle loss was so extensive, it took months for the wound to close.”

Months after her fall, a church friend recommended Jeffrey Johnson, MD, a foot and ankle specialist with Washington University Orthopedics. Dr. Johnson was frank in his assessment. “She had an open wound, multiple fractures of the ankle that were healing incorrectly and causing her foot to be crooked, and she had severe damage to the muscles in the front of her leg, causing her to lose the ability to move her ankle at all.”

Dr. Johnson immediately set to work to craft a long-range treatment and surgical plan for Brenna. Working with colleagues in pediatric orthopedics and plastic surgery, he decided upon a three-step treatment plan.

Comprehensive Treatment Plan

Step one — correct the mal-aligned ankle. Working with orthopedist Eric Gordon, MD, Johnson first shifted Brenna’s bones to bring the foot and ankle back into proper alignment. They then applied a different external fixation device called the Taylor Spatial Frame, which the family would later learn to adjust daily to slowly pull the foot into the correct rotation and tilt.

Step two — repair the damage left by the open wound. Plastic surgeon Thomas Tung, MD, inserted small tubular balloons on either side of the wound to serve as skin tissue expanders. Over the course of several months, saline was injected into the tubes to stretch the skin. Once the skin was sufficiently big enough, the tissue expanders were removed. Johnson and Tung then removed old scar tissue, cleaned the wound and pulled the skin over the area to finally close the wound. At the same time, Johnson inserted a small, flexible tube to create a tunnel for a later tendon transfer.

Step three — With three muscles in the front of Brenna’s leg damaged and with only one functioning artery to ensure bloodflow to the foot and ankle, Johnson had to take an unusual approach to restoring flexibility without risking blood circulation problems. “We used a side tendon and transferred it to the front of the ankle and then threaded the tendon through the tunnel we had created earlier,” he explains. “That enabled the foot to sit square on the ground and the tendon then served as a ‘motor’ to move the ankle up and down again.”

All totaled, Brenna underwent more than 20 procedures to regain her walking ability. Through it all, she graduated from high school and went to college (at times wearing the external fixator and the tissue expanders).  She now is close to graduating with a master’s degree in occupational therapy.

“She was so determined to both continue her life and get better,” her mother says. “I was so proud of her faith and determination through all of this.”

Along the way, Brenna met her husband-to-be, Kyndyl. They got married on May 29, 2016. After their wedding, Brenna’s mother hand-delivered a thank you card and photos of Brenna walking down the aisle to Johnson’s office.

“I knew Dr. Johnson saw this as a challenge, but he knew what the end goal would be,” says Deb. “I wanted my daughter to just get well. He wanted her to walk again and he made that happen.”

As he looks again at Brenna’s wedding photos and reflects on her six-year journey to heal her foot and ankle, Johnson adds, “We truly put our heads, our hearts and our hands into these challenging cases. Photos like these show why it’s all so worthwhile.”

 

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