Nine-year-old Ahmir Goodman was born with a rare condition called fibular hemimelia, in which a bone is missing in the lower leg. Thanks to a limb-lengthening procedure by Children’s Center pediatric orthopaedic surgeon Erin Honcharuk, and physical therapy, the fourth grader is now playing football with ease and back in school, where he excels in advanced math and science classes.

Ahmir’s condition was first detected in utero through prenatal ultrasounds, says his mother, Stephanie. Doctors observed he was missing an ankle bone on his right leg, and had only three toes on his right foot. Born with clubfoot, Ahmir had  a tendon-lengthening operation as a baby but otherwise lived without intervention as the family grew and moved from Virginia to Rosedale, Maryland, and the COVID-19 pandemic canceled elective operations. When Ahmir saw Honcharuk in early 2023, there was about a 3-and-a-half-inch difference in length from one leg to the other, and he was noticeably limping. 

Fibular hemimelia, which affects 1 in 40,000 children, causes an abnormality in the development and growth of the affected leg, explains Honcharuk, who sees a handful of patients each year who have the condition. “There’s differences in how the bones of the foot are formed, and differences in the ligaments of the knee, which are sometimes absent,” she says. “It really changes how the leg and its components look.”

During the March 2023 surgery, Honcharuk cut Ahmir’s tibia, the lower leg bone, and applied an external frame that circled his leg, held in place by pins and struts. Then, his family was instructed to make tiny turns on the struts three times a day to slowly lengthen the bone. 

Limb-lengthening efforts like this do not require implants or artificial bone, Honcharuk says.

“When we cut the bone, the body starts to try to heal, just as it does with a fracture,” she says. “We take advantage of that by very slowly increasing the gap between the bones. Healing factors located at the edges of the cut recruit additional healing factors to fill in the gap, and the process continues until we reach our desired length. [Then] the body will start to turn that healing into solid bone. It’s a long process, but we’re able to get significant amount of length.”

After the frame was fully removed that October, Ahmir wore a boot for a time but was back to wearing shoes by Thanksgiving. Throughout their appointments, Honcharuk made sure Ahmir and his mom could see the leg growing.

Beyond typical postoperative pain, says Honcharuk, “the goal is that this is really a pain-free or very minimal pain experience.” She adds, “Most of my patients are off all pain medication by two weeks after surgery.”

Ahmir may need surgery for his knee and likely will need another procedure as a teenager to further even out his legs.

“We’re not out of the woods just yet, but he’s actually at the size he’s supposed to be,” Stephanie says. “I’m forever grateful for Dr. Honcharuk. She did a wonderful job.”