Children's Hospital Colorado

Kendall: How the Center for Gait and Movement Analysis Got Her Back in the Game

Kendall smiles with a thumbs up next to a soccer scoreboard.

It takes a lot to slow Kendall down — multiple serious medical conditions, in fact. She didn’t even weigh two pounds when she was born and spent two and a half months in our Neonatal Intensive Care Unit (NICU) with her twin sister, Danika. She’s had multiple surgeries to help with differences in her right leg.

But her family and our care teams were determined that she wouldn’t fall behind her peers. Through all her challenges, she’s competed in multiple high-level sports and excelled in the classroom. She once ran so hard that she broke an ankle brace completely in half while playing soccer.

She’s seen more obstacles than most kids her age, but she’s become quite skilled at jumping over them — or breaking straight through them.

Twin-Twin transfusion syndrome diagnosis before birth

Even before Kendal was born, she faced a potentially life-threatening condition. Her and Danika were diagnosed with twin-twin transfusion syndrome (TTTS), which creates abnormal connections between blood vessels from the twins’ umbilical cords. These connections create uneven blood flow and circulation and can lead to serious issues in the heart and other areas.

Their mom, Kristi, had several amnioreductions for TTTS at our Colorado Fetal Care Center. This procedure uses a needle to remove excess amniotic fluid from around the twins to prevent premature labor and relieve pressure on the umbilical cord. Our maternal fetal medicine doctors and other specialists saw Kristi every week to monitor and treat the twins as quickly as necessary.

When our care team was concerned the TTTS was affecting their hearts, Kristi delivered the twins via an emergency cesarean section at 29 weeks gestation. They had stage III TTTS at birth (stage V being the most severe) and Kendall was wrapped in her amniotic sac and didn’t have a visible bladder at birth.

“We were lucky they were born alive at this point as TTTS progresses so quickly,” Kristi says. “It’s very important to be seen by a maternal fetal medicine doctor and have weekly ultrasounds. I think this was the reason the girls survived — the close monitoring and quick interventions.”

The girls were tiny, but they immediately showed the grit and fight they’re now known for. They started occupational and physical therapy with our neonatal therapists to learn how to feed and do daily activities. The twins started overcoming obstacles quickly.

Care for right-side hemiplegia

As Kendall started growing and passing her baby milestones, her parents noticed that she favored her left hand. She didn’t use her right hand much and when she crawled her right leg would sluggishly drag behind her. Her pediatrician referred her to Anne Stratton, MD, one of our pediatric physical medicine and rehabilitation specialists.

At seven months old, Dr. Stratton diagnosed Kendall with right-side hemiplegia, a condition that causes muscle tone and strength imbalances in her body that affects her walking ability. She underwent years of physical, occupational and speech therapy to improve her strength and functionality on her right side.  

Kendall and her family never let her hemiplegia stop her from doing what she wanted. She started early in soccer, basketball, softball and gymnastics. Danika and Kendall tackled snowboarding in the winter. And true to her nature, when Kendall enjoyed something, she didn’t just want to do it — she wanted to do it really well.

As she joined more competitive soccer leagues, her parents noticed it was harder for her to keep up with her peers. She wore a brace to prevent her foot from pointing in, but the brace would also slow her down and bother her. Without the brace, her right foot and ankle weren’t always strong enough to maintain her balance.

And this wasn’t just while she was playing sports, it affected her overall quality of life.

“Emotionally, it was hard for her,” says Kristi.

Considering surgery: calcaneal osteotomy and split posterior tibial tendon transfer

At 9, Kendall was ready to move past what felt like partial solutions to her right-side hemiplegia. She met with Sayan De, MD, a pediatric orthopedic surgeon, and had diagnostic tests at our Center for Gait and Movement Analysis.

Based on these tests, Dr. De recommended and performed three surgeries: a calcaneal osteotomy to correct the structure of her foot so that the heel would sit squarely under her leg, a split posterior tibial tendon transfer to re-direct and balance the muscle forces on her foot to straighten it and guided growth surgery to straighten Kendall’s ankles.

“The surgeries made a night and day difference,” says Kristi.

More than a year after surgery, Kendall has retired her brace, and much more. She trains and plays with her soccer team, which has helped her progress after her surgeries. On the soccer field, she’s faster, stronger, more agile, has more control and shoots the ball better. She attends high-level soccer camps, plays with more confidence and keeps up with her teammates. She also competes in basketball, softball, math-Olympiad and loves reading.

“I am thrilled our paths crossed with Dr. De, and I can only hope that others who are struggling in similar circumstances can see there are ways around these ‘walls,’” says Kristi.

If Kendall does encounter more walls, she might just run right through them.