Limb Differences

The Center for Limb Differences at Mary Free Bed Kids specializes in caring for children and teens with congenital or acquired limb differences. Established in 1946 as the nation’s first pediatric amputee clinic, our program has spent decades helping kids build confidence, mobility and independence.

Our team provides comprehensive care, support and education for children from birth through age 18. We even offer prenatal consultations for families preparing for a baby diagnosed with a limb difference.

Since its founding by physicians Charles Frantz and George Aiken, our program has led national innovation in pediatric orthopedic and prosthetic care. Today, our specialists—Dr. Michael Forness and Dr. Lisa Maskill—continue that legacy with advanced surgical, rehabilitative and prosthetic treatments for children with all types of limb differences.

At Mary Free Bed Kids, we’re not just treating differences—we’re helping children discover their strength.

Congenital Limb Differences (Present at Birth):

• Proximal femoral focal deficiency (PFFD)
• Congenital short femur
• Fibular or tibial hemimelia
• Absence or hypoplasia of the radius, ulna, or humerus
• Amelia / Phocomelia
• Foot and hand differences
• Radial club hand
• Arthrogryposis
• Caudal regression /lumbosacral agenesis

Limb Differences Associated with Syndromes:

• Thrombocytopenia & Absent Radius (TAR) Syndrome
• Cornelia de Lange Syndrome
• Poland Syndrome
• Holt-Oram Syndrome
• VATER / VACTERL Association

Acquired Limb Loss or Differences:

• Cancer
• Vascular conditions
• Accidents or trauma
• Disease
• Post–limb salvage procedures

For nearly eight decades, Mary Free Bed’s Center for Limb Differences has been shaping the future of pediatric limb rehabilitation. Families choose us because we offer:

• A nationally recognized, child-centered approach
• Comprehensive orthopedic and prosthetic expertise
• Seamless collaboration between physicians and therapists
• Advanced technology and motion analysis labs
• Emotional and family-centered support at every stage.

At Mary Free Bed Kids, we’re proud to celebrate every milestone—from first fittings to first steps.

Every child’s care plan is as unique as their story. We develop individualized treatment programs for congenital amputations, syndromes, acquired amputations, limb length discrepancies and limb salvage procedures. Our coordinated approach combines:

• Medical care
• Therapy
• Orthotic and prosthetic support
• Community care and connection

In addition to providing therapies, we also provide community resources, including opportunities to connect with other families.

Treatment plans are crafted to meet the unique needs of each patient, including young people with a broad range of congenital amputations and syndromes, acquired amputations and those undergoing frame treatment for limb lengthening or angular correction and limb salvage.

We develop and coordinate programs to be utilized by local therapists and agencies in the patient’s home community which is especially important when patients come from a distance.

An evaluation should be made as soon as possible after your child’s birth or amputation. We can discuss a treatment plan and provide information about resources and other support services available to your child and family. Our team also can provide second opinions.

Patients generally visit the center two to three times a year. Your child’s schedule depends on circumstances unique to him or her. We’ll assess your child at each visit on things like orthopedic condition, growth and developmental needs. Our services include:

• Medical management and surgical care
• Therapy and functional training
• Orthotic and prosthetic fittings through Mary Free Bed Orthotics & Prosthetics + Bionics
• Motion analysis using advanced gait technology to study how your child walks and moves

We provide medical care, therapy, orthotic and prosthetic fittings and management through Mary Free Bed’s Orthotics & Prosthetics + Bionics department. We also work with our Motion Analysis Laboratory, where experts use sophisticated technology to study the way your child walks and moves. Test results help doctors understand how to better treat your child’s condition.

The Center for Limb Differences is a founding and ongoing member of the Association of Children’s Prosthetic-Orthotic Clinics. As a patient, your child will be under the care of a comprehensive multidisciplinary team specializing in helping children with orthopedic conditions.

Team leadership is provided by physicians who specialize in orthopedics and treating children with limb differences:

• Yunna Sinskey, M.D., a physician specialized in physical medicine and rehabilitation (PM&R)
• Michael Forness, D.O., a pediatric orthopedic surgeon specializing in limb differences
• Lisa Maskill, M.D., a pediatric orthopedic surgeon and upper extremity orthopedic specialist in limb differences

Depending on your child’s needs, his or her treatment team may include:

• Physical therapist
• Occupational therapist
• Recreational therapist
• Registered nurse
• Psychosocial support
• Care manager

Orthopedic Surgeon:

• Performs orthopedic assessment
• Evaluates your child’s functioning and outlines his or her care plan
• Provides medical management regarding prosthesis and orthosis, surgery, therapy, adaptive devices and assistive technology

Pediatric Nurse:

• Performs pediatric assessment, monitors development and provides health promotion and disease prevention information
• Prepares your child and your family for surgery
• Coordinates care with local resources and other specialists

Care Manager:

• Provides diagnostic assessment and facilitates counseling to help your child and family with adjustment, problem solving and coping skills
• Coordinates peer support
• Coordinates local educational, vocational, recreational and financial resources

Physical Therapist:

Your child’s physical therapist coordinates your child’s wheelchair seating and adaptive needs. He or she also will coordinate physical therapy services in your community, providing resources as needed. Your child’s PT also assesses lower limb activities and provides input and/or training in support of:

• Overall gross motor development
• Lower extremity prosthesis use/care/fit
• Walking/balance
• Strength/flexibility/coordination
• Wheelchair mobility
• Functional daily activities

Occupational Therapist:

Your child’s occupational therapist coordinates occupational therapy services in the local community and provides resources as needed. He or she also will recommend and assess the use of adaptive equipment and splints. Your child’s OT also assesses activities of daily living and provides input and/or training regarding:

• Upper extremity function, strength and coordination
• Overall fine motor development
• Strength, flexibility and coordination of upper limb as it impacts activities of daily living
• Upper extremity prosthesis use, care and fit
• Dressing and self-care
• Feeding
• School
• Homemaking

Certified Prosthetist:

• Evaluates your child for the prescribed prosthesis (body part replacement-such as a limb)
• Designs and fabricates the appropriate prosthesis
• Manages your child’s treatment by fitting and adjusting the prosthesis for comfort

Certified Orthotist:

• Evaluates your child for the prescribed orthosis (assistive device for the body-such as an insole)
• Designs and fabricates the appropriate orthosis
• Manages your child’s treatment by fitting and adjusting the orthosis for comfort

Registered Dietitian:

• Evaluates your child’s nutritional needs
• Provides individualized medical nutrition therapy and education for your child and your family

Additional Team Members:

A pediatrician and psychologist may be part of your child’s treatment team on a referral basis. Our team’s goal is to maximize your child’s function and become as independent as possible in all areas of development. We assist with integration into school, recreational pursuits and transitioning into adulthood.

CLD Handbooks

We’ve developed a series of handbooks as part of our commitment to education. Titles available for purchase include:

• Children with Limb Differences (birth to 5 years)
• Children with Limb Differences (6 to 12 years)
• Adolescents with Limb Differences
• Children with Limb Differences: A Handbook for Teachers
• Children with Hand Differences: A Guide for Families
• Guia Para Familias de Ninos con Extremidades con Diferencias
• Your Personal Best (This is geared to young amputees for use under the guidance of physical therapists. The fun format offers several levels of exercises and guides the child through the healing process.) 

Complete this Center for Limb Differences order form and fax or mail to the address listed on the form.

Helpful Handouts

Below are handouts that provide positive strategies for children and teens who may cope with teasing or self-esteem challenges. Click on a title for a downloadable link.

• Teasing Happens: How to Make Friends
• Teasing Happens: What To Do
• Teasing Happens: Tips For Teachers
• Teasing Happens: Tips For Parents
• Teasing: Books For Children
• Tips for Encouraging Self Esteem in Teens With Disabilities

Resources for Parents, Peers and More

• American Childhood Cancer Organization
• Amputee Coalition of America
• Amputee Coalition of America – Support Groups
• Association of Children’s Prosthetic-Orthotic Clinics
• Family Resource Center on Disabilities
• Federation for Children with Special Needs 

Recreational and Camping Information

• Disabled Sports USA
• National Sports Center for the Disabled
• Wilderness Inquiry

Camps:

• American Camp Association
• Children’s Oncology Camping Association International
• Easter Seals