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Center for Limb Differences

The Center for Limb Differences specializes in helping infants, children and teens with hand, foot and limb differences. We were established in 1946 as the nation’s first program to focus exclusively on the needs of children with limb differences.

We help young patients who were born with a limb difference or who underwent an amputation due to a disease or an accident. Our team’s primary goal is to help your child to become as independent as possible in all areas of development.

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Who We Serve

Young patients come to us for a wide variety of conditions, including:

Congenital limb differences (occurring at birth):
• Proximal femoral focal deficiency (PFFD)
• Neonatal brachial plexus palsy
• Limb length differences
• Congenital short femur
• Absence or hypoplasia of the radius, ulna, tibia or fibula (hemimelia)
• Humeral deficiencies
• Amelia/phocomelia
• Foot differences and hand differences
• Radial club hand
• Arthrogryposis
• Caudal regression/lumbosacral agenesis

Limb differences associated with syndromes:
• Thrombocytopenia & absent radius (TAR)
• Cornelia de Lange
• Poland
• Holt-Oram
• Vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal & radial anomalies and limb defects (VATER/VACTERL)

Amputations due to:
• Cancer
• Vascular condition
• Accident
• Disease
• Post limb-salvage procedures

An Overview of Our Services

At The Center for Limb Differences, we provide care, offer support and recommend resources to benefit your child from birth through age 18. We also offer prenatal consultations.

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 three to four 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.

Meet the Team

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:

• Michael Forness, DO, a pediatric orthopedic surgeon specializing in limb differences
• Lisa Maskill, MD, 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:

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
• 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
• 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

Other Team Members:
A pediatrician and psychologist may be part of your child’s treatment team on a referral basis. The CLD’s day-to-day operations are overseen by the department manager.


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