All in the family: Returning to the dance floor

osteochondritis dissecansKristina Peitzch jokes that with four daughters her family keeps the local dance school in business.

It started with Jessica, now 13.

Jessica fell in love with ballet when she was 3. A few years later, Danielle followed, then Madison and finally Abigail. Going to the studio on a nearly daily basis is a family affair.

But when Jessica was 9, she started experiencing mysterious ankle pain. Dancing felt a little less enjoyable.

“It was random at first and seemed to happen more with activities like gym class or ballet,” says Kristina. The pain would disappear for a few weeks, so Kristina attributed it to growing pains.

Over time, Jessica’s ankle pain became more frequent, and she would complain about it several times a week.

Kristina mentioned it to her daughter’s pediatrician, who ordered an x-ray of her ankle. It didn’t show an injury or fracture, so Kristina continued to treat Jessica’s ankle pain with an occasional Advil.

Jessica’s diagnosis: Osteochondritis dissecans

After a few more months of mysterious pain, Jessica’s pediatrician referred her to Dr. Gregory Melkonian, an orthopedist in the Boston Children’s Hospital Orthopedic Center.

“He told us, ‘I think I know what this is, but I want her to see Dr. [Dennis] Kramer. He specializes in ankle pain,” recalls Kristina.

5 things to know about osteochondritis dissecans
♦ It typically affects knees but also can occur in other joints such as the ankles.
♦ The condition can occur in both ankles or both knees in 25 percent of affected patients
♦ Some experts believe it could be an overuse injury, while others feel it might be genetic.
♦ Many patients can heal on their own without surgery with a period of rest and activity modification.
♦ Osteochondritis dissecans lesions can recur after both surgical and non-surgical management.

Kramer confirmed the diagnosis — osteochondritis dissecans. Blood supply to the affected joint is reduced. Although Jessica’s pain was concentrated in her right ankle, her x-rays showed osteochondritis dissecans in both ankles.

“Dr. Kramer took so much time explaining her condition to her. Jessica knew what to expect,” says Kristina.Kramer explained Jessica could try a cast to see if the condition improved. However, surgery may be necessary to treat some children with osteochondritis dissecans.

“Surgery in certain cases that don’t heal on their own may be necessary to kick start the body to get the blood flowing back to the affected area,” says Kramer.

After talking it over with Kramer, the family agreed to go ahead and scheduled Jessica’s first procedure for September 2013. They decided to have Kramer perform surgery on each ankle separately, rather than at the same time. This would provide Jessica some mobility during her recovery.

“It was hard knowing that I wouldn’t be able to dance that year,” says Jessica.

Getting ready for surgery

Jessica had never had surgery before the osteochondritis dissecans procedure and expressed some anxiety. “She was so nervous, but her anesthesiologist was making jokes and had her laughing right until her surgery,” says Kristina.

The operation went well, and six weeks after surgery Jessica started physical therapy to help regain ankle strength and stability at Boston Children’s at Lexington.

Watching her sisters and friends dance kept Jessica extra motivated. “I knew if I worked hard at physical therapy I’d be able to go back to dance the next year,” says Jessica.osteochondritis dissecans

And that’s just what she did.

Six months after her first surgery, Kramer performed the second operation on Jessica’s left ankle. “At this point Jessica was a pro with the process and had a great attitude that helped speed her recovery,” says Kramer.

She returned to physical therapy, relearning how to walk and building strength. Unable to dance herself, she made it to the studio on a regular basis, supporting her sisters and friends.

And when dance recital time rolled around, Jessica was right there for them, too. “I was a little jealous of my class’s costume that year,” she admits. “We never had a blue costume before, and that year it was blue.”

Six months after her second surgery, Kramer gave Jessica the green light to return to the activities she loved — specifically dancing.

“I was worried I’d be behind after missing a year of dance,” Jessica admits. “My teacher showed me everything I missed, and we got back to it,” she grins.

It’s been three years since her diagnosis. Jessica has danced without pain for two years, performed in two recitals and shines as role model for her sisters and other dancers.

Learn more about the Boston Children’s Lower Extremity Program.