When Dugan Smith was in fourth grade, he was diagnosed with bone cancer, and learned he'd need to have his right leg amputated above the knee. His parents had countless questions. Dugan, however, could only focus on one: Would he still be able to play baseball?
Today he can, thanks an unusual surgical treatment he and his parents chose that removed the cancer, and allowed him to keep the remainder of his leg — reattached backward.
"It was a tough decision to make as a parent, because at the time, Dugan was only 10," says his mom, Amy Miller, who lives in Fostoria, Ohio, as do Dugan and his dad, Dustin Smith. (Dugan's mother and father have a shared parenting arrangement.) "The pros out-weighed the cons. The only thing that would stop us from doing it would be — well, his foot would be on backwards."
Near the end of fourth grade, in 2008, 10-year-old Dugan fell and fractured his femur. While treating the boy for that injury, doctors discovered a malignant, softball-sized tumor in his thigh bone, just above his knee. Because of the fracture, the tumor was bleeding into the muscles in his leg, contaminating them with cancer, explains the boy's surgeon, Dr. Joel Mayerson, chief of musculoskeletal oncology at Arthur James Cancer Hospital at Ohio State University.
Dugan was diagnosed with osteosarcoma, a disease accounts for just 2.5 percent of all childhood cancers diagnosed every year, according to the American Cancer Society.
The middle section of Dugan's right leg, including his knee, would need to be amputated — a heartbreaking thought for a sporty kid like Dugan, who loves playing baseball and basketball. So when Mayerson introduced the "backward-leg" procedure, Dugan's parents listened to an idea that, Mayerson says, understandably makes many moms and dads balk.
"Most of them think you're from another planet," Mayerson says. "They really think you're crazy."
It's called rotationplasty, and it's an uncommon procedure — only about a dozen are done each year, and it's almost exclusively done in children, explains Mayerson. In Dugan's case, doctors removed the tumor by cutting above and below his knee. They then flipped around the lower portion of his leg and reattached it to the upper part. "This allows us to cut all of the cancer out, and leave the nerve that controls his foot intact, by turning it around backward," explains Mayerson.
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In other words: Dugan's calf now acts as his thigh, his ankle acts as his knee and his foot acts as his shin bone. He also uses a prosthetic ankle and foot.
As outrageous as the procedure sounds, it made sense for Dugan, explains his dad. With the other options — either a typical above-the-knee amputation or a procedure that would rebuild his leg from the inside using a metal rod — running, jumping, and, consequently, sports, would be out of the question.
"Once it was explained to us, me and his mother thought for sure [rotationplasty] was the best one," says Dustin Smith, who teaches sixth grade in Fostoria, Ohio. "If we would’ve opted for the one that would’ve looked the most normal, he wouldn’t have been able to do anything but walk." When Smith and Dugan's mother discussed the backward-leg option with their son, "He looked us both straight in the eye and said, 'I want that.'"
Just two hours after the 21-hour surgery, Dugan could move his toes. But he missed almost all of his fifth grade year at school, due to follow-up surgeries and treatments, plus chemotherapy.
Dugan, now 13 and cancer-free for two years, is back at school — and last year played pitcher and first base for his junior high baseball team. He says his first year back at school, "everybody was weird" about his backward leg, but by now, they're used to it. Besides, when he's wearing pants — despite a slight limp and some lingering troubles with running — he looks just like any other kid. Dugan leaves us with this advice, which he learned the hard way: "Never give up, because 90 percent of it is in your mind."