New York In her 15 years, Jingle Luis has never walked on the bottoms of her feet.
Born in the Philippines with feet so clubbed they twist backward and upside down, she uses crutches to hobble on what should be the tops of her feet.
"I can accept it," Jingle said Wednesday in a voice so soft it was barely audible.
But Jingle may not have to accept the condition much longer.
She and her mother have journeyed from the Philippines to Montefiore Medical Center in the Bronx for surgery and follow-up treatment that will consist of slowly rotating her feet until she can walk normally.
The surgery took place Thursday and went well, hospital spokesman Steven Osborne said.
Jingle's case is more severe than those usually seen by doctors in industrialized countries.
"Generally speaking, with modern technology, it doesn't get to this point," said Dr. Terry Amaral, a pediatric orthopedic surgeon who performed the surgery at Children's Hospital at Montefiore.
Clubfoot is a relatively common deformity, occurring in about one in 1,000 births. Children are usually treated in infancy with casts or braces that gradually bring the feet into correct alignment.
The condition becomes harder to treat if it is not corrected early on.
Amaral said Jingle's case was complicated by the fact that her clubfoot was associated with spina bifida, a birth defect that involves the incomplete development of the spinal cord or its coverings.
He said doctors who saw Jingle as a baby thought that her spina bifida would shorten her life span and prevent her from walking, so they did not treat the clubfoot.
"They felt it wasn't worth managing because of the life expectancy, so they decided to leave it alone," Amaral said.
But Jingle's spina bifida is relatively mild. Her bladder and bowel functions are impaired, but she has normal intelligence and can move her feet and legs.
Jingle came to the attention of Montefiore after Dr. Randall Owen, a head and neck surgeon, traveled to the Philippines in 2003 on a mission trip organized by the Tennessee-based Christian Medical and Dental Association.
Owen saw Jingle there but could not treat her clubfoot.
"She needs a multidisciplinary team," he said. "It was nothing we could do on a two-week mission trip."
Jingle and her mother arrived in New York on April 17.
In Thursday's two-hour procedure, screws were inserted into the bones of her feet and attached to scaffold-like devices that will stabilize her feet while the screws are turned bit by bit. "It's like putting together an Erector Set," Amaral said during the operation. He estimated that it would take a month to rotate the feet a few degrees at a time.
The scaffolding will be replaced by casts and then by braces, which Amaral expects Jingle to wear for about a year.
Then Jingle hopes she'll be wearing high-heeled shoes, said the girl's mother, Jasmine Luis.
Jingle and her mother will stay with a friend in Bergenfield, N.J., during the treatment.
Jingle's father is a corn farmer; her mother sells farm-raised fish door to door, carrying her wares on her head.
Jingle has other career goals. "I think a doctor or a nurse," she said.