For me, 10% would have been 3.7 cm. I ended up doing about 24%.
If by "tight", you mean tight in the ankle joints or the beginnings of equinas or both, I was aware of and cautioned to train against equinas.
Solomin & Kulesh take x-rays at every centimeter interval of lengthening. They also perform an MD bandage change once per week. For both tasks they take photos. Each time they take photos, they instruct you to pull your foot up as much as possible so that they can assess and document dorsiflexion.
I recall hearing comments when distracting up to the 3 cm point like "foot position looks good--good dorsiflexion".
After 3 cm but before 4 cm, I started getting comments like "can you pull your toes up any more?"
After 4 cm, I got a written warning that my "dorsiflexion is not excellent".
At about 5 cm, I was advised to consider stopping distraction or doing ATL. At this time, after stretching I could maintain neutral dorsiflexion (90 degrees).
I resisted ATL arguing that I had neutral dorsiflexion; therefore, I just needed to work hard and stretch 1 mm per day to keep pace with distraction.
After about another week, I accepted that stretching alone was not realistic--too much work and pain to keep at it for another month and, when I got honest with myself, I was not really keeping pace.
I also decided that I had not gone through this f***ing process for 2 f***ing inches. So, I had a long talk with Dr. Kulesh about ATL and realized that most of what I thought I knew about ATL was inaccurate. Additionally, my remaining valid concerns about possible rupture or over-lengthening/under-lengthening were addressed via Dr. Kulesh's new ATL protocol.
Once the 4th half-ring and hexapods were installed, I distracted and stretched my ATL at the same time. I found that I could not BOTH stretch my ATL and distract at a rate of 1 MM per day so I reduced my distraction rate to .75 mm per day.
Thereafter, I continued at pretty much .75 mm per day up to essentially 9 mm but reducing the rate, taking days off, and once or twice increasing the rate, based upon what my body was telling me it would tolerate at that time.
Please let me know if the above does not fully answer your question.
St. Petersburg Lengthening -- DISTRACTION COMPLETED
Thanks for the pic california.
Your ankles / feet still seem a bit swollen, I hope the swelling subsides soon.
When do you expect to start walking / weight bearing?
Thanks
The most significant hurdle I encountered during this process was edema (swelling of my feet and ankles). I am grateful that my edema began to resolve once I stopped distraction. It is about 80% resolved now and I am told the balance should quickly resolve once I begin walking.
I feel ready to walk now; however, I am instructed to wait until my bones are at least 75% consolidated. My next x-ray is next week and I hope and suspect I will begin walking after that x-ray/appointment.
I am being followed by a local MD team working in consultation with Drs. Solomin and Kulesh.
Quote from: California2 on February 25, 2019, 01:20:10 AMFor me, 10% would have been 3.7 cm. I ended up doing about 24%.
If by "tight", you mean tight in the ankle joints or the beginnings of equinas or both, I was aware of and cautioned to train against equinas.
Solomin & Kulesh take x-rays at every centimeter interval of lengthening. They also perform an MD bandage change once per week. For both tasks they take photos. Each time they take photos, they instruct you to pull your foot up as much as possible so that they can assess and document dorsiflexion.
I recall hearing comments when distracting up to the 3 cm point like "foot position looks good--good dorsiflexion".
After 3 cm but before 4 cm, I started getting comments like "can you pull your toes up any more?"
After 4 cm, I got a written warning that my "dorsiflexion is not excellent".
At about 5 cm, I was advised to consider stopping distraction or doing ATL. At this time, after stretching I could maintain neutral dorsiflexion (90 degrees).
I resisted ATL arguing that I had neutral dorsiflexion; therefore, I just needed to work hard and stretch 1 mm per day to keep pace with distraction.
After about another week, I accepted that stretching alone was not realistic--too much work and pain to keep at it for another month and, when I got honest with myself, I was not really keeping pace.
I also decided that I had not gone through this f***ing process for 2 f***ing inches. So, I had a long talk with Dr. Kulesh about ATL and realized that most of what I thought I knew about ATL was inaccurate. Additionally, my remaining valid concerns about possible rupture or over-lengthening/under-lengthening were addressed via Dr. Kulesh's new ATL protocol.
Once the 4th half-ring and hexapods were installed, I distracted and stretched my ATL at the same time. I found that I could not BOTH stretch my ATL and distract at a rate of 1 MM per day so I reduced my distraction rate to .75 mm per day.
Thereafter, I continued at pretty much .75 mm per day up to essentially 9 mm but reducing the rate, taking days off, and once or twice increasing the rate, based upon what my body was telling me it would tolerate at that time.
Please let me know if the above does not fully answer your question.
It does fully answer the question - thanks a lot!
Would you say the whole journey would have been easy had you stopped at 3cm? Also, despite any increased ease, do you think such a small lengthening amount would be worth the sleepless nights and pain, depending on the height and goals of the patient?
Please forgive in advance my long-winded response.
To me, your question involves a primarily personal decision based on personal goal and desires.
For me, I wanted to increase me height at least 3 inches and as much as 5 inches. I originally envisioned two rounds of procedures increasing my femoral length by about 3 inches; then, coming back again and increasing my lower leg length by about 2 inches.
For me again, if I was not going to get a significant benefit from the surgery(ies); then, there was no good point in putting my body through the trauma and my life through the disruption.
So, would it be easy to stop at 3 cm? Yes, it would be quite easy.
But to me, the salient question is "would it be wise to put your body through the trauma of elective limb lengthening surgery and put your life through the disruption of elective limb lengthening surgery for a height gain of about one inch?" For me, the answer is absolutely "no".
The rub becomes that most surgeons pronounce that lengthening by 10% is safe; yet, for most patients, 10% is not enough height gain nor is it enough to justify the surgery and all the surgery entails.
At the outset, Solomin agreed that I could lengthen my lower legs by 15% -- or about 2.2 inches. I could live with that especially if it was possible that I could lengthen my femurs at a later date.
I was fortunate to get 3.5 inches on my lower legs. I never hoped for that much gain. Now that I have it, I would not consider the trauma and disruption of additional surgery to get the other 1.5 inches about which I fantasized. If I feel I need to be taller, there are many shoe manufacturers who can very comfortably give me another 1.5 inches.
So, my bottom line is that unless you are willing to work for 15-20% of gain; then, there are other much easier and much less costly avenues to investigate rather than subjecting your body to the trauma and your life to the disruption of surgery.
First of all it's a great thing that you managed to go through LL with no serious complications and an overall good outcome. It's also good to know you're satisfied with your height gain, nobody wants to invest that much (money, time and pain) and still be unhappy.
However, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.
No convincing scientific data yet.
But i do see the trend has changed: before people were more ambitious and aiming at 8+ even 10+ cm lengthening in one segment; recently more and more folks became moe conservative and finished under 7.5cm.
Maybe because Dr. Paley set the tone with his precise/stryde nails which cannot go over 8cm? He himself didn’t explain the compelling research behind it either ( if there is).
Quote from: IwannaBeTaller on February 25, 2019, 10:54:44 PMHowever, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.
Please allow me to address your question in two parts--first, potential problems with soft-tissue resisting stretching:
Foremost, soft-tissue presents more of a short-term rather than a long-term problem. By this I mean the damage usually gets done during distraction because a certain soft-tissue cannot stretch the same amount as that moment's distraction. As a result, something tears or ruptures or announces great pain, etc.
In contrast, once you stop distracting, soft-tissue has the rest of your life to catch up.
It is important to understand what happens when you distract. Nerves can grow up to 1 mm per day so folks who distract up to 1 mm generally need not worry about nerve damage. Muscle tissue, tendons, ligaments, blood vessels, and skin is another matter.
Muscle, tendons, and ligaments fight back against distraction. It is hard to hurt these tissues because they are very tough. Blood vessels and skin stretch. To me, a ruptured blood vessel poses the greatest risk; yet, skin at the pin sites seems to present the most common problem.
On my 35 day photo, you can see two wounds, one on each of my lower shins. These wounds were each pin sites. As I distracted past 6 cm, my skin refused to keep up at these pin sites. As a result, the skin started to open up below each pin--like an old-fashioned keyhole. This type of wound is common. I had to keep a very close eye on these wounds to ensure each remained within the realm of acceptable risk.
I wrote repeatedly that I believe you must listen to your body as you go through the process. Wounds such as mine are precisely the type of thing I am writing about--if they became only a little bit worse, I would have had to stop distraction before I reached my goal.
On your second point--osteoarthritis. I am aware of no connection between limb lengthening and osteoarthritis. Osteoarthritis is a condition of the joints caused by a breakdown of cartilage in the joints. Limb-lengthening surgery does not directly involve any joint.
This is not to imply that increased height does not implicate some joints--of course it does. When you become 3 inches taller, your center-of-gravity changes. Likewise, the forces on your knee joint as a fulcrum change because the length of the levers acting upon the fulcrum (your femur and tibia) change in relation to one another.
This means that you have to create new muscle memory and become accustomed to your new leg length and center of balance. A perfect example is that a couple of nights ago I was laying on the sofa with my foot up on the sofa arm. I pulled my leg back so that my foot would drop onto the sofa cushion--except it didn't.
My mind understood that my foot should have dropped onto the sofa cushion because my mind was operating from memory of my old leg length. Now however, I still had 3.5 inches to go before my foot cleared the sofa arm.
In time, new muscle memory will replace the old and I will forget what it was to be my old height. Likewise, I will use my ankle, knee, and hip joints slightly differently but I don't think these is any reason to believe that I will wear them out any more than I would have before lengthening.
Thanks, California. Soft tissue can indeed adapt quite well to lengthening in many cases, although it takes longer than bone consolidation. Quite a lot of the long-term recoveries after lengthening procedures with little complications we saw in the forum looked good.
As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing.
Quote from: IwannaBeTaller on February 26, 2019, 12:56:38 PM
As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing.
I reviewed the abstracts of your two studies; however, neither study draws a causal relationship between osteoarthritis and limb lengthening.
The second study above concludes: "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant."
The primary conclusion is that persons with tibia nails function comparable to the rest of the population. The study also notes "persistent sequelae which are not insignificant". "Sequelae" are conditions related to a certain condition--in this study "tibial shaft fracture treated with locked intramedullary nailing".
"Not insignificant" means the conditions were noted but no causal relationship or even a correlation was found. Moreover, no comparison was made to the population in general. Finally, the study group are trauma patients and not elective limb lengthening patients.
In summary, I do not conclude based on the second study that elective limb lengthening increases the likelihood of developing osteoarthritis.
The first study consists solely of analysis of cadaver bones. Limb lengthening is again not a part of the study. Based on the measurement of 1152 cadaver femurs and tibias, the authors conclude that a tibia should be 80% the length of a femur; and, that if a femur/tibia ratio is otherwise, arthritis may develop.
There is much wrong with this study. Foremost is the failure to identify the ethnic mix of cadavers studied. Second is the conclusion that an 80% ratio is the magic number--many studies suggest otherwise. Last is the conclusion that a variance from the magic number of 80% caused arthritis. There are, in my opinion, simply too many potential causes of arthritis to assert from a cadaver study that limb ratio is the culprit.
To get good information about increased risk for osteoarthritis in limb lengthening patients, you would need a longitudinal study of such patients and a fixed control group of similarly situated persons without limb lengthening surgery.
Moreover, I do not see a good reason to worry about development of osteoarthritis because osteoarthritis is a joint condition. Joints are no directly implicated in limb lengthening. So, to answer your question directly, no I am not worried about developing osteoarthritis caused by limb lengthening in later life.
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