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[SpeedDialer]

34:01
everyone always asks me why is it we can get up to eight centimeters lengthening in the femur but we can only get five
34:08
centimeters in the tibia right and the answer is the Achilles tendon's biggest tendon in
34:15
the body and it doesn't grow very easily you really have to
34:20
hold it really stretched a long long time the second thing is what you're not
34:25
seeing here is that the gastric the gastrocnemius muscle which is part of
34:30
the Achilles actually causes the knee joint it attaches to a beamer and so if
34:38
you bend your knee you're actually relaxing your Achilles tendon oh and so
34:45
you would have to we're only splinting up to the knee you'd have to really make people miserable and put them in a long
34:52
leg type cast or splint that would hold their feet straight and their ankle
34:57
cked up most people won't tolerate that and we don't do that but we encourage them to sit with their legs
35:04
straight which stretches it so what we find in most people is that when you get
35:09
Beyond five centimeters they can't still get to 90 degrees and we won't let
35:15
people go into that ballerina position that the the Aquinas position because it's very hard to recover from that okay
35:23
now what some doctors do is they lengthen the Achilles tendon okay so
35:28
patients ask me why don't you just lengthen my achilles tendon so that would solve the problem of being able to
35:34
will let do more lengthening but now they're permanently disabled why
35:40
because when you lengthen the Achilles tendon you lose strength you push off
35:47
I see and the Achilles is not respond it doesn't recover
35:52
in a child in May in an adult it won't it does not recover its strength so you
35:58
lose the ability to toe off so when you walk every step you're towing off so you
36:04
end up walking very flat-footed very heel heel heel heel instead of heel toe
36:09
heel toe heel toe that's normal water you'll never jump again you'll never run again


I was looking up Dr. Paley's rationale for stopping at 5cm for tibias and found this

Alot of this flew over my head. What I especially don't understand is this part below. People have been doing 6-7.5 cm tibias for a while with externals for a while, why didn't they (or did they) bump into the problems below? This part about "long leg type cast" which seems to be different than the usual calves splints/braces patients already use?


the Achilles actually causes the knee joint it attaches to a beamer and so if
34:38
you bend your knee you're actually relaxing your Achilles tendon oh and so
34:45
you would have to we're only splinting up to the knee you'd have to really make people miserable and put them in a long
34:52
leg type cast or splint that would hold their feet straight and their ankle
34:57
cked up most people won't tolerate that and we don't do that but we encourage them to sit with their legs
35:04
straight which stretches it so what we find in most people is that when you get
35:09
Beyond five centimeters they can't still get to 90 degrees

[Medium Drink Of Water]

what we find in most people is that when you get Beyond five centimeters they can't still get to 90 degrees and we won't let people go into that ballerina position that the the Aquinas position because it's very hard to recover from that

As I suspected he's just being cautious.  Most doesn't mean all and very hard doesn't mean impossible.  One size fits all medicine is more common in the U.S. than elsewhere in my experience.