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[ShortyMcShort]

Could you explain what an ITB release is and what its for? I was thinking of going with Dr Jamal originally and he doesnt do them so really I have no clue what its for. What are the pros and cons with the ITB release?

Also, have you seen or talked to the other guy since the surgery? If you see him could you ask if he is ordering meals from that guesthouse and if so roughly how much is it?

[TRS]

Could you explain what an ITB release is and what its for? I was thinking of going with Dr Jamal originally and he doesnt do them so really I have no clue what its for. What are the pros and cons with the ITB release?

Also, have you seen or talked to the other guy since the surgery? If you see him could you ask if he is ordering meals from that guesthouse and if so roughly how much is it?

ITB release is when the surgeon makes a small incision about 2cm on the iliotibial band(ITB) around the knee region. Some doctors are advocates of ITB release while some are against it. It is quite controversial but many PRECICE surgeons do ITB release. This is suppose to make the lengthening easier without the resistance of the ITB band and maybe for optimal PRECICE nail function.
I saw the other LL'er yesterday and he is doing fine. I will ask him to join LL Forum and provide you with the cost etc....   

[crimsontide]

all the drs, or most in the developed countries do releases.... birkholtz dos, palsy does, rozbruch does, etc etc , and even some in india  do it

the ones that don't do it are old school, and generally against anything except externals for tibia,etc....   dealing with ballerina now  makes me think releases are important and beneficial...

[TRS]

all the drs, or most in the developed countries do releases.... birkholtz dos, palsy does, rozbruch does, etc etc , and even some in india  do it

the ones that don't do it are old school, and generally against anything except externals for tibia,etc....   dealing with ballerina now  makes me think releases are important and beneficial...

Yeah the american doctors are strong advocates of ITB release. But i dont know whether its necessary for exfix/Lon or full weight bearing nails

[crimsontide]

i think its a good thing to get a release.... if i had a release before, i would not have ballerina now... femur has different issues, bt same principle applies..


btw,... trying to get a hold of reception... i think theres a strong likelihood i get a release done in sa, though not 100%...

[Wannabegiant]

all the drs, or most in the developed countries do releases.... birkholtz dos, palsy does, rozbruch does, etc etc , and even some in india  do it

the ones that don't do it are old school, and generally against anything except externals for tibia,etc....   dealing with ballerina now  makes me think releases are important and beneficial...

Its definitely not beneficial to do a tendon release, its always better to avoid it if possible, if the ballerina is to much to fix with pt, then a release might be necessary, but that does not in anyway mean it is beneficial, as it will weaken the tendon permanently.

[crimsontide]

if its not beneficial... why do the top drs do it  routinely even for prevention...  before any issues arise?   


The proper treatment would to be test beforehand to determine if tendon, etc is too tight, and perform the surgery beforehand... again, drs like palsy do exactly this

Why do top drs do it if it's not beneficial? Majority, if not all patients after 6 cm will get  issues, with tibia, it is ballerina... some guys seem to have issues a long time after because of not getting a surgery to fix it, such as sweden....

Tendon weakening is vastly overstated.... the issues that ballerina can and do cause are far more severe than   possible weakness of muscle

Again, he top drs use these procedures    as preventive measures, which would not be done if they did not feel it was beneficial to do.... and this is before any ballerina,etc happens

[Wannabegiant]

if its not beneficial... why do the top drs do it  routinely even for prevention...  before any issues arise?   


The proper treatment would to be test beforehand to determine if tendon, etc is too tight, and perform the surgery beforehand... again, drs like palsy do exactly this

Why do top drs do it if it's not beneficial? Majority, if not all patients after 6 cm will get  issues, with tibia, it is ballerina... some guys seem to have issues a long time after because of not getting a surgery to fix it, such as sweden....

Tendon weakening is vastly overstated.... the issues that ballerina can and do cause are far more severe than   possible weakness of muscle

Again, he top drs use these procedures    as preventive measures, which would not be done if they did not feel it was beneficial to do.... and this is before any ballerina,etc happens

Youre wrong, top doctors like Paley do not do tendon release preemptively on every patient, they do physical tests before hand in case the individual might need it. Every patient that does 8 cm needs it according to them, but we know even that isnt true since Rgkey managed 9 cm with pt instead. However just because releases help if you do very high ammounts of lengthening does not mean they are beneficial, it means they are necessary because you already damaged the legs by lengthening over the safe limit, and the preemtive release will damage the tendon further but allow you to get movement back faster, and it also means you will avoid having to do more complex and expensive surgery to fix it afterwards if you already got ballerina.

Also according to Paley, 50% of his patients who did below 5 cm did not require any tendon release. Those numbers doesnt sound that impressive considering i never had any sign of ballerina during my journey while doing 4.3 cm.

I got this info from here:

http://www.paleyinstitute.org/?q=node/47

"Are there any additional unexpected costs from the initial surgery?
Some patients require a fascia or tendon lengthening to PREVENT complications.
The need for this is determined at the first consultation.
Dr. Paley performs three muscle length tests (Ober test, Popliteal Angle measurement, and Ely test) to determine if the iliotibial band-fascia lata, hamstrings, and rectus femoris muscles are too tight.  It is not possible to advise a patient of this without seeing them first. The greater the amount of lengthening the more likely is the need for such soft tissue releases.

For example, every patient with an 8cm lengthening requires an iliotibial band release while only 50% require this if less than 5cms is carried out. The additional cost for these ranges from $5000 for iliotibial band only vs $7500 for iliotibial band plus hamstrings, if needed. For tibial lengthening if the Achilles tendon is too tight as determined by the Siverskiold test (physical examination) then a gastro-soleus recession is required prior to lengthening (additional cost of $5000).

If these structures are tight before surgery and not prophylactically lengthened then muscle/joint contractures that require later more expensive surgery are required (in the lay literature these are referred to as duck ass deformity for tight iliotibial band and fascia lata, and ballerina feet for tight Achilles tendon). Prophylactic anterior compartment release is often done at the time of tibial lengthening. There is no additional charge for this procedure. This is done to prevent compartment syndrome."

So no, tendon weakening is not overstated, its worse for recovery to have the release. We have many patients who did 6 cm or more and did not require tendon release. Swedens issues with his ankles seem to have to do with his x-legs and lack of fibula fixation, not because of not having a tendon release.

[crimsontide]

Youre wrong, top doctors like Paley do not do tendon release preemptively on every patient, they do physical tests before hand in case the individual might need it. Every patient that does 8 cm needs it according to them, but we know even that isnt true since Rgkey managed 9 cm with pt instead. However just because releases help if you do very high ammounts of lengthening does not mean they are beneficial, it means they are necessary because you already damaged the legs by lengthening over the safe limit, and the preemtive release will damage the tendon further but allow you to get movement back faster, and it also means you will avoid having to do more complex and expensive surgery to fix it afterwards if you already got ballerina.

Also according to Paley, 50% of his patients who did below 5 cm did not require any tendon release. Those numbers doesnt sound that impressive considering i never had any sign of ballerina during my journey while doing 4.3 cm.

I got this info from here:

http://www.paleyinstitute.org/?q=node/47

"Are there any additional unexpected costs from the initial surgery?
Some patients require a fascia or tendon lengthening to PREVENT complications.
The need for this is determined at the first consultation.
Dr. Paley performs three muscle length tests (Ober test, Popliteal Angle measurement, and Ely test) to determine if the iliotibial band-fascia lata, hamstrings, and rectus femoris muscles are too tight.  It is not possible to advise a patient of this without seeing them first. The greater the amount of lengthening the more likely is the need for such soft tissue releases.

For example, every patient with an 8cm lengthening requires an iliotibial band release while only 50% require this if less than 5cms is carried out. The additional cost for these ranges from $5000 for iliotibial band only vs $7500 for iliotibial band plus hamstrings, if needed. For tibial lengthening if the Achilles tendon is too tight as determined by the Siverskiold test (physical examination) then a gastro-soleus recession is required prior to lengthening (additional cost of $5000).

If these structures are tight before surgery and not prophylactically lengthened then muscle/joint contractures that require later more expensive surgery are required (in the lay literature these are referred to as duck ass deformity for tight iliotibial band and fascia lata, and ballerina feet for tight Achilles tendon). Prophylactic anterior compartment release is often done at the time of tibial lengthening. There is no additional charge for this procedure. This is done to prevent compartment syndrome."

So no, tendon weakening is not overstated, its worse for recovery to have the release. We have many patients who did 6 cm or more and did not require tendon release. Swedens issues with his ankles seem to have to do with his x-legs and lack of fibula fixation, not because of not having a tendon release.

wannabe...  i did not state he does them on every patient...

read what i wrote,.  "if its not beneficial... why do the top drs do it  routinely even for prevention...  before any issues arise?   


The proper treatment would to be test beforehand to determine if tendon, etc is too tight, and perform the surgery beforehand... again, drs like paley do exactly this

again... patients determined to have a tight tendon,   get a release.... before any issues arise...  everything quoted supports what i said... again, tell me what is wrong with what i said?   You do not even attempt to reply to that fact....that they are tested, and if found to have a tight tendon,  get a release surgery before any ballerina, not after major ballerina, not after a little, but even before any ballerina... why??? as a preventive measure... that is simply a fact

you made this statement

"Every patient that does 8 cm needs it according to them, but we know even that isnt true since Rgkey managed 9 cm with pt instead. However just because releases help if you do very high ammounts of lengthening does not mean they are beneficial, it means they are necessary because you already damaged the legs by lengthening over the safe limit, and the preemtive release will damage the tendon further but allow you to get movement back faster, and it also means you will avoid having to do more complex and expensive surgery to fix it afterwards if you already got ballerina."

again,    you are avoiding what paley actually says....     that if he determines their tendon to be tight,  he will do a release....  he specifically says this... if the achilles is too tight, he will do a release...  .. he says it is required if the test determines the tendon is tight

you also are not properly reading what he says.., the numbers,etc, he gives that you quote are for femur lengthening, not tibia

if you want to reply, you can reply in my thread if you like, as i don't wanna take over this thread

[Muse]

Merged the posts on ITB release from RisingShorty diary to the new thread here

[Wannabegiant]

wannabe...  i did not state he does them on every patient...

read what i wrote,.  "if its not beneficial... why do the top drs do it  routinely even for prevention...  before any issues arise?   


The proper treatment would to be test beforehand to determine if tendon, etc is too tight, and perform the surgery beforehand... again, drs like paley do exactly this

again... patients determined to have a tight tendon,   get a release.... before any issues arise...  everything quoted supports what i said... again, tell me what is wrong with what i said?   You do not even attempt to reply to that fact....that they are tested, and if found to have a tight tendon,  get a release surgery before any ballerina, not after major ballerina, not after a little, but even before any ballerina... why??? as a preventive measure... that is simply a fact

you made this statement

"Every patient that does 8 cm needs it according to them, but we know even that isnt true since Rgkey managed 9 cm with pt instead. However just because releases help if you do very high ammounts of lengthening does not mean they are beneficial, it means they are necessary because you already damaged the legs by lengthening over the safe limit, and the preemtive release will damage the tendon further but allow you to get movement back faster, and it also means you will avoid having to do more complex and expensive surgery to fix it afterwards if you already got ballerina."

again,    you are avoiding what paley actually says....     that if he determines their tendon to be tight,  he will do a release....  he specifically says this... if the achilles is too tight, he will do a release...  .. he says it is required if the test determines the tendon is tight

you also are not properly reading what he says.., the numbers,etc, he gives that you quote are for femur lengthening, not tibia

if you want to reply, you can reply in my thread if you like, as i don't wanna take over this thread

Replying here since it got off topic

Wrong again crimson, I did read what you wrote and it was inaccurate. Specificially when you say tendon release is beneficial, but its not. Tendon release is best avoided but some patients require it. You might not have had required it though if you lengthened slower or used footholders. Most cases of ballerina can be solved through PT.

I dont see how anybody reading that faq can get the idea that tendon releases are something good. Its only for some patients that they are needed but that simply means those specific patients are not able to lengthen as much without damaging their body more, and thus not recovering as well as those who dont need it.

Since they mention that the surgery required afterwards if you already got ballerina feet is worse and more complex, that is the only reason they do it preemtively if they suspect the patients will develop ballerina, but its still not a good thing for the body.

and while those specific numbers was for femur, it irrelevant, as mentioned, if the achilles tendon is to tight before the surgery, that simply means your body is not able to lengthen as much without weakening it more with a release.

"If these structures are tight before surgery and not prophylactically lengthened then muscle/joint contractures that require later more expensive surgery are required (in the lay literature these are referred to as duck ass deformity for tight iliotibial band and fascia lata, and ballerina feet for tight Achilles tendon). Prophylactic anterior compartment release is often done at the time of tibial lengthening. There is no additional charge for this procedure. This is done to prevent compartment syndrome."

This quote from Paley is basically saying that the only reason they do it from the beginning with some patients is to prevent them from having to do an even worse surgery afterwards if you develop severe ballerina. Again nothing here suggests it being a beneficial thing, at least not for your case as you already have ballerina.

[Sweden]

Tendon release is NOT beneficial if you're looking for more in life than just walking.

My problems come mostly from not standing while lengthening and not from either x-legs nor fibula fixation. The physio we had in India sucked so bad that it was totally unnecessary.

I am much better recovered now and run every other day for 4-5km. Mostly it's my poor stamina that's preventing me from going further right now.

My x-legs are improving and also ROM in my ankles.

If I would have done a tendon release surgery I could forget about ever running without aches again - ever.
It would also weaken the tendon permanently.

Don't do this release surgery. At least try hard with physio at least for 2 years until you even consider it.
The body can adapt - I'm the living proof of just that!!

[Wannabegiant]

Tendon release is NOT beneficial if you're looking for more in life than just walking.

My problems come mostly from not standing while lengthening and not from either x-legs nor fibula fixation. The physio we had in India sucked so bad that it was totally unnecessary.

I am much better recovered now and run every other day for 4-5km. Mostly it's my poor stamina that's preventing me from going further right now.

My x-legs are improving and also ROM in my ankles.

If I would have done a tendon release surgery I could forget about ever running without aches again - ever.
It would also weaken the tendon permanently.

Don't do this release surgery. At least try hard with physio at least for 2 years until you even consider it.
The body can adapt - I'm the living proof of just that!!

thanks for the clarification, also i couldnt agree more with your points here, well said.

[Taller]

Sweden, your residual ballerina foot definitely isn't caused by lack of fibula fixation, but lack of PT and standing while lengthening, as you said.

However, your x-legs and ankle pain are classic symptoms of fibula migration or fibula deformity caused directly by the lack of fibula fixation in your case.

I hate to be harsh, but it genuinely seems to me as though this is the cause of your problems.

[Sweden]

Sweden, your residual ballerina foot definitely isn't caused by lack of fibula fixation, but lack of PT and standing while lengthening, as you said.

However, your x-legs and ankle pain are classic symptoms of fibula migration or fibula deformity caused directly by the lack of fibula fixation in your case.

I hate to be harsh, but it genuinely seems to me as though this is the cause of your problems.

I have asked about this several times to various doctors - they can't see anything wrong with my bones. Including Dr Jamal in Ukraine.