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[betogovy]

Hello, my daugther Lili (10y.old) had femoral lengthening on November 2016 (7cm), now she is in the consolidation stage (about 2 weeks), the thing is that from the first day she got out of the hospital until now she had a very pronunced hyperlordosis (duck ass), every day she has her physical therapy (streching and strengthening) but no improvment, she still cant walk by her own (walker). Can some one tell me what to do with my daugther please?

[682]

Hi betogovy, I'm sorry to hear your daughter Lili is suffering from hyperlordosis as it can be a real nuisance and uncomfortable but certainly isn't a rarity in patients who have lengthened their femurs and many here have reported having suffered from it. The good news is, in almost all cases it can be resolved through dedicated PT and most usually, the passage of time as the spinal musculature adapts to the tension and demand of the lengthened soft tissue surrounding the femurs, it should also improve substantially to the point of being a minor inconvenience when Lili is able to walk more frequently and eventually unaided.

Until then, your best course of action is for your daughter to remain dedicated to the physical therapy, possibly with the addition of a license physical therapist administering massage which may be useful and work towards her being able to walk which I believe will show the greatest improvement in solving the issue. When at home, I would recommend ensuring your daughter attempts to sit with the pelvis in a neutral position to the best of her ability through placing a towel or blanket to prevent the hip and spine entering lordotic curvature as well as extra stretching, specifically addressing the likely tight hip flexors and hamstrings which are likely the culprit. Alongside this, I advise you to be patient and with time and a concerted effort you should see major improvement.

• Here you can find a video on what lordosis actually is and how it affects you - https://www.youtube.com/watch?v=fs5emYQ2x3Y

• Here you can find a video on stretches that may assist and improve the issue which I have found helpful throughout my weightlifting career - https://www.youtube.com/watch?v=GVoMM2Ri6B8

I hope your daughters condition improves substantially in the near future and she's a hero for undergoing such a big procedure at such a young age, after overcoming that, fixing this will be a walk in the park. Best of luck.

[betogovy]

682,
My family really appreciate your advice, Lili (hipoacondroplasia) had her tibias lengthening 2.5 years with very few complications  (achilles), now with her femurs she had early consolidation on both legs (osteotomy), genu varum and valgum, and the hyperlordosis, our doctor in Mexico says that the varum and valgum eventually will correct with her growing, but for the hiperlordosis he did not told us how an when and we could not find answers, so thank you again, very best for you!

[682]

No problem, if my advice helps you and by extension Lili even the tiniest amount then it is completely worth it. It's great that she did so well with tibial lengthening and the early consolidation on femurs is to be expected to some degree, she's so young that her body will bounce back from the trauma at an extraordinary rate. I agree with your doctor, from what I have read of hypochondroplasia, the genu varum and valgum will improve as she gets older at some point which will be great for her. Lordosis can be incredibly uncomfortable and I imagine quite difficult for Lili to deal with as it will have been relatively major but as I said, you should see much improvement in the near future - it's amazing how the body adapts when it needs to. Thank you for your kind words, I wish you all a wonderful future.

[Bigfaker]

Hi betogovy,

It pains me as well to hear all your daughter has gone through.  I'm not a doctor in any way shape, or form, but I'd like to help if I can at all.

A couple questions:
- Did Lili have any equinus contracture (Ballerina Foot) when she lengthened her tibias?
- She lengthened her femurs 7cm? How much did she lengthen her tibias? Do you know her original lengths (or the amount relative to her original lengths)? I realize that as a 10yo, her bones are comparably very short, as we are typically discussing short(ish) adults here.
- Have you determined if it's mainly physical hyperlordosis and not a duck ass position that she walks with because of tightness/insecurity/instability? Does it present when she is not standing/walking? In my own case (and of some of my fellow patients), duck ass while walking can appear because of equinus/tightness AND because hunching over the walker feels more stable..standing too erect feels like one will topple over more easily...especially on weak and broken legs.

The lengthening of the lower legs can increase tightness in the upper (and vice versa). The hamstrings and gastroc/Achilles are inter-connected by nerves and fasciae. Everything works together. Some call it "muscle interdependence", some call it the "Kinetic Chain". She's lucky to be young and should have a lot of flexibility, but it will take time and work to loosen things up.

Does your therapist have experience with these type of issue? There are a lot of great PTs in the world, but that does not necessarily mean they can handle an LL patient.

As 682 mentioned, the varus and valgus can get better over time, but a big factor (for valgus) can be weak hip flexors (at least, it was in my case). Stregthening them through directed PT exercises should help a lot.

Are you currently still in Mexico? If your doc does not have answers for you, it's best to seek a second opinion and more assistance. Was Lili's doctor Santiago Gonzalez or Gerardo Lopez–Mejia? I don't know how far you are from them, but they are both LLRS members. Or, if you are in the part of Mexico bordering CA, I know of a doctor here in San Diego that has experience with lengthening.

I truly hope things get better for Lili soon. My best wishes to her and to you and your family as you go through this.

[betogovy]

Hi Bigfaker,
Answering to your questions:
-Lili had her tibias lengthened 2.5 years ago (6cm) then she was 7 years old, on August she will be 10, and yes she had ballerina foot, aside of that she did ok.
-Yes her bones were very short, i think they grew up between 30-35 % of their original size.
-She shows the Hyperlordosis since the first day out of hospital (22 Nov) very pronunced when standing and walking, mild when lying on a bed, and nothing when we lift her legs when lying on a bed. Almost 3 weeks in the consolidation stage, she is starting to walk alone (few steps).
-As for the PT, our doctor only told us that her only therapy was to bend her knee and to walk, so in the first 20 days after her surgery she only did that, when i saw her not getting progress, i call doctor Paley asistence  (Lili was her patient but our insurance company did not cover the surgery cost) and she gave us the PT information.
-She is doing a little better every day, but definitely much more difficult than when her tibias, she is sad and cries because she can not do the things that her twin sister and her friends do, and that is hard for us. But we have faith she will be just fine.
Really really help us
GOD bless you
We still live in Mexico, we will call the doctors you told me for second opinion as soon as possible.

[Bigfaker]

Wow, that seems like a LOT, especially seeing as her tibias were child-sized! I know children heal fast, but I'm glad she didn't have severe equinus.

Here's the docs info (from LLRS):
Gonzalez, Santiago, MD
Juarez 880 North St.
Lerdo, DGO 35150
Mexico
santiago–md@aol.com

Lopez–Mejia, Gerardo
BluHospital Christus Muquerza
Saltillo Coahuila MEXICO
drlopezmejia@hotmail.com

Here's that doctor in San Diego. I didn't go to him, but I was referred to him by my old ortho:
http://www.sanzoneortho.com/correction-of-complex-deformities-anthony-g-sanzone.html
Looks like he has experience in LL (for deformities, at least).

Again, I'm no PT, but I would think you could do more to help her recovery than knee bending and walking. There's plenty of videos of exercises online. Also, if walking with crutches/walker is too difficult for Lili, try to get to a heated pool so she can walk in shallow water. Or even a hot tub, which may help loosen up tight soft tissues...and it might lift up her spirits to be a little active again. But PLEASE keep your eye on her! Too many fully-healthy kids have accidents around the water, you should be extra cautious since her mobility is so limited.

Best of luck. Keep us posted.

[betogovy]

Thank you Bigfaker, yes doctor Paley assistant gave us the PT for Lili and she had great improvement, but as i told you Lili grew up 7 cm with her femoral lengthening but when messure stand it seems like she is only 1 cm taller because her severe duck ass, by the way she does walk like a duck and also complains for her lower back, the pain appears only when walking with out the walker.
Thank you again Bigfaker, have a nice day!!
We will consider the hydrotherapy.