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[Wannabegiant]

When looking at videos and pictures from diaries of LL patients, ive noticed something. It seems like a good majority of them have some kind of x-shape on their legs, like the legs are bending inwards where the tibias and femurs meet, at the knees.

Ive hread that this is because of the muscle becoming weak and not being able to keep the legs straight or something but im not sure if that makes sense.

Anybody know for sure why x-leg happens in LL patiens? It seems like msialignment of the bone that was lengthened shouldnt be able to factor into this since the legs bend at the knees.

And how do you prevent it? can you fix it without surgery if you get it?

[Medium Drink Of Water]

Patients in Beijing were told to turn the outer knobs more than the inner ones for a while if they were showing signs of x-legs.  This is one of the reasons the Beijing Institute doesn't want to offer internals: corrections like this can't be done with them.

[Wannabegiant]

Patients in Beijing were told to turn the outer knobs more than the inner ones for a while if they were showing signs of x-legs.  This is one of the reasons the Beijing Institute doesn't want to offer internals: corrections like this can't be done with them.

Okey so that explains the disadvantage with the monorail, it only has pins on the outer side so i guess that means you cant do this fix if it ends up looking like x-legs. Still not sure how misalignment in the tibia bone can cause the leg to bend in the knee region. If it bent from the area where the cut is i could understand.

[Wannabegiant]

In light of another topic on that old forum, i simply have to ask and it seems relevant in this topic:

1. According to Sweden he has shrunk after his LL surgery, and it doesnt seem clear why (could be ballerina foot going away, wrong measurment etc) but this makes me think: is there a risk when lengthening tibias that the gap in the bone wont equal the same height gain?

Since tibias arent strictly straight most of the time, and especially if you get x-legs, then the actual gap wouldnt translate to the height gain you want.

So if i agree with the doctor to increase 4 cm, will that simply mean that I am entitled to the 4 cm gap in the bone, and not to be 4 cms taller than before?
Cause If i pay for 4 cm, I want to be 4 cm taller, not simply having a longer bone that might bend. I hope this can be sorted out before going through with the surgery.

[Medium Drink Of Water]

It depends on where and from what angle the measurement is taken.  If your doctor is good he'll know how to measure it so that the length he says you've gained will be how much taller you are.  But if you want to be sure, measure your height throughout your distraction phase and make it clear to your doctor that you want to go by your standing height.

Keep in mind there's no such thing as an exact/official height.  Your body's height will fluctuate a few mm throughout the day and there's no "correct" measurement.   Don't worry about a few mm either way.  I'm probably not 5'10 on the dot if I measured myself right now, but that's okay.  I'm close enough to 5'10 to be considered that height.

[Wannabegiant]

It depends on where and from what angle the measurement is taken.  If your doctor is good he'll know how to measure it so that the length he says you've gained will be how much taller you are.  But if you want to be sure, measure your height throughout your distraction phase and make it clear to your doctor that you want to go by your standing height.

Keep in mind there's no such thing as an exact/official height.  Your body's height will fluctuate a few mm throughout the day and there's no "correct" measurement.   Don't worry about a few mm either way.  I'm probably not 5'10 on the dot if I measured myself right now, but that's okay.  I'm close enough to 5'10 to be considered that height.

By that do you mean a good doctor will measure the right spot to cut and lengthen the tibia so that it will translate to the same height?
But yeah i will have to make clear to to Dr Mirzoyan that i want to be 4 cm taller than my current standing height, and i will probably have to measure myself accurately at evening and morning before i do the surgery. But im pretty sure im 175 in the morning, randomly shrinking to about 174 but not below that in the evening. 

So yeah youre right as long as my evening height is not below 178 I should be fine, 1 or 2 mm wouldnt matter much though.

[Medium Drink Of Water]

It's about how the gaps are measured and how the x-rays are taken.  He needs to measure the gap 100% vertically while standing.  In Beijing the first and last x-rays are taken while standing up for this reason.

[Wannabegiant]

It's about how the gaps are measured and how the x-rays are taken.  He needs to measure the gap 100% vertically while standing.  In Beijing the first and last x-rays are taken while standing up for this reason.

Gotcha, il tell Mirzoyan to measure my gaps while standing then, and it shoudldnt be any problem :p

[Captain America]

The research I have done leads me to believe that "x-legs" develop, at least in part, due to the head of the fibula migrating downwards during the distraction process. In terms of why exactly this precipitates or exacerbates the development of a knee valgus condition I am unsure. It could very well be attributed to the resultant tightness of the lateral muscles of the thigh and connective tissues of the knee, as well as laxity about the knee joint arising from the dislocation of the fibular head.

The only preventative measure I am aware of is to fixate the proximal portion of the fibula to prevent it from migrating downwards. This is a measure I wish had been taken during my own lengthening process.

[Wannabegiant]

The research I have done leads me to believe that "x-legs" develop, at least in part, due to the head of the fibula migrating downwards during the distraction process. In terms of why exactly this precipitates or exacerbates the development of a knee valgus condition I am unsure. It could very well be attributed to the resultant tightness of the lateral muscles of the thigh and connective tissues of the knee, as well as laxity about the knee joint arising from the dislocation of the fibular head.

The only preventative measure I am aware of is to fixate the proximal portion of the fibula to prevent it from migrating downwards. This is a measure I wish had been taken during my own lengthening process.

Sounds like a good explanation to be honest. the tightness of those muscles might push the top of the fibula in that direction. So the preventive measure you mentioned, does that mean to have a pin from the fixator placed on the fibula to keep it in place? is this something you could ask the doctor to do?

also what can be done afterwards if you happen to get x-legs?

thanks for the help.

[Captain America]

If lengthening with an external frame one of the upper fixation wires simply needs to be passed through the fibular head and tibia, identical to how the lower portion of the fibula is fixated to the tibia. The downward migration of the fibula can mainly be attributed to the connective tissue between it and the tibia as well as other surrounding tissues. You could certainly mention this concern to your surgeon prior to surgery.

After knee valgus has developed it seems the only treatment is PT and time to allow the contracture to resolve.

[Medium Drink Of Water]

X-legs is the opposite of bowing.  It's caused by an improper angle of the tibia and/or femur and has nothing to do with the fibula.  Here's an exaggerated drawing of the two problems.

[Wannabegiant]

X-legs is the opposite of bowing.  It's caused by an improper angle of the tibia and/or femur and has nothing to do with the fibula.  Here's an exaggerated drawing of the two problems.

Thats what i thought at first, but for me it doesnt really make sense how the tibia can get an improper angle from the knee area when doing LL. Since the cut is made in the middle of the tibia, (even when doing double cut, the gaps are not close to the knee) i dont get how the angle can bend from the knee.

[Medium Drink Of Water]

In LL the bow/x doesn't start from the knee, it starts to change its angle from the gap.  That drawing is of the natural deformities just to show an idea of what they are.

[Wannabegiant]

In LL the bow/x doesn't start from the knee, it starts to change its angle from the gap.  That drawing is of the natural deformities just to show an idea of what they are.

Yeah thats what i thought as well, but seeing pics of many LL patients (post lengthening phase) a good lot of them seem to have the type of x-legs shown in that picture of yours, at least it looks like it bends from the knee. I could be wrong maybe thats just how i remember it.

 It seems like if it bends from the gap then only those who lengthen a whole lot would be able to get x-legs from LL.

[Medium Drink Of Water]

Yeah the more you lengthen, the more likely/worse it could get if not addressed by your doctor.

Also keep in mind you might be looking at it from a double cut patient's perspective, while most people get a single cut close to the knee.  My osteotomy was just a few inches south of the knee.

[Doflamingo]

Go check out LL ForumorLife his diary, he has x legs caused by LL.
Sysop and himself deny it, but I showed the picture to my personal friend who is in medic school and he told me it was definitely x-legs.
There is not much you can do after LL though.
It all depends and the procedure and the quality of the device (frame).

[Wannabegiant]

Yeah the more you lengthen, the more likely/worse it could get if not addressed by your doctor.

Also keep in mind you might be looking at it from a double cut patient's perspective, while most people get a single cut close to the knee.  My osteotomy was just a few inches south of the knee.

Yeah okey that makes sense, although i always thought when doing single cut, they made the cut in the middle of the tibia, but if it is close to the knee it explains the type of x-legs i have seen in some LL patients.

[Captain America]

In LL the bow/x doesn't start from the knee, it starts to change its angle from the gap.  That drawing is of the natural deformities just to show an idea of what they are.

I disagree, please provide some evidence of your claims if you're going to speak so authoritatively on this subject.

[Medium Drink Of Water]

My knowledge about LL comes from having LL and speaking to the doctors and other patients in Beijing.  The doctors measured the angle of the legs and had us do more turns on the outer knobs if we were developing x-legs.  Some patients had their frames modified so the rods could pivot if they needed more extensive corrections.  I was one such patient.

[Sweden]

I still have x-legs. My PT says it can go away but it is hard work behind it.

I asked Dr Sarin one time why my feet were pointing so much outwards and he explained it was bc of muscle atrophy and it will correct itself with time.

My right leg is close to okey but my left knee is still pointing inwards.

It sure do doesn't look good.

[Smallguy]

I still have x-legs. My PT says it can go away but it is hard work behind it.

I also have obvious sign of x-leg with my right leg. I can't imagine that it can go away. What kind of hard-work does your physio advised?

[Sweden]

I also have obvious sign of x-leg with my right leg. I can't imagine that it can go away. What kind of hard-work does your physio advised?

Yes, I did see it in your video.
I hate the look of it. Makes us look like women.

I always have to turn my knees outside my feet when ever I do some exercises if you understand me(?)!
Standing with both feet straight forward makes your knees point inwards but you can turn them out with your muscles. Body builders that pose does that.
That's what I have to do every time I squat or walk with resistance or whatever I do.

Right after frame removal my knees bumped in to each other every time I was on the bike in the common room so it was terrible.
Now it's much better but far from how I would want it.