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[Athens]

https://imgur.com/gallery/vJwcktU

This is the state of my dorsiflexion after 6cm of limb lengthening. I am 5 months post op. I can’t walk normally. Is this normal or am I way out of the normal range? My job requires physical activity and in 4 months if i can’t get to running, I lose my job. I am considering reversing my length to 5cm. What do you think I should do, continue stretching as it is? Additional surgery is not an option for me. I must get back to running condition for the sake of my livelihood in 4 months. I am standing on the slant board infrequently, but i’m now doing it 4-5x a day at 10 minutes. I’m also laying on my stomach and letting my knees stretch out. Looking for suggestions as well as if you think my progress is normal/satisfactory, and if i should reverse lengthening.

[MirinHeight]

Were you walking before at 4 cm.

Imo 4-5 cm is most you should do on tibias. I would go down to 5cm and do a lot of stretching. What did giotikas say?

[Athens]

He says to reduce down to 5cm if i have to and also possible gastroc recession. but i don’t want it to have to get to that.

[Athens]

also, i can’t remember the last time i was walking fine. it was probably around 2-3cm.

[snowpiecer]

Seeing the state of your dorsiflexion and the fact that you're still using walkers at 5 months post-op, running after 4 months will be a difficult goal unfortunately.I also believe 5cm should be the limit for tibia.

[Movie]

I think a centimeter wouldn't make a difference at this point, at 6 cm or 5 cm the same damage is done already .. let your body heal, work on helping it recover as much as possible, eat good and you'll see how your situation starts improving. tibias is harder and different recovery time than femurs for sure they take longer, so be patient and dedicated to recover.

[Nestor]

I'd be inclined to take Dr G's advice if he said to reduce. I know it's discouraging to not achieve your original goal but no one will notice 1cm difference. You need to ask yourself what you really want, be able to walk normal again at 5cm or be 1cm taller and not be able to move properly?

[California2]

It is difficult to evaluate your dorsiflexion because of your posture and foot position.  Please stand on a flat floor with your shoulders, backside and heels against the wall; then, see if you can get the bottom of your heels on the floor.

If so, you are at about a 90 degree angle between the plane of the foot and the plane of the shin (or neutral dorsiflexion, sometimes called "0 degrees dorsiflexion). 

If you can achieve neutral dorsiflexion now; then, you have a decent shot at achieving normal dorsiflexion with hard work.

At least your right leg looks like it might be at neutral dorsiflexion; maybe -5 degrees which is not hideous.

Normal dorsiflexion is 0 to 40 degrees.  Most people have 10 - 30 degrees; that is, the plane of the foot can be pulled up off the floor from 10 to 30 degrees.

Provided your bones are sufficiently healed and all other systems are "go", I suspect it will be possible for you to run in 4 months provided you aggressively train; that is, stretching, walking, stairs and stretching again at least three significant sessions per day; then, adding in some running steps; then, running when able. 

Whether or not you should be attempting to run is a conversation between you and your surgeon.

[ghkid2019]

You need to actually do more dorsiflexion exercises. It's obvious you slacked off quite a bit. This is very bad dorsiflexion. You main goal is to treat this dorsiflexion. Unless you want to sit and watch Netflix, stay having your heel up forever,then start treating exercises like a religion. Like 3-4 hours a day. Japanese leg lengthened routine 5-6 hours a day.

[10cmOnTibiaOrGTFO]

damn bro you look fked up. wish you the best. hope you get well in time so you can work again.
you need to work extra hard!!!

[Athens]

https://imgur.com/gallery/mrvmeNB

What is the Japanese leg routine?

Note: i’m only receiving near neutral dorsiflexion after stretching for 10 minutes.

[California2]

Based on your updated photo, I agree with you assessment that you are near neutral--maybe negative 5-10 degrees.

The longer you wait, the tougher it will be to gain flexibility. 

Your post is unclear as to when you stopped lengthening.  You wrote that you are "5 months post op".  Do you mean you stopped distraction 5 months ago; or, that you had your initial surgery 5 months ago and just stopped distraction recently?

Time matters.  Unfortunately, if you stopped distraction 5 months ago and still have not achieved neutral dorsiflexion; then, you may need to consider surgical correction.

However, irrespective of your surgical timeline, if you are cleared to bear full weight; then, I encourage you to hit it hard and see if you can make some gains because you are close. 

[Athens]

My surgery date was 8 January. 2 months post distraction. I am also going to employ this device. Nearly 800 dollars for the month, but let’s hope it does the trick: https://www.ermi-motion.com/program/ankle/

[ghkid2019]

https://imgur.com/gallery/mrvmeNB

What is the Japanese leg routine?

Note: i’m only receiving near neutral dorsiflexion after stretching for 10 minutes.

It's tough, but the Japanese people that rehab like a alcoholic hold a light and easy dorsiflexion stretch for like 45 minutes at a time.. yes the entire 45 no break.. for multiple sets in a day.. it's extreme but it is very beneficial for those who lengthen alot against doctors recommendation

[California2]

Thank you for clarifying your surgical history.

From my perspective, you have two related but independent issues: running and dorsiflexion.

You report you lengthened 6 cm.  A good rule of thumb is two months consolidation for every centimeter lengthened for full bone recovery.  This means your bones will likely be largely healed in 10 months from now (6 cm x 2 months = 12 months - 2 months for consolidation already underway = 10 months).

Yet, you want to run in 4 months.  Perhaps your timeline is too aggressive?

While many internal nails are fully weight bearing, bearing weight and running are not the same.  Run too early and you risk shearing off the screws that hold the nail in place.  Do that, and you will drive your nail through your ankle or your knee--bad either way.

So, has your surgeon approved running in four months?

As for dorsiflexion, you are only two months into consolidation and your equinas is not bad.  However, your flexion will NOT improve on its own.  Half-measures are rarely productive.  Gadgets cannot replace good, hard, fundamental work.

If you are approved for weight-bearing; then, get on your feet!  Doing so promotes bone growth and improves flexibility. 

Stand, hold onto something, and concentrate on relaxing until your legs are straight and your heels are on the ground.  Alternate pressure by putting all of your weight on one leg for several minutes; then, switch.  Repeat this process for at least 30 minutes, at least 3 times per day. 

Make sure you get good rest too because rest is a necessary part of recovery.

Best of luck!

[Movie]

I second California2's last reply, there's no need for that over complicated device ... standing flat/slanted surface stretches will work you just have to be consistant.

[Kogi314]

Wow.
First of all, wish you all the best, and be optimistic, their people who have done way more than you and recovered to walking properly. But you have me scared for a bit, I'm planning to do 6cm with Dr G, tibias. How would you rate him? How flexible were you before the surgery?

[TemakiSushi]

Wow.
First of all, wish you all the best, and be optimistic, their people who have done way more than you and recovered to walking properly. But you have me scared for a bit, I'm planning to do 6cm with Dr G, tibias. How would you rate him? How flexible were you before the surgery?

If you are very serious about tibia lengthening I recommend Donghoon
After researching quite a lot patients from all over the world
I feel he is the only CLL doctor who can do tibia safely and precisely
Many of his patients do tibia lengthening unlike other top CLL doctors patients

[Arcon]

I second California2's last reply, there's no need for that over complicated device ... standing flat/slanted surface stretches will work you just have to be consistant.

1. I don't think you are that bad for the phase you are in, it's just your tight schedule that puts pressure on you.
2. I have huge respect for @California2 but don't listen to anyone here and stick with Dr G's advice, he definitely knows what to do and we all know that he never stops caring for his patients, so...if he said CPM stretching device, that's what it is for you IMO!

[Athens]

He is a good surgeon. It wouldn’t be accurate to view my lack of flexibility as his fault.

Thank you all for your words. It has put me in the right mood to reclaim my life back with some hard work. I hope to update you on my progress in the coming weeks.

[ghkid2019]

He is a good surgeon. It wouldn’t be accurate to view my lack of flexibility as his fault.

Thank you all for your words. It has put me in the right mood to reclaim my life back with some hard work. I hope to update you on my progress in the coming weeks.

Good luck man. Rooting for you. Just remember that there is no shortcuts or life hacks to fix your dorsiflexion. You're gonna need months of hard work and dorsi exercise. No magic pill. Make up for your previous lack of effort, prove yourself now, today.

[Ghostfish]

I second California2's last reply, there's no need for that over complicated device ... standing flat/slanted surface stretches will work you just have to be consistant.

Hi Athens
I think your current status is not too bad. But you have to work hard to improve your dorsiflexion. 
I completely agree with Movie and California2. I don't think that expensive device can help you more. It is you. You just need to stand on the slant board much more often and much longer. And Walk!! Walk!!

Regarding running, sorry that I have to say that it is pretty much not possible to run in 4 months with tibiae CLL.  I know one patient who did only tibia with stryde under Paley.  He is very athletic and diligent at working out.  Even after 1 year postop, he said he couldn't really run like sprint, although he can jog.  Some patients with femur cll can do a little better.  But overall running is hard within a year or so with nails inside.  I don't know what is the level of running you need.  Hopefully, it is not too demanding.

Good luck!!