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[Hobbit99]

Hi all

I had another appointment with the doctor. The procurvatum tibia deformity is only slightly better. It appears that the calf muscles are too big and push the tibia anteriorly, so we cannot procede with the correction until the calf muscles will be more relaxed. So the dr, told me to stop turning completely with the fixator (i was only turning the posterior rods to fix the misalignment since december 28). At least for 1 month, so until the next appointment, to give time to the muscles to relax so the the tibia will be slightly pushed posteriorly as well, than the next time we’ll do some “mini adjusments” for the “final correction”. This had me a bit worried, because i fear premature consolidation during this month.

I feel that my knee is slightly better since i stopped turning, but my feet are still bad. I have equinovarus feet, so they’re bot equinous and varus. I put all my weight on the point of my feet (equinous) and on the external border (varus).
The equinous, or ballerina as it’s called on this forum, is what really prevents me from walking. My heels do not touch the ground and the points of my feet hurts. I cannot remove my hans from the walker or I fall. I cannot even move the walker forward (no wheel) because of this. So I basically let someone pull the walker and I do 3-4 steps before feeling really tired on my upper body and in need to sit down to rest a bit, than other 3-4 steps.
Also i cannot stand straight, otherwise I tend to fall.

I’m feeling the worst since the surgery because I can’t walk like this, and if I can’t walk I cannot properly stretch the achille tendon.

I think my heels are 3-4 cm above the ground.

the doctor said this (equinous and varus) will go away with time and not to worry about. He also said I can use lifts to walk, but still have not tried. I fear lifts prevent me to fight ballerina?

I really hope the doctors are right and are not just trying to keep me calm. I will follow instructions and hope for the best.

[lucindaris]

Stay strong and keep us updated.

[sxxa]

If I were you I would have serious concerns. Just don't be alarmed but be diligent. I would believe the main reason you got all these problems it's because you over-extended your tibias. In my opinion for tibias anything above the 4 to 5 cm range it's a big NO. I still don't understand why some Doctors suggest going over 4-5 cm. It makes no sense. If you do a quick research, the very best Drs. (Paley, Lee) they would never EVER suggest doing more than 5cm for tibias and a max of 8cm for femurs. There is a reason for that.

[TheDream]

If I were you I would have serious concerns. Just don't be alarmed but be diligent. I would believe the main reason you got all these problems it's because you over-extended your tibias. In my opinion for tibias anything above the 4 to 5 cm range it's a big NO. I still don't understand why some Doctors suggest going over 4-5 cm. It makes no sense. If you do a quick research, the very best Drs. (Paley, Lee) they would never EVER suggest doing more than 5cm for tibias and a max of 8cm for femurs. There is a reason for that.

Lee does 7 cm does he not? At least I think I remember from his paper on recovery of his patients the average amount lengthened was 6 or 7 cm.

[Body Builder]

Most LLers can do 6.5cm on tibias without many issues. At least no more than 8cm on femurs.
4-5cm on tibias as a safety limit is a joke.
Bf of 3-4cm will become better as you start walking. Use lifts in the begining and with time remove 1cm till you don't need them. Even having always 1-2cm lifts is not a big deal to help you walk easier.
After all most of us before LL used much more than 2cm lifts.

[Hobbit99]

If I were you I would have serious concerns. Just don't be alarmed but be diligent. I would believe the main reason you got all these problems it's because you over-extended your tibias. In my opinion for tibias anything above the 4 to 5 cm range it's a big NO. I still don't understand why some Doctors suggest going over 4-5 cm. It makes no sense. If you do a quick research, the very best Drs. (Paley, Lee) they would never EVER suggest doing more than 5cm for tibias and a max of 8cm for femurs. There is a reason for that.

I definitely reached my limit. Every doctor suggests different amount of lengthening. I did what my doctor suggested and not more.
As far as I know only paley suggests maximum 5 (but he did more, as you can understand from his article from the 90s: “problem, obstacles and complications of limb lengthening by the ilizarov technique”) https://www.researchgate.net/publication/20751607_Problems_Obstacles_and_Complications_of_Limb_Lengthening_by_the_Ilizarov_Technique

I just hope the ballerina feet will go away as I’m being told and that atl surgery is “rarely” necessary

[Hobbit99]

Most LLers can do 6.5cm on tibias without many issues. At least no more than 8cm on femurs.
4-5cm on tibias as a safety limit is a joke.
Bf of 3-4cm will become better as you start walking. Use lifts in the begining and with time remove 1cm till you don't need them. Even having always 1-2cm lifts is not a big deal to help you walk easier.
After all most of us before LL used much more than 2cm lifts.

never used lifts
I will buy some 4 cm ones soon

even tho I prefer I won’t need them in the future, and that my heels will just go flat on the groung so I can easily walk barefoot

[Hobbit99]

Lee does 7 cm does he not? At least I think I remember from his paper on recovery of his patients the average amount lengthened was 6 or 7 cm.

donghoon lee? as far as I know, yes he goes beyond 6 cm, up to 7 and maybe more? It depends on the patient. Some can achieve greater amount of lengthening without (serious) complications, other may need to stop much sooner

[sxxa]

Most LLers can do 6.5cm on tibias without many issues. At least no more than 8cm on femurs.
4-5cm on tibias as a safety limit is a joke.
Bf of 3-4cm will become better as you start walking. Use lifts in the begining and with time remove 1cm till you don't need them. Even having always 1-2cm lifts is not a big deal to help you walk easier.
After all most of us before LL used much more than 2cm lifts.

>BS
>The best doctor in the field (Paley) say 5cm it's the limit
>Some anon on the internet say its BS.

Who should I believe?

[sxxa]

donghoon lee? as far as I know, yes he goes beyond 6 cm, up to 7 and maybe more? It depends on the patient. Some can achieve greater amount of lengthening without (serious) complications, other may need to stop much sooner

I don't remember where I read he stated 5cm its the safest lenght for tibias. But again, Paley is very clear with this. I would trust his word more than internet randoms or not so well known surgeons.

[Hobbit99]

I don't remember where I read he stated 5cm its the safest lenght for tibias. But again, Paley is very clear with this. I would trust his word more than internet randoms or not so well known surgeons.

It’s probably true that 5 cm is safer than 6. Like 3 is safer than 5. This does not mean that more than 5 is not possible if your body lets you.

I know that paley is very strict with 5cm lately and I know he’s considered the best, but there are many experienced surgeons with different opinion on this.

 I did my research, i know that in medicine there are often different opinions that are equally true. We don’t have a peer review paper that states anything beyond 5 cm you are crippled.

I don’t think it’s my fault just because I didn’t follow paley recommendations or I didn’t choose to go to paley.

Anyway, I’ll wait for my feet to return to normal and even if they do not, ballerina foot is fixable in some ways. But the doctor said it goes away by itself in most cases.

What worries me more is the procurvatum/misaligment. I hope to see that completely fixed next month.

[sxxa]

It’s probably true that 5 cm is safer than 6. Like 3 is safer than 5. This does not mean that more than 5 is not possible if your body lets you.

I know that paley is very strict with 5cm lately and I know he’s considered the best, but there are many experienced surgeons with different opinion on this.

 I did my research, i know that in medicine there are often different opinions that are equally true. We don’t have a peer review paper that states anything beyond 5 cm you are crippled.

I don’t think it’s my fault just because I didn’t follow paley recommendations or I didn’t choose to go to paley.

Anyway, I’ll wait for my feet to return to normal and even if they do not, ballerina foot is fixable in some ways. But the doctor said it goes away by itself in most cases.

What worries me more is the procurvatum/misaligment. I hope to see that completely fixed next month.

Of course is possible going for more than 5cm. But I don't believe its worth it. The risk-reward ratio its just too dangerous. Even if it isn't yet a peer review paper its your health what you are putting ar risk (Im not lecturing you, it's your health and not my problem).

What I don't like about all these doctors is they suggest patients to go for these dangerous limits. I don't think is ethic. I much rather hear and believe what Paley says.

[Hobbit99]

Of course is possible going for more than 5cm. But I don't believe its worth it. The risk-reward ratio its just too dangerous. Even if it isn't yet a peer review paper its your health what you are putting ar risk (Im not lecturing you, it's your health and not my problem).

What I don't like about all these doctors is they suggest patients to go for these dangerous limits. I don't think is ethic. I much rather hear and believe what Paley says.

This surgery is risky

of course 4 cm is safe, but not worth 20k euros and you need to consider you can do this once in your life probably

when you are short, every cm matters and every cm is an added risk

these are not easy decisions to make and I’m not ignorant, I did my research and I accepted the risks. Contractures are fixable by pt or surgery. We’re not talking about the risk of an amputation here, but things that are fixable.

Now, probably it’s me being a bit paranoid, but I feel I’m being judged (or yes, lectured).

It’s already hard as it is now so please understand

[sxxa]

This surgery is risky

of course 4 cm is safe, but not worth 20k euros and you need to consider you can do this once in your life probably

when you are short, every cm matters and every cm is an added risk

these are not easy decisions to make and I’m not ignorant, I did my research and I accepted the risks. Contractures are fixable by pt or surgery. We’re not talking about the risk of an amputation here, but things that are fixable.

Now, probably it’s me being a bit paranoid, but I feel I’m being judged (or yes, lectured).

It’s already hard as it is now so please understand

Don't get me wrong I'm not in any way judging you or trying to lecture you on anything, I just hope the best for your recovery. It just makes me really mad when doctors suggest to patients going for more than the general accepted safe limits. I do understand every centimeter could be potentially life changing but I don't believe it's worth it. Its certainly a risky surgery, why to put even more risk factors on it?  I hope the very best for your recovery

[Hobbit99]

thanks
but there is no general accepted safe limits
every one has slightly different opinions on this

[opimisme2022]

Kind of worried about you.. no update since two weeks.. hope you are getting better.. let us know you are okay

[lucindaris]

Same I would like to know if everything is ok.

[Hobbit99]

Hello

I tried to join the forum but it was offline for some reason? Now is back up.

Things are not going well with my equinus. He says he has seen worse cases that recovered, but I need to keep a tight shoe that pushes my feet in dorsiflection, day and night. I can't stand the pain from I think some callouses that formed on the soles of my feet, but he said that If I can't do it he will need to to ATL. He prefers not to do ATL because he says it's "traumatic"?
I told him maybe it's better to go back 1cm to when my equinus started but was somewhat manageable, but he again said it's better to try with the shoe and a lot of standing since usually people recover from this.

In this last month I saw some progress. I can again walk a bit every day, but it's exhausting because of the equinus. Wearing a 5cm lifts helps but not too much and my PT says that if I use lifts then my achille tendon will never stretch.

Tomorrow I will have another appointment. I think he will finally tell me if I need to keep pushing with rehab or I need to do ATL.
If I need to do ATL I hope it will go well and not like some users on this forum.
I will let you know.

If I manage to fix the equinus without surgery would be fantastic but it's hard, really hard. Basically you can't stand with both ballerina feet. I thought you could before the surgery, reading this forum, but it's not my case. Standing up and walking without the full support of your feet is the hardest thing so far.

EDIT: at least it looks like there is not more procurvatum. Legs look straight from the rx. Bone callus is forming well.

[peter07]

Hello

I tried to join the forum but it was offline for some reason? Now is back up.

Things are not going well with my equinus. He says he has seen worse cases that recovered, but I need to keep a tight shoe that pushes my feet in dorsiflection, day and night. I can't stand the pain from I think some callouses that formed on the soles of my feet, but he said that If I can't do it he will need to to ATL. He prefers not to do ATL because he says it's "traumatic"?
I told him maybe it's better to go back 1cm to when my equinus started but was somewhat manageable, but he again said it's better to try with the shoe and a lot of standing since usually people recover from this.

In this last month I saw some progress. I can again walk a bit every day, but it's exhausting because of the equinus. Wearing a 5cm lifts helps but not too much and my PT says that if I use lifts then my achille tendon will never stretch.

Tomorrow I will have another appointment. I think he will finally tell me if I need to keep pushing with rehab or I need to do ATL.
If I need to do ATL I hope it will go well and not like some users on this forum.
I will let you know.

If I manage to fix the equinus without surgery would be fantastic but it's hard, really hard. Basically you can't stand with both ballerina feet. I thought you could before the surgery, reading this forum, but it's not my case. Standing up and walking without the full support of your feet is the hardest thing so far.

EDIT: at least it looks like there is not more procurvatum. Legs look straight from the rx. Bone callus is forming well.

Sei una cazzo di roccia, si può tornare indietro con l'allungamento?

[Hobbit99]

Sei una cazzo di roccia, si può tornare indietro con l'allungamento?

Si si può ma me lo ha sconsigliato.

[Hobbit99]

I'm happy to say that the doctor said my feet are much better now. He says I won't have to do ATL because my soft tissues are very flexible.
He said I need a bit of more effort and patience (but he didn't say how much time) and I will recover from ballerina without surgery.

For now, he said I need to walk with high shoes and lifts. This will relax the posterior muscles of the leg and somewhat will also help to stretch the achille tendon even if I can't understand why.
Until now I didn't use lifts because my pt said that with lifts my tendon would never stretch. The doctor said that walking on tip toes is actually worse because it worsen the contracture (?). I didn't understand the reasoning, but I'll trust and follow what he says no matter what my pt thinks.

I'll buy some tall shoes and start to walk with them and hope that I will be back to normal in some months.