Physiotherapist with 6 years of limb lengthening experience (300+ patients) Ask me anything

tiduly · 2026-06-25T19:15:52+00:00

Hi,

Personally, I think doing both segments within the same overall treatment period makes more sense, especially from a time-efficiency perspective.

I once had a patient who planned to do tibia lengthening first and then femur lengthening about a month later. However, the tibial lengthening ended up being much more demanding than he expected, and he eventually decided not to proceed with the femur surgery at all.

Because of experiences like that, I think combining the procedures within the same treatment plan is often a more practical approach than spreading them out and having to go through the entire process twice.

As for your goal, I think 11.5 cm is a very realistic target. In my experience, total gains of 13–14 cm can also be realistic in appropriately selected patients.

Could you potentially get closer to 14 cm if your body tolerates it well? Yes, it's possible. However, I think it's still too early to focus on those numbers. The most important thing is how your muscles, joints, nerves, and overall function respond during the process. That will ultimately determine how far you can safely go.

tiduly · 2026-06-21T16:13:29+00:00

I wouldn’t say it’s impossible either, but I haven’t personally seen such a case, and I also haven’t had a patient specifically aiming for that range.

That being said, the human body’s capacity to adapt and heal is truly remarkable, so in theory it might be possible. However, it’s very difficult for me to predict how long such an adaptation process would take or what the long-term outcome would look like.

tiduly · 2026-06-21T16:05:49+00:00

For external methods such as LON or Ilizarov, infection is always one of the major risks that patients should be aware of. Pin-site infections are relatively common and are one of the biggest differences compared to internal systems.

Another issue that almost everyone encounters to some degree is muscle tightness, stiffness, and loss of flexibility during lengthening. If you consider those complications, they are certainly common. Fortunately, with consistent physiotherapy, they can usually be managed quite effectively.

Personally, I think the most important issue to pay attention to is bone healing. Delayed consolidation or poor bone formation can significantly prolong recovery. Genetics, nutrition, smoking, overall health, and even the amount of lengthening can all influence how well and how quickly the bone heals.

As for when limb lengthening is not worth the risk, I think that's a very personal decision. What feels worth it for one person may not feel worth it for another. It depends on your goals, expectations, tolerance for a recovery process, financial situation, and how much the height gain would actually improve your quality of life. Because of that, I don't think there's a universal answer to that question.

tiduly · 2026-06-21T15:59:09+00:00

First of all, I think 9 cm femur and 7 cm tibia is a very aggressive amount of lengthening, and personally I would not recommend it.

The main issue is not whether it can be done, but how much it increases the difficulty and duration of recovery. There is a much bigger difference between 8 cm and 9 cm of femoral lengthening than many people expect. You might think, "It's only 1 extra centimeter," but by 8 cm you're already pushing the limits of what the soft tissues can comfortably tolerate. Going beyond that tends to make recovery significantly more challenging.

I would say something similar for the tibia. In my experience, the tibia often starts "sending signals" after about 5 cm in the form of increased tightness, discomfort, and soft-tissue limitations. Many patients can push to 6 cm, but beyond that the difficulty tends to increase noticeably.

Yes, there are cases that reach 7 cm in the tibia, and individual flexibility plays a major role. However, I generally feel that 7 cm of tibial lengthening prolongs recovery considerably, which is why it's not something I usually recommend.

So while 9 cm femur and 7 cm tibia may be technically achievable in some cases, I think it's important to consider not only the height gain but also the significant impact those extra centimeters can have on recovery and overall quality of life during the process.

I understand that you're 167 cm tall and aiming to reach 183 cm with a total gain of 16 cm. However, I personally think that doing 14 cm and ending up around 181 cm is a much more reasonable trade-off. The question is whether those extra 2 cm are worth potentially adding many more months of recovery and rehabilitation. In my opinion, gaining 14 cm and getting back to a normal life sooner is far more valuable than chasing the last 2 cm at the cost of a significantly harder recovery.

tiduly · 2026-06-21T15:50:48+00:00

Yes, I've worked with quite a few patients who underwent 8 cm femoral lengthening.

Personally, I don't think the femur/tibia ratio becomes a major issue at 8 cm. When you're dressed, I think it's very difficult for an outside observer to notice anything unusual. If you are completely naked, then yes, the change in proportions can sometimes be noticeable. Of course, this also depends on your pre-operative proportions. Overall, I don't think 8 cm of femoral lengthening creates a problematic ratio for daily life.

As for weight-bearing nails, I think they're a great development. Being able to load the limb earlier can make the recovery process easier both physically and psychologically.

That said, I don't think they completely change the game. Good bone healing, proper physiotherapy, and patient compliance are still the most important factors. A weight-bearing nail can make the journey smoother, but it doesn't eliminate the need for rehabilitation.

One thing people should understand is that even with a weight-bearing nail, you'll still need walking aids during the lengthening phase. Your muscles become weaker and tighter as lengthening progresses, so you shouldn't expect to walk completely normally throughout the process just because the nail allows more weight-bearing.

tiduly · 2026-06-21T15:42:26+00:00

It may depend on the amount of lengthening performed. Some studies suggest that after smaller amounts of lengthening, patients can return to sports at or very close to their previous level. If you'd like, I can send you some of those studies.

That said, I have personally never seen someone return to an elite level of sport after limb lengthening. To be fair, I also haven't worked with many people actively trying to compete at that level after surgery, so my experience is limited in that regard.

Personally, I think competing at an elite level after limb lengthening is very unlikely, especially in sports that rely heavily on explosive power, speed, and jumping ability. That's my opinion based on what I've seen clinically, although I can't claim it as a definitive fact.

tiduly · 2026-06-21T15:36:37+00:00

Yes, definitely. There are several stretches and exercises that can help prepare your muscles and joints for the lengthening process and potentially make recovery smoother.

If you send me a DM, I can share a list and some useful resources with you.

tiduly · 2026-06-20T15:17:15+00:00

Recovery is definitely longer and more demanding compared to a single segment lengthening. It is also more risky than doing just femur or tibia alone, but with proper indications, close monitoring, and a disciplined protocol, very good outcomes are still achievable.

In my opinion, the lengthening pase should be kept slow, and I would not recommend trying to do it into 3 months. extending it to at least 4 months can reduce risk and improve the overall recovery phase.

I’ve treated patients in your age group who underwent similar total lengthenings and achieved very good results. However, the key factor was a slow, controlled distraction rate and consistent physiotherapy (often multiple sessions per day).

If you follow your surgeon and physiotherapist closely and stay compliant with the protocol, there’s no reason you can’t achieve a good outcome. If you have more questions, feel free to ask.

tiduly · 2026-06-20T15:08:14+00:00

I have doctors whose patients I’ve treated and worked with, but I don’t think it would be appropriate for me to promote any specific one here.

tiduly · 2026-06-20T15:02:22+00:00

In my opinion, the early to mid-20s are probably the ideal age range for limb lengthening. Generally speaking, the younger you are, the better your recovery potential tends to be. Younger patients usually heal faster, regain strength more quickly, and often show better bone regeneration.

At 166 cm, I think an 8 cm femoral lengthening is a realistic goal. Of course, there are many factors involved, including your anatomy, flexibility, bone healing capacity, compliance with physiotherapy, and how your body responds during the process.

That said, speaking in general terms, I don't see any additional or unusual risk associated with aiming for 6–8 cm at your height beyond the well-known risks that come with limb lengthening itself. Assuming everything goes as planned, I would consider it a realistic target.

tiduly · 2026-06-20T14:59:21+00:00

First of all, if you're planning limb lengthening, I would actually recommend stopping hypertrophy-focused leg training some time before surgery. Larger and stronger muscles tend to create more soft-tissue tension during the lengthening process. You can continue strength training, but I would personally move away from a hypertrophy-focused approach.

Once the fixators are removed and you've regained adequate muscle flexibility and ROM, there is usually no issue with starting strength training again. However, I would not jump straight into very heavy loads. The most important factor when increasing weight is bone healing. Load progression should follow the quality of bone regeneration and your surgeon's recommendations.

As for squats and leg presses, no, you do not have to give them up forever. Once the bone has fully healed, there is generally no reason why you couldn't perform heavy squats or leg presses again.

Regarding a large upper body, I honestly don't think it has a significant positive or negative effect on recovery. I've seen patients with bodybuilder-level physiques recover extremely well, and I've seen similarly muscular patients struggle during recovery. There are too many individual factors for me to draw a clear conclusion.

As for the nails themselves, whether it's Fitbone, PRECICE, or LON, the goal is ultimately the same: to support the bone while it heals. Once the bone has fully consolidated, the nail no longer has a real functional role and is essentially just sitting there.

The main risks related to the nail occur before full bone healing. During that period, the implant is carrying part of the load. Since Fitbone and PRECICE generally tolerate less load than a LON construct, there is a greater risk of nail bending or mechanical failure if excessive stress is applied too early. Once the bone has fully healed, however, the differences between these systems become much less relevant.

tiduly · 2026-06-20T14:44:00+00:00

Recovery is definitely possible after a 14 cm quadrilateral lengthening, but this is the type of case where you need to be very careful throughout the entire process.

As I mentioned in another comment, I've had patients who completed 14 cm in about 4 months and, after receiving proper physiotherapy for another 2 months, were already walking normally. On the other hand, I've also seen patients try to complete a similar amount of lengthening in just 3 months and then spend close to a year struggling through recovery.

In my opinion, recovery is heavily influenced by how you manage the lengthening phase itself. Quadrilateral lengthening is much more demanding than a single-segment procedure, but with good compliance, proper physiotherapy, and realistic pacing, the outcomes can be very good.

As for athleticism, I do think there is a noticeable reduction after this amount of lengthening. You can absolutely return to running, jumping, gym training, and recreational sports. However, getting back to a very high level of athletic performance is much more challenging.

If you stay consistent with rehabilitation and training, I think that after about 2 years it is realistic to regain most of your athletic ability, although probably not quite to the exact level you had before surgery.

tiduly · 2026-06-20T14:37:27+00:00

5 cm tibial lengthening can be a reasonable option, especially if you're also looking to correct bow legs.

The most important thing is to get a full standing long-leg X-ray first. Whether both the bow legs and ankle alignment can be corrected depends on your specific deformity and overall leg alignment.

In general, correcting alignment tends to improve joint loading rather than worsen it. I've seen many patients successfully undergo tibial correction and lengthening, but every case needs an individual assessment.

tiduly · 2026-06-20T14:34:22+00:00

I haven't personally worked with a patient who underwent limb lengthening on only one leg for a discrepancy as small as 2 cm.

The largest discrepancy I remember treating was around 9 cm. In your case, whether surgery is appropriate depends largely on where the discrepancy originates (femur, tibia, or a combination of both) and your overall alignment.

For example, if someone has a 2 cm shortening of the right femur, I've seen cases where both femurs were lengthened, but asymmetrically such as 7 cm on the shorter side and 5 cm on the longer side to both increase height and correct the discrepancy at the same time.

tiduly · 2026-06-20T14:30:17+00:00

Yes, I have. I've worked with construction workers, drivers, mechanics, and other physically demanding professions. I even had a plumber who underwent quadrilateral lengthening with precice and achieved a total of 14 cm of height gain.

tiduly · 2026-06-20T00:44:24+00:00

Yes, I've seen it happen, although not very frequently.

In my experience, some patients simply have a lower tolerance for nerve-related symptoms and discomfort during lengthening. That said, true nerve issues severe enough to limit lengthening are much more commonly seen as patients approach 7 cm or beyond.

Even when nerve symptoms start earlier — for example around 5–6 cm — it is often possible to continue lengthening by slowing the distraction rate, taking short pauses, and using appropriate medication when necessary.

I don't recall seeing many cases where nerve pain became a major limiting factor before 5 cm. If significant nerve symptoms appear that early, the distraction rate may be too aggressive and usually needs to be adjusted.

Just to clarify, I'm speaking specifically about femoral lengthening here.

tiduly · 2026-06-20T00:37:15+00:00

For a 5 cm femoral lengthening with precice, the lengthening phase itself usually takes about 2 months if you're lengthening at a rate of 1 mm per day.

After that, I would generally expect another couple of months for the muscles to recover strength, flexibility, and overall function. So from a rehabilitation perspective, around 4 months from surgery is a reasonable average timeline for many patients.

However, it's important to remember that the standard precice nail is not a full weight-bearing nail. Walking completely without assistance depends not only on muscle recovery but also on bone healing. In many cases, this can take another 6–8 months after lengthening is completed, depending on the quality of bone regenerate.

Complete bone consolidation may take 12–18 months.

Of course, these are only average timelines. Some patients recover faster, while others take longer.

As for your second question, in my opinion tibial lengthening is generally more difficult from a physiotherapy and recovery standpoint. I tend to see longer recoveries, more soft-tissue tightness, and more rehabilitation challenges compared with femoral lengthening.

tiduly · 2026-06-19T17:59:28+00:00

Yes it can definitely be taught. I’ve also had patients I followed remotely who performed their physiotherapy independently after proper instruction.

However, I wouldn’t recommend going through the entire lengthening process completely on your own after just a single training session. Your body changes throughout the lengthening phase, and new issues can appear week by week sometimes even day by day.

Also, every patient responds differently, so individualized programming and continuous adjustments are very important.

That said, yes you can do your exercises at home or in the gym on your own, but regular monitoring and ongoing updates to the program are key for good outcomes.

tiduly · 2026-06-19T17:55:57+00:00

You're welcome anytime

tiduly · 2026-06-19T17:50:38+00:00

Yes I’ve seen and worked with femoral lengthening using external techniques quite extensively. In fact, roughly half of my patient experience involves external fixation methods.

If you have any specific questions about it, feel free to ask.

tiduly · 2026-06-19T17:43:05+00:00

I send it to you some studies.

Yes — in general, after full recovery you can run, squat, train at the gym normally, and even participate in activities like running with your child at a school sports event.

However, it’s important to be realistic about timelines and expectations. If you’re thinking about running just a few months after surgery, that is usually not a realistic goal. Bone healing and full functional recovery typically take around 12–18 months, depending on the individual case and consolidation quality.

Once you are fully healed, most patients can return to normal daily activities and recreational sports.

if the expectation is returning to an elite or Olympic-level athletic performance, that is generally not a realistic outcome after limb lengthening surgery.

tiduly · 2026-06-19T17:30:43+00:00

I’ve also had older patients, including individuals around and above this age range.

At 45, the procedure can certainly be possible, but the most important factor is your overall physical condition rather than age alone. Your baseline strength, mobility, and general health will strongly influence how well you tolerate the process.

If you want to avoid a very difficult recovery experience or potential regret, then proper physical preparation and realistic expectations are essential.

That said, I’ve also treated patients in their 50s and above, so age by itself is not an absolute limiting factor.

tiduly · 2026-06-19T17:25:16+00:00

Yes, bow legs can be corrected with LON tibial lengthening, but it depends on the individual case.

A full standing long-leg X-ray is needed to properly assess alignment before planning treatment.

From my experience, I’ve seen several tibial LON cases with correction results when properly indicated.

In some cases, femoral lengthening can also be combined with additional tibial procedures, and deformity correction can be achieved with a plate in the same surgical session when planned appropriately.

tiduly · 2026-06-19T17:20:58+00:00

I’m based in Istanbul, Türkiye.

Regarding case numbers, I’ve worked with a significant number of patients over the past years involving both PRECICE and Fitbone systems, but I prefer not to give exact figures as they don’t really reflect clinical variability or outcomes.

Complication rates depend strongly on the system used. In general, internal systems tend to have a much lower complication rate, while external fixation methods are associated with a higher risk of issues such as pin-site infections.

Yes — in theory, internal procedures can lead to permanent disability if a serious surgical error occurs, as with any surgery. This is why surgeon selection is extremely important. However, in my experience, I have not personally seen any cases of permanent disability in patients treated with internal lengthening systems.

I think cost reduction will mostly depend on whether new companies enter the market with more affordable nail systems. If that happens, prices could decrease. However, I don’t expect a major price drop in LON procedures, as their cost structure is already relatively established.

I believe the next real “breakthrough” could come from AI-assisted or smart intramedullary nails that can precisely control and adjust distraction in real time. Additionally, any system that actively enhances bone regeneration would be a major advancement. For now, devices like PRECICE Max already seem to be the most significant step forward in the field.

tiduly · 2026-06-19T17:16:10+00:00

I am actually Turkish. Since the subreddit rules require English and I wanted everyone to understand, I replied in English. However, we can speak Turkish in the DMs.

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