Leg Lengthening Surgery - Timeline to Full Recovery
Written by Joshua Leaf | Updated on August 21, 2021
For those considering leg lengthening surgery, recovery time is a huge concern since it’s nearly impossible to press pause on life.
Many ask how long does it take to get back to walking after leg lengthening surgery? When are you able to go back to work? When can you play sports again?
Rehabilitation times vary from person to person, from phase to phase, and between various methods, but you can expect it to take roughly two years to fully recover. These two years can be broken into phases with varying degrees of relief and progress throughout each.
Note, the following information is based on stryde and other internal nails. External nails generally have longer recovery periods because they can’t handle much weight or walking during the lengthening process.
Leg Lengthening Recovery Phases
Leg lengthening surgery is broken into four recovery phases:
- Surgery: 14-21 Days
- Lengthening (Distraction): 3-4 Months
- Consolidation: 2-6 Months
- Rod Removal: 1-8 Weeks
While this is a recovery timeline, it’s worth noting that many people consider preparation before surgery to be phase 0.
Preparation entails tons of stretching of the hips and legs to reduce how painful leg lengthening surgery is. Some even suggest running and avoiding barbell squats if you are already fairly flexible and have adequate muscle mass
Limb Lengthening Surgery (Phase 1)
The first phase of recovery is also known as the post-op surgery phase.
Simply put, this is how long it takes the body to heal from surgery. The leg lengthening surgery itself is a multi-hour, traumatic operation that involves breaking two or more bones (when having tibiae leg lengthening surgery, the tibia and fibula of each leg must be broken—4 total bones).
The first 24-48 hours following surgery can be extremely painful, depending on the person. With that said, pain is a highly individualized thing and many patients find that the pain is much more manageable than expected.
Surprisingly, some patients can walk the day after surgery with the full weight-bearing stryde nail. Other nails require prolonged use of walkers or canes. 1
Here’s a breakdown by weeks:
- Post-op Week 1 – Bedridden and wheelchair only
- Post-op Week 2 – Able to begin using walker to mostly get around
- Post-op Week 3/4 – Able to begin using only a cane to mostly get around (if your job or life makes it possible, most suggest using the walker with less-less pressure rather than limping and building imbalances with a cane)
Lengthening & Distraction (Phase 2)
The second phase of leg lengthening surgery recovery is known as the lengthening phase. Sometimes the lengthening phase is referred to as the distraction phase because the intramedullary (inner-bone) nail is distracting or pulling apart the leg bone millimeters at a time.
This is the most excruciating part of lengthening surgery.
The big thing that makes leg lengthening surgery different from other cosmetic procedures is that it isn’t just a surgical process that takes place within a few hours…It is a multi-month process that involves hours of physical therapy every single day.
The leg bones must be pulled apart slowly each day to allow the muscles, tendons, and bone enough time to grow.
In contrast, if the leg bones are lengthened all at once during surgery, the soft tissues of the legs would tear and the bones would never grow back or consolidate properly.
Top doctors advise that patients must forgo working for at least three months after surgery or not perform the surgery. Not every doctor has this protocol, but this really stresses the fact that physical therapy is a full-time job and a key ingredient for safe leg lengthening.
Patients who attempt to work during the lengthening process often find it futile. If you slack off with physical therapy during this phase, it can have lasting effects, impede progress, and limit the amount you can “grow”.
How long does the lengthening phase last?
Roughly 80 to 120 days for most patients, depending on two variables:
- Total amount lengthened
- Which segment was lengthened (femurs vs tibiae)
The current most-popular lengthening nail is the STRYDE nail and is capable of lengthening up to 8cm. However, the STRYDE nail is on recall for further biological testing, so the PRECICE nail is the next best option as of 2021. 2 1
While the maximum length of 8cm is possible in the femurs, most doctors will only allow 5cm of lengthening for tibiae. 1 In fact, some surgeons argue that the maximum safe limit for femurs is actually 6.5cm and not 8cm.
Currently, there is no research to determine the maximum amount someone can lengthen safely. Therefore, each surgeon’s lengthening maximums will vary because it’s based on their personal education, experiences, and evidence observed in their patients.
The rate of distraction per day is different depending on which surgery is performed:
- Femurs: 1mm maximum distraction per day -> ~90 days to lengthen full 8cm (1mm per day for the first 5cm and then .75mm per day for the last 3 cm) 1
- Tibiae: .75mm maximum distraction per day -? ~80 days to lengthen full 5cm (.75mm per day for first 3cm then .5mm per day for last 2 cm) 1
Note: the above distraction times are for the latest, best STRYDE technology and may be different for external fixator methods or various internal nails.
Additionally, some patients may have extremely high bone consolidation and require a quicker rate of distraction which is actually not ideal and can lead to more soft tissue damage.
Do not expect to lengthen at the maximum daily distraction rate. Many patients are unable to lengthen the maximum daily amount due to tightness and are required by their surgeon to lower their daily distraction rate.
While bone can grow at a rate of more than 1mm per day, the soft tissues of the legs (muscles, tendons, ligaments, nerves) are unable to grow as quickly—thus, 1mm is the maximum daily lengthening suggested femur distraction. 34
The slower distraction rate for tibiae is because the nerves are smaller and do not tolerate stretching as much as the larger soft tissues found in the femurs.
You can think of the soft tissues in the legs as a rubber band. They have a certain amount of “slack” in them (flexibility), but once that slack is fully used up, the soft tissue becomes the limiting factor.
For this reason, if the leg muscles become too tight, the surgeon may not allow you to lengthen at the maximum daily distraction rate.
The following is a more reasonable recovery time for the lengthening phase of leg lengthening surgery:
- Femurs: 90 days to lengthen full 8cm (1mm per day for the first 50 days and then .75mm per day for the last 40 days)
- Tibiae: 80 days to lengthen full 5cm (.75mm per day for first 40 days then .5mm per day for last 40 days)
Consolidation (Phase 3)
In the consolidation phase, the bones begin to heal fully and pain management becomes much easier. This is because the constant inflammation caused by your legs being slowly pulled apart can finally begin to settle down.
Most patients will fly back home during the consolidation phase and email their doctor x-rays every 1-4 weeks. Patients may lessen physical therapy to 3 times a week during the consolidation phase but the more you stretch and exercise, the sooner you will get to 100%. 1
How long does the consolidation phase take?
Just like with the lengthening phase, the specific answer depends on the method, the individual, their worth ethic, and countless other factors.
A general rule of thumb is approximately one month of consolidation per cm of length gained for femurs. Then about two months of healing per cm of length gained for tibiae.
This means that if you lengthened 8cm in the femurs, you should reasonably expect to have full bone consolidation by 8 months.
The consolidation phase of recovery is even more variable and will largely depend on your pre-existing level of fitness. The more fit you are going into the procedure, the quicker and easier you will bounce back.
- Consolidation Week 1 – Resting from weeks of constant lengthening
- Consolidation Week 2/3 – Able to use cane to get around but mobility still greatly limited and likely prefer a walker for longer distances (may be able to return to work if you have an office job but don’t expect to be able to focus very well)
- Consolidation Week 4 – Able to walk very short distances (around the house) with no assistance device, pick things off the ground (with great effort), and begin working full time again because of mental fog finally dissipating enough to work
- Consolidation Week 5 – First week of walking ~5,000 steps every day (about half the normal, healthy recommended amount of steps for adults), able to stand up with no help from hands (ONLY if you are doing PT hardcore every day)
- Consolidation Week 6 – Able to begin going out to eat, socialize, etc. with only a cane
- Consolidation Week 7 – Able to begin handling daily life errands, go to the store, etc.
- Consolidation Week 8 – Transition away from walker completely to only using cane or nothing at all
Height Surgery Rod Removal (Phase 4)
The rod removal procedure is a simple outpatient procedure that should be done within 1-2 years from the last surgery. Most patients can walk out of the hospital but may need assistance such as a walker or cane for about a week afterward.
The screw holes take around 10-12 weeks to heal. Patients should not lift anything heavy until the holes are healed but always follow the doctor’s specific orders.
Patients can begin light sports anywhere from 6-18 months after the last surgery or about 3-6 months after rod removal. The shorter side being if one segment was lengthened with the longer range if there’s any complications or externals were used
If you get the rod out around the one or 2-year mark, the two-year mark will generally be when patients can reap the full rewards. If you get the rod out around the 1 year mark it’s important to stay on top of the stretches and exercises for another year.
Excess bone growth internal nails should generally be removed within 1-2 years after surgery to minimize corrosion. 5
Life After Getting Taller
If you look at patient experiences online, the vast majority report a positive outcome. Positive meaning the surgery cured or lessened their height neurosis, there’s minimal or no long term effects, in addition to the cost, time, and pain being worthwhile.
Ultimately there’s a positive outlook, but it’s worth noting that there’s not too much data surrounding patient happiness post-surgery. However, there is tons of anecdotal information and patient diaries online. These journals detail their journeys before, during, and sometimes even years after.
The road to recovery is far easier than the other phases but as always, focus on your safety and always follow the doctor’s orders.
1Paley, D. (n.d.). Cosmetic Stature Lengthening Frequently Asked Questions (FAQ’s). Paley Orthopedic & Spine Institute. <https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs15.pdf>
2Collins, M. (2021, February 20). URGENT RECALL NOTIFICATION PRECICE STRYDE, PRECICE PLATE AND PRECICE BONE TRANSPORT. Nuvasive. https://www.nuvasive.com/wp-content/uploads/2021/02/NSO-Precice-FSN-United-States-Biodur.pdf. <https://www.nuvasive.com/wp-content/uploads/2021/02/NSO-Precice-FSN-United-States-Biodur.pdf>
3Ilizarov, S., & Rozbruch, S. R. (2007). Limb Lengthening and Reconstruction Surgery. New York: Informa Healthcare USA Inc.
4Paley, D. (1990). Problems, Obstacles and Complications of Limb Lengthening by the Ilizarov Technique. Clinical Orthopaedics and Related Research , (250):81‐104.
5Egonu, V., & Paley, D. (2021, July 3). STRYDE nail Update interview with DR. DROR paley of Paley Institute – Limb Lengthening Surgery. YouTube. <https://www.youtube.com/watch?v=-_CukMeKwlI>