Limb Lengthening Surgery: Long-Term Side Effects

The long-term side effects of limb lengthening or height increasing surgery are a significant source of worry for many potential candidates. However, with a good doctor and proper aftercare, most of these effects can be mitigated or even eliminated entirely. If you’re worried about how you may feel 10 years after leg lengthening, let us shed some light on some of the most common long-term complications and what can be done about them.

Please note, this article is about potential long term side effects and complications. For a full list of surgical risks and complications, check out this article instead. 

Why Do Complications Arise?

Short-term complications are generally related to the surgery itself, but long-term effects can manifest due to both doctor and patient error. Patients may neglect regular stretching or physical therapy or lengthen too much daily, both of which can cause permanent muscle problems.

On the other hand, a careless doctor may miss indications of malunions, fibula displacement, or infection. If these conditions are left untreated for too long, they may lead to irreversible arthritis and chronic pain in the long term.

Some believe that the surgery isn’t worth the risks, but in reality, candidates must research and find a good doctor and follow their advice instead of looking for the cheapest option. Patients can’t undo this surgery, so it’s better to wait and save up for it instead of risking one’s health with an unreliable doctor.

Drop Foot

Drop foot, also known as ballerina foot amongst limb lengthening patients, is commonly a result of nerve damage. Patients with drop foot suffer damage to the peroneal nerve and cannot flex their feet upwards (otherwise known as dorsiflexion), making their toes drag on the ground.

This type of nerve damage is more likely with tibia lengthening than the femur. Tibias can also only be safely lengthened up to 5 cm,[1] so more aggressive elongation increases the likelihood of drop foot.

Orthopedics treat this condition with a brace known as an ankle-foot orthosis that helps fix the foot’s walking position. If this doesn’t help, the surgeon can perform a Bridle surgery.[2] This surgery involves attaching tendons that connect to the front of the foot to the tibial tendons. The tibial muscle then pulls on these tendons, allowing people to flex their foot upwards.

Knock Knees (X Knees)

If the bone is misaligned and heals incorrectly, leading to a malunion, it can cause knock knees or genu valgum. The malunion can change the alignment of the bones at the knee. These patients’ knees will bend inward, forming a kind of incomplete “X” shape.

While knock knees are commonplace in children around 2-8 years of age,[3] adults with this complication might experience knee and hip pain, stiff joints, a limp, and eventual arthritis are common side effects of knock knees.

Since limb lengthening or stature lengthening patients tend to be adults, a knee-realignment osteotomy generally corrects this condition.[3] The surgeon removes or adds a wedge of bone to the tibia or the femur to prevent weight bearing on the damaged part of the knee.

Bow Legs (O Knees)

While knock knees bend inward, bow legs or genu varum bend outward at the knee joint. The legs assume a rounded shape, giving rise to the name “O legs”. The trauma of limb lengthening can cause malunions, leading to knee misalignment and possibly resulting in bow legs.

This condition can be counterproductive as the patient appears shorter than they are, worsening height neurosis or dysphoria. Surgery for correction of bow legs involves inserting a plate with screws and can take 6-8 weeks to heal.[4]

Anterior Pelvic Tilt (APT)

APT is colloquially called “duck ass” amongst the limb lengthening community thanks to how it makes patients’ rears extend upward and outward, similar to a duck. Improper or a lack of stretching the leg muscles is the leading cause of this condition.

The hip flexors, which are a part of the quadriceps (front of the thigh), stiffen while the extensors, which are at the back of the thigh, weaken and become longer. Weak abdominal and glute (butt) muscles also contribute to the backward tilting of the spine.[5]

Keeping up with physical therapy is the most crucial factor when it comes to preventing APT. Patients who regularly perform exercises such as hip flexor stretches, glute bridges, and squats have a negligible chance of developing APT.

Arthritis

According to Dr. Dror Paley, head of the Paley Orthopedic and Spine Institute, the improper fixation of the fibula is a significant cause of arthritis in limb lengthening patients. It’s the bone connected to the upper and lower end of the tibia, and if it’s only fixed to the lower end of the tibia, it can migrate 2-3 mm during the lengthening process.[6] This slight migration significantly increases the chances of developing arthritis.

Besides, since limb lengthening is a one-time process and doesn’t cause repeated wear and tear of the muscles and bone, it ideally shouldn’t cause arthritis.[7] Anti-inflammatory medicine can also help to prevent arthritis.

An attentive and experienced surgeon can fix the property in its proper place and, in most cases, can prevent arthritis.

Scars

Since the doctor makes an incision along the entirety of the femur or tibia during surgery, patients may come out with quite prominent scars. There are no physical consequences to these scars, and some proudly call them battle-scars.[7] These usually fade with time until they become almost unnoticeable. If not, one can always get laser correction to have them removed.

Biomechanics

With a change in leg length come changes in how the patient squats, deadlifts, runs, plays sports, or even walks. The body feels different, and many need time to adjust and strengthen their muscles to accommodate the more extensive range of motion.[7]

Biomechanical changes are inevitable, but physical therapy and time are vital to feeling as if you have fully “recovered”. Unless the candidate is an elite athlete, patients can regain most, if not all, physical ability. Even some athletes have reported a full recovery with stiffness being the only lasting side effect.

Stiffness

Muscle and joint stiffness is usually a consequence of the muscle around the bones stretching slower than the bones themselves. Suppose a muscle gets so stiff that the person can no longer move the joint; it becomes muscle contracture. Regular stretching of the leg muscles can prevent this.[8]

If stretching is not enough, the patient might be extending their bones too fast per day. Not everyone’s muscles can handle 1 mm of lengthening a day, and some even say that 0.66 mm is the maximum you should do every day. Consulting the doctor and decreasing the rate of lengthening might reduce lasting stiffness.

Malunion

A malunion forms when the two sides of the bone don’t align perfectly, especially during the lengthening phase. Malunions can lead to improper healing of the bone, making you more likely to sustain fractures.[7]

Extreme malunions can also result in knock knees or bow legs because of uneven pressure on the knees. The doctor will usually recommend surgery to fix the misaligned bone, and lengthening can continue afterward.

Nerve Damage

The nerves around the femur or the tibia are bound to stretch and sometimes tear as the bone lengthens since nerves aren’t very tensile. Patients can lessen the chances of nerve damage if they limit the daily rate of lengthening to 1 mm.

The external nerves or the nerves running alongside the bone can heal with time, but the surgeon should look out for symptoms like decreased motor function or paralysis. These can be treated with nerve decompression surgery to prevent conditions like drop foot.[8]

Infection

Keeping the internal nail inside the bone longer than necessary, i.e., after the bone fully heals, can increase the chances of infection. The vast majority of surgeons strongly recommend getting the nail removed.

Since internal limb lengthening is still a relatively novel procedure, the long-term effects of letting steel, titanium, or magnets remain in the bone are unpredictable. The magnets in STRYDE can even interfere with MRIs, leading to worse health outcomes in the future.[6]

A Potential Cure of Height Dysphoria

Height dysphoria is a dissatisfaction with one’s height, and many people with short stature seek limb lengthening surgery to cure the distress surrounding their height.

In some cases, limb lengthening surgery has shown to cure or help patients with height dysphoria, but the surgery in itself isn’t always a magical solution. There’s some patients that feel their dysphoria was resolved after gaining a few inches in height, while there’s others who have lengthened several inches with little to no relief.

When considering leg lengthening, always be cognizant or weigh the risk vs rewards. There’s no one fits all solution.

Conclusion

If you find a reputable doctor and go in with a strong persistence and willingness to follow your doctor’s advice, you’ll likely finish lengthening with no significant long-term effects. Most people will have minimal complications,[9] and the vast majority of side effects are treatable if doctors and patients catch them in time. Be sure to keep up with physical therapy and exercise caution when lengthening.

As always, consider your options carefully and always speak with a medical professional about your goals, intention, and reasoning for seeking treatment, whether it be surgical, psychological, or another form of medical care.

References

[1] Paley, D. (2018, August 15). Cosmetic Stature Lengthening FAQs. Paley Orthopedic and Spine Clinic. https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs.pdf

[2] Foot Drop Treatment (Tendon Transfer). (n.d.). Foot Care MD. https://www.footcaremd.org/conditions-treatments/midfoot/foot-drop-treatment-tendon-transfer

[3] HSS. (n.d.). Knock Knee. HSS. https://www.hss.edu/condition-list_knock-knee.asp

[4] Bowlegs. (n.d.). International Center for Limb Lengthening. https://www.limblength.org/conditions/bowlegs/

[5] Six fixes for anterior pelvic tilt. (2017, May 11). Medical News Today. https://www.medicalnewstoday.com/articles/317379#fixes

[6] Cyborg 4 Life. (2020, June 13). Interview with Dr. Dror Paley of Paley Orthopedic & Spine Institute – Limb Lengthening Surgery [Video]. YouTube. https://www.youtube.com/watch?v=mC6ws6lCslM

[7] Cyborg 4 Life. (2020, April 17). The Long-Term Effects of Limb Lengthening Surgery [Video]. YouTube. https://www.youtube.com/watch?v=YfXaCoO1EMM

[8] Paley Institute Statute Lengthening Center. (n.d.). Statue Lengthening Complications. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/centers-of-excellence/stature-lengthening/complications/#/

[9] Catagni, M. A., Lovisetti, L., Guerreschi, F., Combi, A., & Ottaviani, G. (2005, October 1). Cosmetic bilateral leg lengthening. The Journal of Bone and Joint Surgery, 87-B(10). https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.87B10.16468