Leg Lengthening Surgery Pain: How Bad is it REALLY?

Written by Joshua Leaf | Updated on August 31, 2021

A medicine bottle with the letters rx on the side and pain pill inside.Pain.

This is the one phrase on most people’s minds when it comes to height surgery.

How bad is it truly? How long does it last? Is it the worst pain imaginable? What is the pain comparable to?

This article might scare some away but rest assured, it will also inform you on just how painful leg lengthening surgery really is. The journey isn’t easy, but it can surely change your life.

Leg Lengthening Surgery Pain: What To Expect?

Bottom line: most patients experience a 7-8/10 on the pain scale at the peak of their pain levels, throughout different times during lengthening. 

Don’t be fooled, some patient coordinators (including those for the top surgeons) tout the procedure as “minimally invasive and pain-free.” They are ill-informed at best and maliciously misleading at worst.

Furthermore, the pain from leg lengthening is quite different when compared with other surgeries. This is because of the unique psychological aspect of lengthening your legs when they are already inflamed and in pain. In other words, the pain isn’t horrible, but it is constant. In other words, it’s withstandable but takes a toll on you over time. 

And you are the one causing it.

This means many people simply give up once they reach 5-6 cm. Their height neurosis is mostly cured, they no longer have a burning desire to grow every last inch possible, and the persistent pain isn’t worth continuing. 

It is painful. It will require mental fortitude to push through and endure. But many have gone before you and completed surgery successfully, and you can too.

Leg Lengthening Surgery Pain vs Tightness Pain from Distraction

The pain from height surgery can be broken into two different categories:

  1. Pain from the surgery
  2. Pain from the distraction–the actual act of lengthening your bone

By far, number 1 is the worst aspect: the pain from broken bones, cut muscles, and severed soft tissues. The pain is distinct and sharp but can be relieved by moving the legs as little as possible.

But that is also great news because once the post-op surgical-related pain goes away, things get much easier, and your quality of life improves drastically.

Discomfort from stiffness begins to develop for patients around 2-3 cm for tibias and 4-5 cm for femurs. It is a gradual process of becoming tighter and tighter as the joints lose flexion and temporary deformities develop (like ATP and Ballerina Foot).

This pain is much, much more manageable than the post-op surgical pain but in some ways is actually more “mentally difficult”. It can be a bit nerve-wracking and scary to watch yourself become tighter and tighter.

Furthermore, this tightness starts to develop into a constant aching pain once you are in the final stages of lengthening. 

For a brief time in the middle of the distraction phase, after the post-op pain has gone away, but the tightness pain has not yet set in, there is almost no pain or discomfort. 

This is known as the honeymoon period of limb lengthening.

The Honeymoon Period: Post Surgery Relief

Once the post-op surgical tenderness goes away, and before moderate to severe tightness sets in from the lengthening, there is a sweet spot of almost no pain and no discomfort.

  • The honeymoon period for femur lengthening is roughly between 2-4 cm
  • The honeymoon period for tibia lengthening is roughly between 1.5-2.5cm

Keep in mind the figures above are general timelines and could be shifted up to 1 cm earlier or later depending on personal factors.

Do All Patients Get a Honeymoon Period?

No.

If you plan to lengthen all four segments (quads & tibias) within the same month, your surgeries will be scheduled too close together to experience any real relief. 

By the time you are just entering your honeymoon period for tibs, it will be time to have your femur surgery (it is recommended to have surgery on your tibs (tibias) first and then femurs 3 weeks later). 1

Then, once the post-op surgical pain from the femurs has dissipated, your tibs will begin to experience the tightness pain phase.

Patients who lengthen 4 inches or more should be aware that it is not easy. In fact, it’s challenging. For this reason, it’s not recommended unless you have a very high level of pre-existing fitness and willpower of iron to complete your daily PT throughout the 4+ month distraction process.

Leg Lengthening Surgery Pain: What Factors Affect It?

Many different factors will influence the amount of pain associated with height increase surgery. 

  1. What lengthening device you used (internal vs external)
  2. What segment you had lengthened (femur vs tibia)
  3. Your level of fitness, both pre-existing flexibility and muscularity
  4. How far you lengthen (in other words, how much height you gain during the distraction phase)
  5. Your age, ethnicity, and other key medical factors
  6. Gender (females tend to have smaller, easier-to-stretch soft tissues)

The first few are the most important to consider when it comes to pain management, and the last few you have little control over.

The amount you can lengthen will generally correlate with how well you can manage pain and, in turn, handle the psychological turmoil. If you are determined to get the full 3 inches and take the physical therapy protocol seriously, chances are you will achieve it.

Internal Leg Lengthening Pain vs. External Leg Lengthening Pain

As explained above, internal and external lengthening methods have completely different aspects of pain.

But it’s more complex than just “one is more painful than the other”.

For example, external tibia lengthening is considered almost painless, while external femur lengthening is considered archaic in 2021 because of the very high pain levels and immense scarring created.

External Leg Lengthening Pain

Some things to keep in mind when it comes to externals:

  1. External lengthening methods come with the downside of pin-site infection pain (this doesn’t mean your leg becomes infected; pin-site infections are a common nuisance throughout the entire lengthening period and must be cared for properly)
  2. All external methods are not created equal; external femur lengthening is by far the most painful method when accounting for patient testimonials and diaries.

Internal Leg Lengthening Pain (Magnetic Nails: Stryde and Precice 2)

While internal lengthening with a magnetic intramedullary rod like Stryde and Precice comes with countless benefits that simply can’t be ignored, one should also consider their downsides.2

  1. Internal lengthening requires screws to be inserted into the hip (for femur lengthening), which cause a dull aching pain, especially when sleeping
  2. Nerve pain is more likely with an internal device, again by the nature of the surgery requiring the surgeon to cut through muscle and avoid many different nerves while doing so

The main issue with internal lengthening devices is that they must be inserted…internally. By the simple nature of the surgery, there will almost be significantly more trauma and inflammation created during an internal nailing procedure vs. an external procedure where no nail is placed inside your leg bones.

Please note, some leg lengthening nails are better than others. 

For example, the Betz bone requires the user to twist their leg to perform “clicks” that cause the nail to distract (pull apart). According to the majority of patients using the Betz nail, this can be extremely painful. In addition, some doctors say this nail in particular, should be outright abandoned. 3

Femur Leg Lengthening Pain vs. Tibia Leg Lengthening Pain

Leg lengthening pain for femurs is much, much different than leg lengthening pain for tibias. As explained above, a lot of this comes down to simply the method of lengthening.

However, don’t be fooled: the segment lengthened also matters.

Larger muscles surround the femur bone, and because these muscles are larger, they can naturally stretch easier compared to the tibia muscles that are much smaller.

In fact, this is why the distraction rate for femurs is double that of tibias. Femurs can simply take more of a beating in a shorter amount of time and still heal faster. 3

Muscular Patients (Bodybuilders) Beware

Based on the available evidence online, only one group of patients is prone to experiencing excruciating pain during the lengthening process: bodybuilders and fitness junkies. This only seems to apply for femur lengthening and is thought to happen because the larger the muscle is, the more resistance it will provide during the distraction process–thus causing more pain.

In other words, there seems to be a positive correlation between pre-existing muscle size and tightness-related pain levels.

Excruciating Adductor Pain

Some patients may experience excruciating adductor pain every time after lengthening during the entire distraction phase.4 The pain is far worse than any of the pain experienced immediately after surgery. 

What is the Least Painful Method to Gain Height?

External tibias with no internal nailing are considered almost completely painless 72 hours after limb lengthening surgery. But of course, external tibias take a long time to distract: you will be forced to wear frames for a year or more depending on your height increase goals.

It’s a balance: the least painful method takes the longest, by far.

Luckily, that doesn’t mean that the fastest, easiest method is the most painful. It’s just more painful.

In fact, the second least painful method is internal femur lengthening which is also the quickest and easiest height surgery.

From others anecdotal experiences, here’s a recap of the different methods from least painful to most: 

  1. External tibias
  2. Internal tibias
  3. Internal femurs
  4. External femurs

While internal nails are not the least painful, they are the most advanced and surefire way to quickly become taller. 

Is The Pain Actually Worth It?

Each person must come to their own conclusion based on their personal outlook, experiences, and financial situation. 

To determine if the benefits outweigh the risks, it’s recommended to weigh the pros and cons for yourself. 

For some people, the sacrifices seem extreme, and they simply can’t justify everything involved. For others, it makes sense to endure a few months of pain to alleviate or cure their height dysphoria and increase their perceived quality of life. Please take your time and do your own research to determine if leg lengthening surgery is right for you


References

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.  <https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs16-1.pdf >

2PRECICE System. NuVasive. (2021, April 13). https://www.nuvasive.com/procedures/limb-lengthening/precice-system/.  <https://www.nuvasive.com/procedures/limb-lengthening/precice-system/ >

3Paley, D. (n.d.). Stature Lengthening Guide Book. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/wp-content/uploads/StatureLengtheningGuide-Website.pdf.  <https://paleyinstitute.org/wp-content/uploads/StatureLengtheningGuide-Website.pdf >

4BetzLandLiberator. (2020, May 27). My pain level was absurdly higher than I expected. Considering that i was (and still am) very fit and very [Comment on the online forum post Was the pain as you expected or more?.]. Limblengtheningforum.com. http://www.limblengtheningforum.com/index.php?topic=65106.msg174474#msg174474.  <http://www.limblengtheningforum.com/index.php?topic=65106.msg174474#msg174474 >

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