September 22 – Day 70 after surgery, Day 8 of consolidation. Physical therapy for recovery of range of motion (ROM) and strength is going well. I have a video of my physical therapy in early consolidation and the PT exercises I do.
The videos were taken last Monday, September 19 (3 days ago), which was day 5 of consolidation. I really didn’t have the time to make a more sophisticated video with audio and music, but the video should be sufficiently informative.
I also have scheduled my first doctor’s appointment in consolidation with standing X-rays on Monday, October 3. That will be day 19 of consolidation. I also mention this at the end of the video.
September 18 – Day 66 after surgery, Day 4 of consolidation. It has been 4 days since I finished tibial lengthening for 3.5cm (1.38 inch) on September 14. Here’s my first post on my status in the consolidation phase.
Each day into consolidation slowly and steadily improves and gets better. It’s more organized to write in categories of my progress.
Pain levels are decreasing every day. Muscle tightness and nerve irritation continue to slowly decline since I ended lengthening because my muscles and nerves are not being stressed from additional lengthening. I reported pain levels of 3/10 in the later stage of lengthening. By day 4 in consolidation, I think it is about 2.7/10 (these are just estimates). I noticed improvements from pain because during the lengthening phase, I would take 2 acetaminophen (aka Tylenol) pills every 4 to 5 hours since waking up in the morning, which sums up to 8 acetaminophen pills daily. By day 4 in consolidation, I take 2 acetaminophen pills in the morning and 1 pill every 4 to 5 hours, which sums up to 5 acetaminophen pills daily.
Sleep and Rest
My sleep quality is improving and I have more energy when I am awake. It must be because I am done lengthening, so I am saving much energy from reduced osteogenesis and histogenesis. When the body creates something from nothing, it is nowhere easy at all. It requires a lot of energy or calories, and nutrients, to create something from nothing. Osteogenesis is the process of rebuilding bone, and histogenesis is the process of creating new cells for soft tissue. It still takes much energy in the consolidation phase, but I am relieved quite a bit without lengthening.
During the second half of the lengthening phase, I estimate I was sleeping 10.5 hours daily (which includes daytime naps and sleeps). It’s only 4 days into consolidation so my total daily sleep time only decreased slightly. Based on my femur lengthening experiences last year, it will probably be 2 to 3 weeks into consolidation when my total daily sleep time goes to 10 hours, then continue to slowly decline to about 8 hours over the next several months.
Physical therapy continues to be important and evolves into consolidation. I am focusing on restoring my flexibility or range of motion (ROM) around my calves, ankles, and hamstrings. My immediate goals are to restore my dorsiflexion angle to neutral (0 degrees) and then into positive degrees, and to correct the foot supination that I developed and is common for tibia lengtheners. Each day I feel my dorsiflexion angle and foot supination improving because I am not lengthening, which slowly makes it worse.
I am also progressively increasing the resistance of the strengthening exercises to build up more leg muscles and stimulate bone consolidation. With the mini exercise bicycle machine at home, I increase the resistance and exercise for 10 minutes. With the NuStep machine, I increased the resistance last Friday to level 2, which is more than the level 1 I’ve been using during lengthening. I also do not use the arm handles for support on the NuStep, so my legs are doing all the exercising. I also stand with minimal support from my walker for a few minutes to stretch my calves and weight bear on my legs.
I will have a YouTube video soon on the PT exercises in consolidation for my tibial lengthening.
Interesting and informative reading for those interested in leg lengthening surgery. GQ magazine just posted a recent article (Sep 15, 2022) on leg lengthening surgery in the United States. It also includes interviews of some patients who have had LL surgery.
September 14 – Day 62 after surgery, Day 53 of lengthening. My surgery was on July 14. So exactly 2 months after surgery on September 14, I have finished my tibia lengthening. I’m 3.5cm (1.38 inch) taller to almost 5’11” barefoot, which is effectively 5’11”.
My first doctor’s appointment in the consolidation phase will be within 2 to 4 weeks. This is longer than the 1 to 2 weeks usually for femur lengtheners because I need to restore my dorsiflexion angle to close to neutral (i.e. relieve my ballerina foot) so that I can stand with my heels on the ground for the standing X-rays.
There are several reasons for the first doctor’s appointment in consolidation. Some patients may have issues that require lengthening correction or even reduction, such as unequal leg lengths, bone deformities, bad callus formation, severe muscle tightness, posture or walking gait problems, or nerve contractures. Also, it is to get an accurate measurement of actual height gained, which can slightly differ by a few millimeters at most from the electronic remote controller (ERC) readings.
I have this celebration song to celebrate the end of the toughest phase of leg lengthening. As this song My Way by Frank Sinatra says, “And now, the end is near”. I’m done femur lengthening and almost done tibia lengthening. I’m not yet at the end of my tibia lengthening, but I am near the end as I passed the toughest phase of leg lengthening. Just the tibia consolidation, then the internal nails removal from the femurs and tibias, and I am done and ready to start a new life. And I did it My Way.
September 11 – Day 59 after surgery, Day 50 of lengthening. My final day of lengthening is coming up soon in just 3 days. Wednesday September 14 is my last planned day of lengthening when I will reach my goal of 3.5cm. I will have a celebration post on that day.
Last week, I asked Dr Assayag about some recommended products to use to help heal my surgical scars better. Within the last week, I have started using two recommended products for more efficient scar healing.
Scar Away Silicone Tape
Mederma Scar Cream
I’ve only used these products for a little less than one week so far. I’m supposed to start using these products several weeks after the surgery date when the scars and wounds are closed so I can apply them. Below are pictures of the current scars (left picture) and AWD Medical Silicone Scar Tape (right picture) on my right tibia.
I’ll report to you how effective these products are within 1 to 2 months from now. If they are effective and I recommend them, I’ll place them on my Equipment Page for Leg Lengtheners.
When I reach a few months into the consolidation phase, I will also update the Equipment Page for Leg Lengtheners with a section for tibia lengtheners. Already there are 2 equipment items that are essential for tibia lengtheners, the (1) calf slant stretching board and (2) plantar fasciitis night splints. I bought some other stuff, such as tall tibia fracture boots, that I won’t be able to use or access until later in the consolidation phase. Once I have a complete list of equipment used and accessed, I will update the Equipment Page.
In the meantime, here are the 2 equipment items that I have found essential for tibia lengtheners.
September 9 – Day 57 after surgery, Day 48 of lengthening. My bi-weekly doctor’s appointment with X-rays was today. 8 weeks after surgery and I’m almost done lengthening. Just 5 more days on Wednesday September 14 is my last planned day of lengthening when I will reach my goal of 3.5cm. I have my X-rays and the analysis in a YouTube video.
Everything is looking much better since I slowed down lengthening to 0.50mm daily (from 0.75mm daily) almost 2 weeks ago. Slowing down lengthening allows better callus and bone formation and relieves the tightness around my calves and ankles. My nerve irritation symptoms have also improved as well.
I’m good to continue lengthening at 0.50mm daily until my last planned day of lengthening: Wednesday September 14. After that I will be in the consolidation phase.
During the consolidation phase, I get X-rays monthly rather than bi-weekly. I don’t have to see my doctor every month, so I can send my X-rays over if I return home and get X-rays at a local clinic. However, I should see my doctor in person at least every 3 months.
I’ll be in Baltimore for over 6 weeks into consolidation. For my first X-rays in consolidation, I found out that the protocol for tibias is different than femurs. When I was done femur lengthening last year, the first doctor’s appointment with standing X-rays at Dr Assayag’s satellite office is often done 1 to 2 weeks into consolidation. With tibias the first doctor’s appointment in consolidation is often done 2 to 4 weeks into consolidation because the standing X-rays require the patient to be standing while using your arms to help support yourself on a support rack. However, tibia lengtheners have ballerina foot in early consolidation which prevents standing on their heels. It will require weeks of stretching to restore dorsiflexion angle and be able to stand with the foot and heels on the ground.
I thought I was going to set up my first doctor’s appointment in consolidation on September 19, but with the tibias it will be in early October. I have to restore my dorsiflexion angle to stand with the foot and heels on the ground to determine the date of the first doctor’s appointment.
September 4 – Day 52 after surgery, Day 43 of lengthening. Today I reached a major milestone of tibial lengthening, the 3.0cm mark. 3cm on the tibias is the approximate equivalent of 5cm on the femurs. This is approximately when you exit the easy stage of lengthening and enter the immediate stage of lengthening.
I’m only 10 days away from reaching my goal of 3.5cm. My planned final date of lengthening is September 14.
I have “how to” videos on transferring from a walker or wheelchair to various areas (like toilet, shower chair, car, etc…) but I was missing two important videos: How to transfer (1) from wheelchair to toilet and (2) from wheelchair to shower chair. Here are the links to my new videos and the playlist of my “how to” videos.
September 2 – Day 50 after surgery, Day 41 of lengthening. Today, Friday September 2, is the end of week 7. I’m almost done lengthening. Less than 2 weeks remain for lengthening. Here’s a review of week 7.
The muscle tightness in my calves and especially my ankles are getting better because I slowed lengthening to 0.50mm daily (from 0.75mm daily) at the beginning of week 7. This helped relieve the muscle tightness. My pain is mostly related to my muscle tightness in my calves and ankles. I reported a pain level of 3/10 in week 5 because my surgical wounds were healed by then. Then in week 6 the pain seemed to jump to 4/10 because of high muscle tightness around my ankles. I now report a pain level of 3/10 for week 7 because I have slowed down lengthening.
Last Monday August 29, I started the Astym treatment at the Sinai PT center. While I started my Astym treatment about 4 weeks after femur surgery, I started later (6.5 weeks) for tibia surgery. Astym treatment for tibia lengtheners is delayed longer, typically 6 weeks or more, because the tibias need more time to heal from the surgical wounds (bruising, swelling, incisions) than femurs.
Astym treatment applies an Astym gel on the skin covering the affected muscles with a plastic instrument. It helps heal damaged soft tissues and scars, and encourages blood flow.
The skin around my tibias tends to get dry and flaky, so I’ve been using Jergens skin lotion for dry skin since over a week ago.
I previously mentioned that my goal for tibia lengthening was 3.4cm on the Electronic Remote Controller (ERC), then hopefully gain an additional 1mm from the initial separation at surgery and a rounding margin for a total of 3.5cm. At the lengthening rate of 0.50mm daily, my final lengthening date would be Monday September 12.
I’ve decided to increase my goal to 3.5cm on the ERC. A good number of leg lengtheners tend to go for a little more than their initial goal. This is a once-in-a-lifetime opportunity and I have the large Precice 2 nails to help me get to walking independently much sooner (it was initially planned to use the medium Precice 2 nails), so I can definitely increase my goal to 3.5cm on the ERC. This will move my final lengthening date to Wednesday, September 14.
Here are my remaining plans for the lengthening phase as the end is approaching.
Mon Sep 5 – No later than Labor Day (Sep 5), publish videos on how to:
Transfer from Wheelchair to Toilet
Transfer from Wheelchair to Shower Chair
Fri Sep 9 – Last bi-weekly doctor’s appointment with X-rays.
Tue Sep 14 – Last day of lengthening to reach 3.5cm on the ERC.
Just a little side article and analysis about height. How much on average do men exaggerate their true height? When a dating app or driver’s license lists a man’s height as 6’0″, is that their true height?
The true height of a person is measured by the person standing up without shoes or padded socks, heels on the ground without tippy-toeing, and preferably at least 4 hours after waking up. The measuring device touches the top of the person’s head, not the top of the hair. I have a post on the true average heights of adult males in the United States.
The dozen males who agreed to be measured were, on average, just shy of 1.5 inches off their stated marks. And this was no random deviation; not a single error was made in the underestimating direction. (By contrast, six females were only half an inch short of their stated heights, attributable mostly to upward rounding to the DMV’s whole numbers. Weights were typically underreported by both sexes, but normal fluctuations make them an unreliable gauge of dishonesty.)
Men’s Health article at a local Las Vegas DMV
I read an article a few years ago about the differences between the listed profile height and the true measured height of men on a major dating website. I can’t find that article, but I remember it noted that the difference was usually between 1 to 2 inches, about 1.5 inches on average overall.
It seems like 1.5 inches of height on average is a typical exaggeration for men. I’m guessing these factors help overexaggerate a person’s true height by 1 to 2 inches.
Height with shoes: Add 0.50 to 1.25 inch
Round up at least 0.25 inch to the next higher inch (e.g. 5’9.25″ becomes 5’10”): Add up to 0.75 inch
Height right after waking up: Add 0.50 to 0.75 inch
August 28 – Day 45 after surgery, Day 36 of lengthening. Last Friday, August 26 was the end of week 6. After the physician’s assistant (PA) analyzed my lower leg mobility and X-rays, we decided to slow down lengthening from 0.75mm daily to 0.50mm daily since yesterday (Saturday). Slowing down lengthening is better for callus and bone formation (since the regenerate quality declines at longer lengths) and helps relieve muscle tightness and nerve irritation. It’s only day 2 since I slowed down lengthening to 0.50mm daily and already it’s been easier on the muscles and nerves of my lower legs.
Physical therapy is going fine, but my calves and especially my ankles have been getting tighter since about 1.8cm. I continue to lose dorsiflexion angle as I lengthen, but my PT stretches my lower leg muscles and tendons well enough to minimize the loss. My dorsiflexion angle is a few degrees negative at best, so I am developing ballerina foot. One good thing about this is that when I do standing calf stretches with my walker, I don’t need the slanted calf stretch board for now. Just placing my feet on the floor while standing with the walker provides sufficient stretching.
My tightening ankles are developing another problem called foot supination. When my feet point downward because of ballerina foot, it would be preferable that my feet point down evenly in a neutral position.
As my ankles are tightening, they are unevenly tight which causes the outer arches of my foot to point down more than the inner arches. This is a medical condition called foot supination because my inside ankle muscles and tendons are tighter.
This is one of many reasons why you need an experienced PT. My PT has been stretching the ankles and feet at the necessary areas to help restore my feet to neutral position.