I've been thinking about LL for a while now. In particular, I was thinking about going to see Dr. Guichet about getting a femur lengthening for 3". I was not worried by the cost or even time/difficult recovery. But what concerns me is the prospect of debilitating knee/ankle/foot pain for the rest of my life.
Looking at the biomechanics I have come to the conclusion that misalignment of the joints is possibly inevitable with leg lengthening. This is due to the fact that legs are not straight lines. Legs have a natural inward angulation to them. When we grow as children, our entire legs including all of the joints are remodeling with every step we take to keep the axes of our joints flat and functionally correct. This same process does not happen when you are an adult doing LL. By lengthening one segment in isolation, it throws off the entire structure.
Whether this is going to be significant or not in terms of pain or disability I'm sure will vary from one person to another. I'm sure some people could get this done and never really notice it, either because they aren't doing anything demanding, or maybe their prior alignment was very favorable to the misalignment so they don't notice it.
What I have decided is that as much as I'd like to be 3" taller, it's not a viable option for me unless there is a better technique or something I'm not thinking of.
I've attached a very (VERY) crude diagram to show what I mean. Basically what you see is that in the "before", as well as the "LL non weight bearing" pictures, the joint lines are perfectly horizontal, as they are meant to function. However, once LL has occurred, the only way to maintain normal feet spacing when weight bearing is to then abduct the legs (open them outwards) ie. "LL weight bearing", which then puts ALL the joint lines on angles.
These joints are not meant to function with their axes on these abnormal planes. This is the source of x-legs and I believe the chronic knee and ankle pain many people experience even years post LL once their short term contractures and soft tissue trauma are dealt with.
Opinions and further thoughts are very welcome. In particular I'm wondering if there are any LL procedures that can circumvent this issue. It seems inevitable to me. Further diagrams also would be nice if there is something I'm not thinking of. 
Thanks all for the great forum and all the wonderful discussion. Whether I can get LL or not, I've enjoyed and appreciated it all.
How LL (inevitably?) misaligns joints, creates x-legs, and causes joint pain
Interesting to see misalignment yet lengthening is for everybody.
You can avoid this by lengthening tibiae instead of femurs. The tibia is a vertical bone so lengthening it doesn't change the angle of anything.
That's called speculation.
Given my muscle pain in my left leg that has proven hugely inconvenient. Permanent pains down the road are pretty scary prospects. That being said, the people who check back in and are fine seem to outweigh anyone who checks back in with horrible issues(and usually the latter are mysteriously under-documented).
This has been discussed a few times on the forum, if you read the Dr Birkholtz thread he states this is the reason he doesn't like big lengthening's along the anatomical axis (femur). It is something that those who do LL have to take into consideration.
Maybe if you're bow legged to start, you'll end up ok.
Quote from: Medium Drink Of Water on April 08, 2015, 04:11:43 AMYou can avoid this by lengthening tibiae instead of femurs. The tibia is a vertical bone so lengthening it doesn't change the angle of anything.
I was thinking about this as well. I think lengtehing the tibia reduces the risk of this problem because it is more vertical than the femur. But it is not 100% vertical either. As per my (again, crude) diagrams, the tibia/fibula have a slight inward angle too.
If I stand straight or bend my unoperated knees a bit with my feet naturally apart, my midline of my knees are clearly slightly lateral to the ankles.
ie.:
The theoretical advantage I wonder of doing tib/fib is that if you can control the lengthening in both segments, perhaps if you can lengthen the fibula more than the tibia, you can compensate for this a bit. But it will still throw off the mechanics again. And I understand tib/fib lengthening comes with it's own set of unique risks due to the more complex joint interactions at the knee/ankle. Furthermore, as in the xray below, the tibia can have some interesting natural curvatures to it. This means that the outcome in terms of angulation will vary largely on where it is nailed and where it is broken.
The only way I imagine to maintain full, normal mechanics at the knee and ankle would be to lengthen both the femur and the lower leg, and to somehow do the lengthening more on the outside than the inside of BOTH segments in proportion (which I think is impossible). This would then only throw off the hip a bit, but being a ball/socket joint, I think that would be fine. I can post a diagram to show later.
Quote from: theuprising on April 08, 2015, 06:50:59 AMThis has been discussed a few times on the forum, if you read the Dr Birkholtz thread he states this is the reason he doesn't like big lengthening's along the anatomical axis (femur). It is something that those who do LL have to take into consideration.
Thanks. I might have read that already. I'll look again.
Quote from: programdude on April 08, 2015, 05:11:55 AMGiven my muscle pain in my left leg that has proven hugely inconvenient. Permanent pains down the road are pretty scary prospects. That being said, the people who check back in and are fine seem to outweigh anyone who checks back in with horrible issues(and usually the latter are mysteriously under-documented).
I hope you do okay. To be clear I don't think this kind of tiny misalignment would usually cause "horrible issues". I think it would cause the kind of nagging stiffness and achiness that a lot of the diaries I've read seem to end with. This is the sort of stuff you take a tylenol for and keep going. It's sort of stuff most 65-70 year olds have to deal with due to wear and tear. But it's not the sort of stuff most 30 year olds need to worry about.
Quote from: SAD on April 08, 2015, 08:48:22 AMMaybe if you're bow legged to start, you'll end up ok.
Yeah, I was thinking this perhaps might be true as well.
We learned that femur lengthening may cause premature arthritis some time ago, however, I have yet to hear from someone who have actually experienced it. Most likely this is an issue over a longer timespan, perhaps 15-30 years post-operation. Indeed this might have been one of the issues the australian bone specialist referred to in that earlier thread made by a discouraged LL-prospect a few weeks ago.
Certainly unnerving but at least joint misalgnment are often treatable, though this is something I will have to learn more of.
Quote from: Sean Connery on April 08, 2015, 03:28:44 AMInteresting to see misalignment yet lengthening is for everybody.
u r 1 cheeky kont m8
I would love to hear what Dr. Guichet would have to say about this, since as I understand it, he is now the foremost and most reputable femur lengthener out there. Is anyone in contact or consult process with him that can ask?
As much as this concept of misalignment and x-legs (genu valgum) worries me, I still wish I could get the surgery. I guess one has to weigh how much the psychological pain of being short is relative to the physical pain of having possible chronic joint aches. I'm not sure how to weigh that now.
Also making it difficult to decide, you have the rare specimen like ShyShy who seems to have developed some mild x-legs but yet is functioning well with them. Here's his xray at 1" lengthening and you can already see it developing:
Here's his final picture and it's somewhat evident, but hard to fully judge in this posture:
I honestly don't know what to do with this realization. I will always dream to be taller. I may always wish to lengthen. We all have that drive. But would we regret it when our knees still ache 5-10 years from now?
I would say the solution is to stick to tibias. But tibias are on a slight angle too, so that's not going to stop this effect completely. Also, the complexity of tibia lengthening is greater, as you have to worry about the tibiofibular joints, and the articulation with the ankle which is a more complex joint than the knee/hip. Sometimes with tibias, people get abnormal rotation of the feet (intoeing, outtoeing), and a lot of the people that really get butchered seem to be tibial surgeries. Plus tibias are slower.
How do you guys feel about all of this? How does it affect your decision making process? What are the odds any of us will end up as functional as ShyShy once we too have some degree of x-legs (genu valgum) or intoeing/outtoeing?
I've read so many diaries and almost all of them seem to end with "my knees/ankles still get stiff and/or sore but I'm moving on with my life now so I'm not going to be posting further." What percent do you think tolerate this misalignment without any pain or discomfort at all?
The more I think about this issue the more distraught I become because I can think of no real good solution. 
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