TIBIAS & FEMURS with Dr. Becker & Dr. Betz – FULL JOURNEY (8+5=13 CM)

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Posted on Jul 6, 2025, 7:14 am

Hi all,

I just had my tibias surgery with Dr. Becker (successor of Betz) on Friday (04.07.2025) and already excited for what's to come!

Some background: I had my femurs lengthened with Dr. Betz five years ago (+8 cm), going from 171 cm to 179 cm.

Here's some info about me:

- Age: 35, Male
- Starting height: 179 cm (after femur lengthening)
- Wingspan: 175 cm
- Weight: 79kg
- No health issues

Goal: 5-5.5 cm, so I land at 184 cm at the end!

I know how much this forum helped me a few years back when I was doing research for my femur surgery and I figured there aren't too many patients out there who did BOTH femurs AND tibias and lengthened 13 CM in total. Planning to provide some insights here comparing the two surgeries and my journey in general.

I will post regular updates here, but if you want to have more real-time updates, including pics and vids, protocols, best practices, clicking + pain level logs, etc., check out my personal diary here:

https://puzzled-petunia-6bb.notion.site/Welcome-to-my-Patient-Diary-227d096a769b80bf9757e51c04b15e69?pvs=74

Excited to kick off this diary — I’m aiming to make it the most detailed one yet! If you’ve got any questions already, I’m happy to share.

LFG 🚀

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StepByStep

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Posted on Jul 6, 2025, 10:50 am

FIRST UPDATE

FYI: ABOVE LINK IS BROKEN – UPDATED DIARY HERE:
https://ll-diary.notion.site/Welcome-to-my-Patient-Diary-227d096a769b80bf9757e51c04b15e69?

PRE-SURGERY:

I did a pre-operative consultation call with Dr. Becker a week before the surgery. We did an hour-long Zoom call where he explained the procedure, risks, etc. Dr. Becker is super chill and a very cheerful person which is so helpful during the whole process. I'm glad Dr. Betz found such a great successor.

You need to arrive in Freiburg (where the clinic is) two days before the surgery, so I booked a hotel right around the corner for 2 nights. One day before the surgery I did X-rays at a radiology and then went to Dr. Becker's office and discussed my goals, X-rays and measurements. They also printed out mockups, how I would look with +5cm, +6cm, and +7cm. I was set on 5 to 5,5 cm anyway, but this already confirmed that going further than that would look increasingly unnatural in terms of LBR.

My wingspan will be slightly off when I'm done (184 cm height vs 175 cm wingspan) but Dr. Becker told me that, since I'm lengthening tibias, it won't be so harmful for aesthetics and I could also confirm that with the mockups.

SURGERY DAY:

I arrived at the clinic fairly early and I just slipped into my "surgery gear" (surgical cap, foot covers, hospital gown) and went to the surgery room. It was a crazy feeling that there was a room full of specialists who where focused completely on your surgery. While getting general anesthesia and drifting off, Dr. Becker held my hand and gently stroked it and said I should think of my next dream vacation. You might think that a (half-)grown ass man doesn't need that, but honestly at that point you are your most vulnerable and that moment was so important for calming down.

I woke up later in the clinic and felt almost no pain at first, but as the meds from the surgery gradually wore off, I felt it more and more. You get your pill box (for morning, noon, evening, night) with painkillers and other supporting meds. For me the pain gradually built up and the first night was brutal in terms of pain even though I took a lot of painkillers. Needless to say I didn't sleep at all. Dr. Becker said that that's normal for tibias (you break 4 bones instead of 2, after all) but that there are also cases where it is not that "severe".

SECOND DAY

I was afraid that it would be like this for the next days as well but on the second night already, pain levels dropped off significantly and I slept like a baby (Dr. Becker also gave me a sleeping pill, just in case). Today, Dr. Becker also removed the drainages (the ones which you can see on my online diary https://ll-diary.notion.site/Welcome-to-my-Patient-Diary-227d096a769b80bf9757e51c04b15e69) which made lying in bed more comfortable.

I also already made a few short laps in my room using crutches and pain levels are maybe at 0-1 right now (noon, second day).

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StepByStep

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Posted on Jul 6, 2025, 11:11 am

FYI: The diary link from my first post doesn't seem to work anymore and apparently I can't edit the post.

HERE is the updated one:
https://ll-diary.notion.site/Welcome-to-my-Patient-Diary-227d096a769b80bf9757e51c04b15e69

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StepByStep

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Posted on Jul 7, 2025, 2:40 pm

Hi all!

Just a brief update today: Two milestones unlocked!

1. Went to the bathroom alone

(with tibia you actually have to rest in bed a bit longer initially)
2. Did a full round on crutches in the hallway (+ Dr. Becker said my progress is above average, yay

)

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StepByStep

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Posted on Jul 8, 2025, 5:34 pm

Hi LL folks,

Aside from my wins I also wanted to share a setback:

I didn’t have a great 4th night (no excruciating pain, but uncomfortable enough to keep my central nervous system occupied and my body exhausted). I still managed to get 6-7 hours of sleep but I woke up every 2 hours to let someone come with new ice packs, which helped a bit to drift off again. I guess after the last 2 nights were completely painless I hoped I was lucky and that’s just how I would progress, but oh well

I guess walking around for the first time and some new exercises triggered these pains. Still, got enough sleep and Dr. Becker already counter-acted with some extra yummy pills I can take in case this night appears to be similar.

Oh btw, insight of the day: Biggest hack for me to be able to sleep under these circumstances and to not focus on the pain was playing some white noise on Spotify the entire night

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StepByStep

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Posted on Jul 9, 2025, 2:48 pm

DAY 5 – FINALLY SHOWERED

Big win for me (and probably also for everyone around me)

Feeling like a human again 🚿 Small things like these compound and make the process more bearable, step by step. Next small win will be to walk around more, thereby removing the pain you get in your lower back and buttocks by lying around too much.

One more thing: I started doing knee-bending exercises with this crazy machine. It’s more comfortable than it looks, and you can watch Netflix while it automatically bends your knee.

You can check out a photo of the machine over in my diary: https://ll-diary.notion.site/Welcome-to-my-LL-Patient-Diary-227d096a769b80bf9757e51c04b15e69

DAY 6 – X-Rays are in!

I just did X-rays and snapped a pic right from the monitor. You can also check it out in my online diary

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Taller90

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Posted on Jul 9, 2025, 8:04 pm

Hey man,

You are blessed with your wingspan

and I think you are right by adding the tibia LL now. It will move you proportions back to normal.

As I have done both as well I can tell be patient as the recovery takes much longer for tibias. You will be quicker on the road and able to walk but you need to stay cautions for a longer time after you have stopped the clicking.

However, have fun with the knee bending machine. I loved it and took it even with me to the rehab

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StepByStep

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Posted on Jul 10, 2025, 4:58 am

Thanks mate!!

Did the knee bending machine work that well for your recovery? I actually planned not to take it to rehab today and focus more on walking, but now I'm reconsidering..

I thought I could bend my knee myself with some exercises so I don't have to carry that massive machine around with me

Also in terms of tibias vs femurs recovery, I'd love to know:

- How long were you on crutches? (is that what you mean with staying cautious?)
- When could you walk "normally" (without anybody noticing) again without crutches on the road?
- When were you able to sleep normally (i.e. not waking up from pain or feeling any discomfort)
- What was your "daily protocol" in the lengthening phase? (e.g. stretching, when did you click, any clicking prep?, sauna, cycling, swimming, diet, etc.)
- How many clicks did you do per day? Dr. Becker suggested I go with 8 clicks/d

Haha sorry lots of questions man, but super interesting for me to know in my current stage

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chipsnsalsa

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Posted on Jul 10, 2025, 12:50 pm

Am I right in thinking 8 clicks a day is 0.4mm in total? Damn, that's pretty slow. Is that just at the start and you will do more after you get used to it?

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Pan Island Expressway

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Posted on Jul 10, 2025, 8:04 pm

#10

Tibia consolidation is a lot slower than femurs. Because it is more outside the leg so blood supply is less than femur. On average most people do 1mm a day. If your x rays show premature consolidation, then you can go faster. Otherwise if you are older and less healthy you can go slower like 0.5mm a day to prevent non union. Also it is less painful if you do slow, but becareful because too slow can lead to premature consolidation and you will need a new surgery to rebreak. And also, remember that tibia has 2 bones, tibia and fibula. Fibula can join quite fast, while tibia joins slowly so you need to balance the speed carefully.

I did 0.25mm each session split into 4 times a day. But your doing betz bone I assume. I don't know how many distance each click is.

Also, your diary is really interesting. I hope you continue writing until the end

Quote from: StepByStep on July 10, 2025, 04:58:11 AM

Also in terms of tibias vs femurs recovery, I'd love to know:

- How many clicks did you do per day? Dr. Becker suggested I go with 8 clicks/d

Haha sorry lots of questions man, but super interesting for me to know in my current stage

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StepByStep

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Posted on Jul 12, 2025, 11:18 am

#11

Day 7 – Arrival Dorint Hotel (for Rehab)

I was picked up today at the clinic by Luciano, a personal driver from the BeckerBetzInstitute, to drive to the rehab hotel (Dorint). He came right up to my room and carried all of my stuff down for me (backpack, bag with my meds that Daniela – who already works there since 11 years I believe – gave me, and my bag with supplementary food). If you ever decide to do LL, take the opportunity to chat with Luciano when he drives you there, he had a super interesting life. He is a Canadian with Italian roots who moved back to Europe, had his own business and travelled to over 150 countries. I wish the drive lasted longer so I could have asked more questions. Btw, sometimes also Dr. Becker himself drives the patients to rehab if he needs to go there anyways.

The day of arrival was tough in general, moving around that much is definitely taxing and I felt a lot of pain. Dr. Becker said that this is to be expected and that this kind of intensity goes away within 3-4 days of arriving for tibias. Lea from the Becker PT team picked me up at the entrance and gave me an introduction plus a little backpack with some things like pill organizers, a stretching “strap” that helps you stretch your legs, clipboard with your meds plan and tracking sheets for clicking, as well as some muesli bars to eat before taking your meds in the morning.

FYI: Dorint Restaurant

Dr. Becker has a table reserved at all times for his patients. It’s pretty cool because you can chat with other LL patients over breakfast, lunch, and dinner. I heard some patients order their food in via room service. I advise you to not do that because:

- you need the movement for recovery. Going to the restaurant 3x a day is a good routine to get that movement
- chatting with other LL patients has multiple benefits: 1) everyone I met who did or is doing LL always had an interesting character and interesting stories to share which helps take the mind off the pain. 2) “A sorrow shared is a sorrow halved”. Sharing challenges makes everything more bearable. 3) You exchange best practices with peers on different things (diet, routines, protocols, tackling specific pains, etc.)

You can check out images here (look for Day 7 entry): https://ll-diary.notion.site/Welcome-to-my-LL-Patient-Diary-227d096a769b80bf9757e51c04b15e69

Day 8 - Second Day at Dorint

My second and first full day at the Dorint hotel. Kathrin from the Becker team and who leads PT gave me an introduction to everything and answered all my questions. After that, someone came to measure my legs for my tailor-made stockings. Then I had a massage appointment with Ahmed from PT. The rest of the day I spent doing nothing (except for going to lunch and dinner with two other LL patients) because the pain didn’t allow me to do much more. Compared to my femur LL surgery 5 years ago, the first few days of tibias are definitely tougher.

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StepByStep

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Posted on Jul 12, 2025, 11:21 am

#12

Quote from: chipsnsalsa on July 10, 2025, 12:50:02 PM

Am I right in thinking 8 clicks a day is 0.4mm in total? Damn, that's pretty slow. Is that just at the start and you will do more after you get used to it?

yes, that's correct. at least that's the starting velocity. depending on my ossification, or how good my bone grows, and how my flexibility is, this could potentially be increased. Will be discussed with Dr. Becker and team once the first X-rays come in I believe (new X-rays every 6-8 weeks).

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StepByStep

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Posted on Jul 12, 2025, 7:49 pm

#13

Quote from: Pan Island Expressway on July 10, 2025, 08:04:41 PM

Thanks for your input!

Betzbone is 0.052 mm per click. Dr. Becker recommends starting slowly (and possibly even keeping slow pace of 8 to max 10 clicks per day). He said it does not make sense to lengthen at a much higher rate. With tibias it's not so much about stretching (mainly calves, while for femurs you have a lot more muscles to stretch) but about having good consolidation to prevent non-union and walk safer/more normally. So if you click a lot faster, you just risk non-union, nerve damage, muscle deficits etc. while gaining nothing. If you click slowly and steadily, you already consolidate pretty well and have a good basis for the rest of the consolidation phase after you stopped clicking.

But I'm curious if anyone who did tibias has a different opinion on this?

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Taller90

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Posted on Jul 13, 2025, 10:39 am

#14

Quote from: StepByStep on July 10, 2025, 04:58:11 AM

I liked the machine because it was easy to exercise your legs with it but you can also do it via walking. Back to your questions:

1. I was on crutches until 3-4 months post-clicking but the normal walk took some more time.
2. I think I was there 6 months after I stopped clicking (post-clicking). By cautions I mean you will be able to walk without crutches sooner but you still need to be cautious as you will still have a gap in you bone and the consolidation goes much slower compared to the femur segment.
3. I don´t think that I really had issues with sleeping, I mean the pain killers have been strong enough for me to manage any pain which could have disturb me from sleeping
4. Well I mean at the rehab you will have you structured day anyway and afterwards I did the same like I did for the femur. I did the clicking always in the morning, tried to go into the gym 2-3 times per week and I also returned back to work after I left he rehab which was about 4 weeks after the surgery. I have an office job with some business travel which I have tried to limit as much as possible during the remaining lengthening period but I returned quite fast back to my normal schedule (3-4 business travels per months) in month 3 post-clicking.
5. I did 10 clicks the majority of the time with no issues, so that I got to 5 cm in 3 months.

Hope this helps.

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Pan Island Expressway

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Posted on Jul 14, 2025, 10:25 am

#15

Quote from: StepByStep on July 12, 2025, 07:49:05 PM

Thanks for your input!

8*0.052=0.42mm a day which sounds like a very good rate!

You're blessed enough to do full internals, so do it as slow as you want. I think anything between 0.1mm to 1mm a day is a good rate. Just don't be that person who does literally 0.052mm a day. Because that sort of slowness is not "safe" either. You may end up in a case where the fibula unites while the tibia hasn't, and the unequal force from pulling can deform the alignment of the bone (on second thoughts...maybe it doesn't apply to you or me. I heard it from someone who did LATN)

But anyway how's it going? Any new updates?

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StepByStep

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Posted on Jul 15, 2025, 5:04 pm

#16

Day 11 – First Time Clicking!

Today was the first day I had to click. Tibias patients start clicking a few days later (10 days after surgery) than femurs patients because they had a more demanding surgery.

Daniela from the Becker team joined me on my first session in case I needed help clicking. I started with the right leg and aside from the fact that I didn’t notice the first click and almost tore my foot off before Daniela stopped me, the right leg was surprisingly easy on my very first try. The first click on my left leg was a completely different story. I had troubles getting to the first click and the more I twisted my foot the more pain I felt to the point of me almost crying. However, we then paused, I took another 5mg Oxycodon (painkiller) so I had 15mg in total (10mg I took 1 hour prior to clicking), and after half an hour I tried it again and used a slightly different technique (just turning the food a bit faster so you don’t have this) et voilà, I did my first click! After that, all following clicks were substantially easier and less painful (still unpleasant though, compared to the right leg).

FYI: I did 8 clicks per leg, i.e. 8*0.052mm=0.416mm in total.

(attached a pic of the timeline/checkpoints for tibias in my online diary)

-------------

Day 12: Second Time Clicking

The second time clicking was a lot easier than the first and now I'm starting to understand why people are saying clicking with tibias is so much easier than femurs (having done femurs as well, I do agree, even though I also didn't have a hard time clicking with femurs). I started with the left leg this time to "get the hard part out of the way" first. I was really afraid of the first click being similarly hard as the day before but luckily that wasn’t the case and all clicks were fairly easy. The right leg was even easier, I felt almost no pain (1 out of 10) and was done in 2 minutes.

Dr. Becker & team have their own app where you can track clicks and progress. I attached a pic in my online diary:

https://ll-diary.notion.site/Welcome-to-my-LL-Patient-Diary-227d096a769b80bf9757e51c04b15e69

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chipsnsalsa

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Posted on Jul 16, 2025, 9:07 pm

#17

Good to hear the second day of clicking was easier.

You're 12 days in, so you're due to leave the centre and return home in two days? How do you feel about that? Must admit I'd probably want to stay another couple of weeks.

Do you get several weeks (or even months?) of painkillers before you leave? Have you been shown all the necessary stretches, and are you able to do them on your own?

Btw is it true that the Betzbone surgery itself adds 0.7cm straight away? I'm considering tibias 4.5cm, so I would only need to do 3.8cm worth of clicks?

Thanks and best of luck bud.

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StepByStep

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Posted on Jul 17, 2025, 5:17 pm

#18

Quote from: Taller90 on July 13, 2025, 10:39:52 AM

Thanks a lot @Taller90!

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StepByStep

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Posted on Jul 17, 2025, 5:19 pm

#19

Quote from: Pan Island Expressway on July 14, 2025, 10:25:34 AM

Thanks mate! And yeah, my hope is that the next X-rays will show above average consolidation so that I might be able to increase from 8 to 10 clicks a day.

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StepByStep

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Posted on Jul 17, 2025, 5:29 pm

#20

Quote from: chipsnsalsa on July 16, 2025, 09:07:05 PM

Yup, I'll leave tomorrow which marks the end of my 2 weeks here. To be honest, I'm glad I can go home. It's much easier for me to design systems and routines there that keep me both healthy and productive. The rehab at the Dorint hotel has some benefits and conveniences (PT and massages every day, restaurant, room service, etc.) and it is definitely good while you are more incapacitated, but after 2 weeks I'm looking forward to go to a "familiar habitat" where I can control my diet, workouts, etc.

Quote from: chipsnsalsa on July 16, 2025, 09:07:05 PM

Do you get several weeks (or even months?) of painkillers before you leave? Have you been shown all the necessary stretches, and are you able to do them on your own?

Yes, everyone gets a huge bag of meds that will last for the entire process. And yup, I have been shown everything and am able to do them on my own. Additionally, you'll do regular check-ins with the PT team to check on your progress and make changes if needed.

Quote from: chipsnsalsa on July 16, 2025, 09:07:05 PM

Btw is it true that the Betzbone surgery itself adds 0.7cm straight away? I'm considering tibias 4.5cm, so I would only need to do 3.8cm worth of clicks?

Yes, that's true, between 0.5 and 0.7cm I believe. For me it was 0.5cm.

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TIBIAS & FEMURS with Dr. Becker & Dr. Betz – FULL JOURNEY (8+5=13 CM)

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