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[Beemer m3]

I am going to do lon on my tibia and I'm afraid I will get ballerina foot. They say 5 cm is safe.  But my goal is 7cm.. I've seen many stories with lon and tibia reaching 7cm. What's going to happen if I have ballerina feet? I heard there's a foot casting. Then I hear therapy helps. My surgery will be in vietnam. The doctor has worked on ballerina foot before. But not many stories . So I'm not sure whats going to happen.  I like to know first. With lon its safer to do over 5 cm? Any theory to that?

I have the money for it just not the time. So I can't wait to get it done. In my home country too.

[Jackieeechan]

From what i have read in this forum anything beyond 6 cm causes prob in tibia, no matter the method. 4 is safe, 6 is a bargain in tibia,

[Michael J. Assayag, MD]

equinus contracture of the ankle (ballerina feet) is not associated with method of lengthening. It is associated with baseline flexibility and amount of lengthening.

With 7cm, I strongly advise getting a gastrocnemius recession at the initial surgery. also , stretch aggressively during then lengthening and wear and ankle foot orthos is (AFO) at night)

The best treatment of it is prevention.

I have treated ballerina feet up to 60 degrees before without an issue.

I hope this helps

[Beemer m3]

So you're saying my doctor can fix this equines contracture of the ankle right before surgery?
Is this surgery easily done if you found out you have it after lengthening? My doctor in vietnam haven't mentioned this topic. But I heard he fixed it before.


There's also a doctor in Greece that does precice for 43k usd. On femurs with 8cm. So that may help. It will be my 2nd choice.

[Michael J. Assayag, MD]

So you're saying my doctor can fix this equines contracture of the ankle right before surgery?
Is this surgery easily done if you found out you have it after lengthening? My doctor in vietnam haven't mentioned this topic. But I heard he fixed it before.


There's also a doctor in Greece that does precice for 43k usd. On femurs with 8cm. So that may help. It will be my 2nd choice.

There is a distinction between prevention and treatment . If your lengthening goal is 7cm, I would advise getting a gastrocnemius recession during the initial surgery . Prevention is always easier than treatment.

[Medium Drink Of Water]

Won't it stretch out on its own given enough time and stretching/weight bearing?  Or is there some point past which ballerina foot will never improve without medical intervention?

[Beemer m3]

I heard of a doctor that injects botox into calf muscle to prevent equines contracture of the ankle. Is injections good compare to lengthening of the achilles tendons better?

[Michael J. Assayag, MD]

Won't it stretch out on its own given enough time and stretching/weight bearing?  Or is there some point past which ballerina foot will never improve without medical intervention?

It may or may not, depending on the severity and one’s dedication to Physical therapy.


As for Botox to decrease Calf tightness, I do it for select patient and so does Janet Conway my partner. It does tend to help

[Beemer m3]

You are saying I can run full speed after gaining 7cm with PT and afo? I saw my doctor had sum pics of strings attached to there feet to raise it up during Lon. Gives me some hope.

I heard lengthening the achilles tendon can bring a lot of pain is this true? Still need more info. But I heard some doctors don't like it.

[Ayesha12345]

Hey dr,

When you say you’ve treated it, do you mean with a surgery or the patient doing stretches and standing overtime? I’m at 4cm distraction of tibia and my ballerina looks quite bad to me, angle looks about the same as wearing a 2 inch heel? I started noticing it as early as 2cm and it’s has gotten drastically worse although I reduced letting to 0.5 some days. My goal is 5cm but do you think I should stop at 4.5 or just go very slowly? Or recovering after lengthening is an option? I’ve seen a few cases that got better. I have only recently started using the walker as I had the thinnest nail and I was told not to weight bear although im only 44kg female.

[Sorcerer]

I heard you could fix it by doing an Achilles tendon releasing surgery, but you will lose much athleticism... which however is better than having ballerina feet forever... and this st  is indeed very likely to happen when you do 7cm tibial lengthening, and as a side note don't go to Vietnam to do this surgery as doing yourself a favor. Third-world countries are really not good places for you to do this surgery. This surgery is a deadly serious surgery and you need to go to countries that are very advanced in surgery and have very good medical equipments.

[breakmylegs]

I heard you could fix it by doing an Achilles tendon releasing surgery, but you will lose much athleticism... which however is better than having ballerina feet forever... and this st  is indeed very likely to happen when you do 7cm tibial lengthening, and as a side note don't go to Vietnam to do this surgery as doing yourself a favor. Third-world countries are really not good places for you to do this surgery. This surgery is a deadly serious surgery and you need to go to countries that are very advanced in surgery and have very good medical equipments.

Most Vietnam diaries are positive. And we have a few here.

[TheDream]

Hey dr,

When you say you’ve treated it, do you mean with a surgery or the patient doing stretches and standing overtime? I’m at 4cm distraction of tibia and my ballerina looks quite bad to me, angle looks about the same as wearing a 2 inch heel? I started noticing it as early as 2cm and it’s has gotten drastically worse although I reduced letting to 0.5 some days. My goal is 5cm but do you think I should stop at 4.5 or just go very slowly? Or recovering after lengthening is an option? I’ve seen a few cases that got better. I have only recently started using the walker as I had the thinnest nail and I was told not to weight bear although im only 44kg female.

How fast have you been lengthening? As in how many mm/day?

[Body Builder]

Stretch a lot, lengthen as slow as you can without risking premature consolidation (about 0,66mm after the first month where you may lengthen 1mm will be fine) and stand as much as you can. If you do these things you will probably be ok for 7cm without major equinus that can't be fixed with walking some months after frame removal.
Avoid atl at all costs and for me not even do gastrocnemius recession, most of the times achilles will be stretched with walking to a normal degree if there is no major equinus.

[Body Builder]

I heard you could fix it by doing an Achilles tendon releasing surgery, but you will lose much athleticism... which however is better than having ballerina feet forever... and this st  is indeed very likely to happen when you do 7cm tibial lengthening, and as a side note don't go to Vietnam to do this surgery as doing yourself a favor. Third-world countries are really not good places for you to do this surgery. This surgery is a deadly serious surgery and you need to go to countries that are very advanced in surgery and have very good medical equipments.

You have no idea what you are talking about.
At lengthening is the worse option for any LLer. Even huge equinus is better than crippling your achilles with this cr*p surgery.
The only way to gain some rom in major equinus is gastrocnemius recession, nothing else and for no fking reason.
And also Vietnam is by far a better option compared to turkish and indian butchers and the best option for someone with a low budget.

[Sorcerer]

You have no idea what you are talking about.
At lengthening is the worse option for any LLer. Even huge equinus is better than crippling your achilles with this cr*p surgery.
The only way to gain some rom in major equinus is gastrocnemius recession, nothing else and for no fking reason.
And also Vietnam is by far a better option compared to turkish and indian butchers and the best option for someone with a low budget.

Ah sorry, ok. The things I talked about are indeed ultracrepidarian to me.

[Ayesha12345]

Mostly 0.75/day except maybe a week of 0.5/day when I started noticing the ballerina getting bad plus wanted to relax my legs on some days like the weekend when there was no PT n it felt too stiff.

[Ayesha12345]

Yeah ATL is not an option not doing that so I realistically want to know when I should stop. Everyone seems to have a different opinion on it. I think my angle is at 45 degrees right now at 4cm which is quite high up and if I do another cm I really don’t know how long it will take to bring my foot back or if it’ll even be possible with a lot of stretching. My goal was 5cm and my PT says I should push through, plus I’ve paid for precise so really want to make the height the moneys worth.. at the same time I don’t want to be left with months of trying to fix my equines..

[guy_incognito]

Dont cut your achilles, you will regret if in the future. Do go very slow on the entire process. Ask to start the distraction phase asap, but lengthen only .3 per day if possible. If xrays allow it, make multiple breaks during distraction. Off days are great for stretching. The thing they dont tell you is, the further you go, the more difficult it is to stretch. A 60 degree ballerina at 4cm is not the same as 60 degree ballerina at 6cm. The second one hurts as hell.

[Beemer m3]

im currently doing lon ilizarov and they got a heel shoe to go with the device. pt every 5 days so they work my achilles tendon . it gets really tiring sometimes though. i have to the heel shoe on me about most of the days not fully tight but good enough.
not sure how they do it with the monorails or precice but the way they do with ilizarov its setup for you real well. maybe thats why they allow for 7cm.

[Golden]

im currently doing lon ilizarov and they got a heel shoe to go with the device. pt every 5 days so they work my achilles tendon . it gets really tiring sometimes though. i have to the heel shoe on me about most of the days not fully tight but good enough.
not sure how they do it with the monorails or precice but the way they do with ilizarov its setup for you real well. maybe thats why they allow for 7cm.

Where are you doing it? How much did you lengthen so far?

[Beemer m3]

I did it in ha noi vietnam with Dr doan. I'm around 4 cm already. 1 more cm and I'll be done because it's been really boring.

[YOUNGandSTRONG]

 if it's boring or fun that bs doesn’t matter. The only essential thing is to recover and put into practice the tips that have been shown to you.

[Beemer m3]

I'm in my apartment most of my days. Watching YouTube and video streaming. No friends to talk to. Mostly online chatting. I got a roommate but he's doing 1 leg. I need to get out and smoke a bong hit lol. But that's along way from now. After removing my fixators I can be more mobilized and go out on a taxi with my crutches which I'm waiting for.

[Beemer m3]

i have developed ballerina foot after practicing how to stand. im currently standing and slowly tapping my heels. its been a week and i havent seen any changes. its only 1 cm on both feet. i notice when i place both feet fully down my body is curved and not straight. this makes me sad. i still have been able to walk yet. my legs are still week from surgery 1 week ago. still need to practice standing up. too bad i had on my heel shoe for 24.7 and still didnt fix my problem.

standing tip toe does not give me enough strength to walk just yet. i still need to work out my legs it has been awhile and im losing alot of muscles on my quads.