Aesthetic Limb Lengthening | Find Accreditted Surgeons

What is limb lengthening surgery?

Aesthetic limb lengthening surgery (also called cosmetic stature lengthening) is an elective orthopaedic procedure designed to increase height by lengthening the leg bones—most commonly the femur (thigh bone) and/or the tibia (shin bone).

Think of a long bone like a sturdy beam. If you carefully cut the beam and then slowly separate the two ends, the body can fill the gap by growing new bone. This controlled bone-regrowth process is called distraction osteogenesis. As the bone lengthens, the surrounding muscles, nerves, skin, and blood vessels gradually stretch and adapt too.

What actually happens

1. Osteotomy (create the lengthening site): The surgeon makes a controlled cut in the femur or tibia.

2. Lengthening device placement (internal nail or external frame)

Internal lengthening nail (most common in aesthetic cases): A telescoping rod is inserted inside the bone.
External fixator (less common cosmetically): A frame outside the leg is attached to the bone with pins/wires.

3. Distraction phase (slow daily lengthening): After a short rest period, you lengthen gradually—often around 0.75–1.0 mm per day—so new bone forms in the gap.

4. Consolidation phase (bone hardens): Once the target length is reached, the new bone must calcify and strengthen, which takes months. Physical therapy is essential throughout to prevent stiffness and protect function.

It it covered by insurance?

In Canada, aesthetic (cosmetic) limb lengthening is almost never covered by insurance.

When it’s not covered

Stature/aesthetic height increase (no functional impairment) is considered elective/cosmetic.
Provincial plans (e.g., MSP in BC, OHIP in Ontario, AHCIP in Alberta) do not pay for it.
Most private/extended health insurance plans also do not reimburse cosmetic limb lengthening, and they often exclude non‑medically‑necessary surgery done privately or outside Canada.

When it may be covered (medically necessary cases)

Coverage is sometimes possible when limb lengthening is part of reconstructive care for a clear medical problem, such as:

significant limb length discrepancy that affects gait/function
congenital conditions (e.g., hemihypertrophy, skeletal dysplasia management when function is impaired)
post‑traumatic shortening (after fractures)
growth plate injury, infection, tumour resection, or deformity correction

In those cases, surgery is typically done through the public hospital system with an orthopaedic limb reconstruction specialist, and coverage depends on province, indications, and surgical program availability.

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Limb lengthening surgery: what to expect

Typical limb lengthening surgery (one segment: either femurs or tibias) often takes about 2–4 hours of operating time, depending on technique (internal nail vs external fixator), whether one or both legs are treated, and surgeon preference. Add time at the centre for check‑in, anaesthesia, and recovery (usually a few extra hours). Bilateral lengthening (both legs), complex deformity correction, or revision cases can take longer and may require a longer hospital stay.

Basic steps

1. Check‑in and confirmation

You meet the team, review your plan (femur vs tibia, target length in cm, internal nail vs external frame), confirm laterality (usually both legs in cosmetic cases), and go over imaging and consent. Safety checks are completed.

2. Anaesthesia

General anaesthesia (you’re fully asleep). Many centres use X‑ray guidance (fluoroscopy) throughout. Some surgeons use nerve monitoring depending on risk and anatomy.

3. Position and prep

You’re positioned on the operating table (often on your back). The legs are cleaned and draped sterilely from hip to foot so the surgeon can check alignment and joint motion during the case.

4. Small incisions and access to the bone

Incisions are made to access the femur or tibia. For internal nails, a small incision is also made to enter the bone canal. Soft tissues are handled carefully to reduce trauma and protect nerves and blood vessels.

5. Osteotomy (controlled bone cut)

The surgeon performs a precise, controlled cut in the bone (osteotomy). This creates the “lengthening site” where new bone will form.

6. Device placement (internal nail or external fixator)

Internal lengthening nail (common in aesthetic cases):

The canal is prepared, and a telescoping nail is inserted inside the bone.
Locking screws are placed above and below the osteotomy to stabilize the bone and control rotation.

External fixator (less common cosmetically):

Pins/wires are placed through the skin into the bone.
An external frame is assembled to hold alignment and allow controlled lengthening.

7. Alignment and imaging checks

Using live X‑ray, the surgeon confirms:

correct device positioning
bone alignment (rotation, straightness)
stability of fixation and screw placementThey may also test joint motion (hip/knee/ankle) to reduce risk of early stiffness.

8. Close up

Incisions are closed and dressings applied. If an external frame is used, pin sites are dressed carefully. A drain is uncommon but may be used depending on bleeding risk.

9. Wake‑up, early physio, and discharge plan

You recover in the post‑anaesthesia care unit and begin early mobilization as allowed (often same day or next day). You’ll receive:

weight‑bearing limits (often partial/non‑weight‑bearing early, depending on device)
pain control plan
blood clot prevention plan
wound care instructions
a physio schedule (usually starts immediately)

10. The lengthening phase begins (after a short “latency” period)

Most programs wait about 5–7 days after surgery before lengthening starts. Then you lengthen gradually—often 0.75–1.0 mm/day—with frequent follow-ups and X‑rays to ensure bone is forming properly and nerves/muscles are tolerating the stretch.

Orthopedic surgeon discussing surgical process with male patient

What can I expect from the recovery process?

Every body is different—follow your surgeon’s plan. Limb lengthening is a months-long process with two big phases: distraction (active lengthening) and consolidation (bone hardening). Steady, consistent rehab beats pushing too hard.

Week 1 (Hospital + early home)

Reality check:
Pain, swelling, bruising, and tightness are expected. You’ll feel stiff and tired. Mobility is limited, and you’ll likely use a walker/wheelchair depending on your device and weight-bearing limits.

Goals: Control pain, prevent blood clots, protect the osteotomy, and learn safe transfers.
Activities:

Short, frequent assisted walks (as permitted)
Start daily range-of-motion work (hip/knee/ankle—especially important)
Incision/pin-site care as instructed
Begin a structured physio plan immediately (often daily early on)

Weeks 2–4 (Routine building)

Still hard, but you get more capable.
Goals: Establish a rehab rhythm, maintain joint motion, and prevent muscle contractures.
Activities:

Daily physiotherapy (often 5–7 days/week early)
Stretching focus:
- Femur lengthening: hip flexors + hamstrings + quads
- Tibia lengthening: calves/Achilles + ankle mobility
Upper body strengthening (you’ll rely on arms for mobility aids)
Continue short, frequent walks within weight-bearing rules
Many people can do desk work remotely, but fatigue is real

Weeks 4–12 (Distraction phase: active lengthening)

This is usually the most demanding period.

Reality check:
As you lengthen (often ~0.75–1 mm/day), muscles and nerves are being stretched. Tightness and soreness may increase. Sleep can be disrupted. If you push too fast, you risk nerve symptoms or joint stiffness.

Goals: Keep joints moving, protect nerves, and maintain safe mobility while lengthening.
Activities:

Daily lengthening adjustments (per surgeon protocol)
Frequent follow-up X-rays to confirm new bone formation and alignment
Intensive stretching + strengthening under supervision
Strict attention to gait mechanics and assistive device use
Monitor for “warning signs” like increasing numbness, burning pain, or loss of ankle/knee extension—often a cue to slow lengthening

Months 3–6 (Early consolidation: bone hardening begins)

Reality check:
Lengthening may stop once you hit the target, but you’re not “done”—now the new bone must harden, and you slowly regain strength and normal movement patterns.

Goals: Transition toward more weight bearing (when cleared), rebuild muscle, improve endurance, normalize gait.
Activities:

Gradual progression in weight bearing based on X-rays
More strengthening work (glutes, quads, calves, core)
Stationary bike/pool therapy may be added if cleared
Continued flexibility work to prevent lasting contractures

Months 6–12+ (Return to normal function)

Reality check:
Most people improve steadily, but full recovery can take 9–18 months, especially for return to running or jumping. Some residual tightness can persist without ongoing mobility work.

Goals: Walk normally without aids, restore athletic capacity, and return to sports safely.
Activities:

Progressive strength and balance training
Impact activities (running/jumping) only when explicitly cleared
Continued physio or performance rehab for higher-level goals

Helpful tips (the “success factors”)

Physio is non-negotiable: Think of it as part of the procedure, not optional aftercare.
Do not chase pain: Stretching discomfort is expected; sharp pain or nerve symptoms are a stop signal.
Nutrition matters: High protein + adequate calories support bone growth.
Sleep and stress control: Both affect pain and recovery.
Protect your joints: Knee extension (femurs) and ankle dorsiflexion (tibias) are critical.

Red flags—call your care team urgently

Fever, spreading redness, foul drainage, or worsening pin-site infection signs
New/worsening numbness, burning nerve pain, weakness, or foot drop
Sudden severe swelling/pain in the calf, chest pain, or shortness of breath (possible clot)
Increasing inability to straighten the knee (femur) or bring the foot up (tibia) despite therapy
Severe, uncontrolled pain or a sudden “pop” with loss of function (possible hardware issue)

How much does limb lengthening cost in Canada?

Exact prices depend on which bone(s) are lengthened (femurs vs tibias), whether you do one segment vs two segments, whether it’s one leg vs both legs (most aesthetic cases are bilateral), the device type (internal motorized nail vs external frame), hospital stay length, and how intensive the included rehab/follow-up package is. Always ask for a written, itemized quote.

Cost in Canada (private)

Typical range (one segment, both legs): $90,000 - $160,000+

Two segments (femurs + tibias) staged over time: often CA$180,000 – CA$300,000+ total across both surgeries and rehab phases.

Cosmetic stature lengthening is not publicly covered, so Canadian pricing is typically private-pay and varies widely based on device and aftercare.

Cost in United States

In the U.S., cost can be significantly more expensive, ranging from $102,000 to $300,000+

What’s usually included

Surgeon and assistant fees
Anaesthesia services
Accredited facility/OR time, nursing, and standard disposables
Lengthening devices/implants (often the largest cost line—confirm this explicitly)
Intra‑op imaging (fluoroscopy) and routine supplies
Initial inpatient care and standard discharge planning
A set number of early follow-up visits and X-rays (varies by clinic)

What’s often not included

Initial consults and pre‑op imaging/labs done outside the clinic
Physiotherapy (which can be extensive for months) beyond any bundled sessions
Mobility equipment (walker, wheelchair, shower chair)
Medications after discharge (pain, anticoagulants, stool softeners)
Complication-related care (extra imaging, procedures, readmissions)
Future hardware removal surgery (internal nails are often removed 1–2 years later)
Travel, accommodation, and caregiver costs if you’re out-of-province

Tips to compare quotes

Ask whether pricing is a global bundle and request line items for:

surgeon, facility, anaesthesia
implants/device cost (brand/model and whether it’s included)
inpatient stay length and what triggers extra nights
follow-up schedule + how many X-rays are included
physio: what’s included vs what you must arrange/pay locally
what happens financially if complications require additional procedures or extended care

Choosing a surgeon and clinic

Here’s how to choose wisely for limb lengthening.

What to look for

Experience and volume (limb lengthening–specific)

Ask how many cosmetic stature lengthening cases they do per year (not just trauma, fractures, or general orthopaedics).

Limb lengthening has a steep learning curve because:

the surgeon must control alignment (rotation/angulation) while the bone is lengthening
outcomes depend on protocol precision (latency period, daily distraction rate, adjustments if nerves/muscles tighten)
complications are often rehab- and follow-up–dependent, not just “intra-op”

Also ask about their case mix:

femur vs tibia lengthening volume
internal nails vs external fixators (and why)
staged two-segment programs (femur then tibia)
revision/complication management experience (non-union, premature consolidation, malalignment)

Credentials and training

Verify licensure with the relevant provincial medical college (e.g., CPSBC, CPSO, CPSA, CMQ).
Look for FRCSC status where applicable: In Canada, many orthopedic surgeons will list FRCSC (Fellow of the Royal College of Surgeons of Canada). This indicates Royal College specialist certification (i.e., they completed an accredited residency and passed national exams).
Prioritize limb reconstruction expertise: Choose a surgeon with a clear track record in limb reconstruction/deformity correction/limb lengthening, not just general orthopaedics or sports injuries.
Ask about fellowship training: Specifically ask whether they completed a fellowship in:
- limb deformity and limb reconstruction
- external fixation / Ilizarov techniques
- complex trauma reconstruction
  And where they trained (centre and mentors matter).
Confirm active practice focus: Ask what portion of their practice is dedicated to deformity/lengthening work, and how often they manage lengthening follow-up and complications (non-union, malalignment, contracture, nerve symptoms).

Outcomes and safety (ask for real numbers)

Request recent clinic-level outcomes, ideally separated by femur vs tibia and internal nail vs frame:

infection (especially pin-site infection if external frames are used)
nerve complications (temporary numbness, neuropathic pain, foot drop)
joint contractures (knee flexion contracture; ankle equinus/“ballerina foot”)
delayed union/non-union and how often bone grafting or reoperation was needed
malalignment rates (varus/valgus, rotation) and how they correct it
unplanned return to OR within 30–90 days
patient-reported outcomes: gait quality, pain, satisfaction, time to independent walking

A good surgeon should be willing to tell you what their “normal” looks like and what complications they see most often.

Clear indications and psychological screening

A careful program will assess whether you’re a good candidate—not just medically, but psychologically and practically.

They should explicitly assess:

your goals and expectations (cm target, proportions, tolerance for scars and long rehab)
mental health screening (body image distress, anxiety/depression, coping skills)
ability to comply with restrictions (weight-bearing limits, daily physio, follow-ups)
bone health and risk factors (vitamin D, anemia, nicotine use, diabetes)

A reputable program will decline high-risk candidates (unrealistic targets, poor compliance risk).

Surgical plan and device strategy

Ask for a written plan that covers:

which bone (femur vs tibia) and why (proportions, biomechanics, nerve/tendon tolerance)
target gain (e.g., 5 cm vs 8 cm) and the clinic’s recommended maximum per segment
internal nail brand/model vs external frame—and why it fits your anatomy
whether the plan is bilateral (both legs) and how symmetry is maintained
the lengthening schedule (typical daily rate) and what triggers “slow down / pause / reverse”
whether and when nail removal is recommended (often 1–2 years later)

Imaging and planning (must be thorough)

Good clinics perform pre-op planning to minimize deformity and joint issues:

full-length standing X-rays (hip–knee–ankle alignment)
rotational assessment if needed
bone quality screening when appropriate
baseline joint range of motion measures (hip/knee/ankle)

Confirm they plan to monitor regularly with X-rays during distraction and consolidation.

Facility, rehab, and aftercare integration

This is where many programs differ.

Choose centres with:

an accredited facility (Accreditation Canada, CAAASF) capable of managing pain control, mobility training, and complications
a clear emergency pathway (and hospital transfer plan if needed)
a dedicated physio team experienced in limb lengthening (not generic PT)

You want a structured rehab plan covering:

daily stretching priorities (femur vs tibia are different)
contracture prevention benchmarks (knee extension, ankle dorsiflexion)
gait training and safe progression of mobility aids
realistic return-to-work timelines

Also ask about follow-up logistics if you’re traveling:

how often in-person visits are required
virtual check-ins
how they coordinate local imaging and physiotherapy

Transparent pricing (lengthening is cost-variable)

Request an itemized quote including:

surgeon, facility, anaesthesia
device cost (internal nails are expensive; confirm exactly what’s included)
inpatient stay length and what triggers extra nights
number of included follow-ups and X-rays
physio: what’s included vs out-of-pocket
complication coverage: what costs extra (and what doesn’t)
nail removal: included or separate, and estimated cost

Questions to ask at your limb lengthening consultation

Surgeon and plan

How many cosmetic limb lengthening cases do you perform per year?
For my goals, do you recommend femurs or tibias first, and why?
What is your typical maximum lengthening per segment—and why?

Technique and safety

Internal nail vs external frame: which do you recommend for me?
What are your rates of: non-union, nerve issues, contractures, malalignment, and reoperation?
How do you monitor and respond if I develop nerve symptoms or joint stiffness?

Rehab and support

What does my weekly rehab schedule look like during distraction?
Do you have a dedicated limb-lengthening physiotherapist/team?
If I live out of province/country, how do you handle imaging, physio coordination, and urgent issues?

Costs and logistics

What exactly is included in the quote (device, imaging, physio, follow-ups)?
What typically increases cost (extra months of rehab, extra imaging, complications, revision)?
Is nail removal included? If not, what does it usually cost and when is it done?

Signals of a high-quality limb lengthening program

Does limb lengthening routinely, not rarely—and can show outcomes
Screens candidates carefully (medical + psychological + compliance)
Provides a written lengthening + rehab protocol and tracks range-of-motion targets
Has strong physio integration and rapid access for complications
Operates in accredited facilities with clear escalation pathways
Offers transparent, itemized pricing and clearly defines what happens if complications occur

Aesthetic limb lengthening - frequently asked questions

How do I know if limb lengthening is right for me?

Limb lengthening (distraction osteogenesis) is a major orthopaedic commitment for patients seeking a permanent height increase. It is right for motivated, healthy individuals who are prepared for the physical and mental demands of the process.

Signs limb lengthening might be right for you

‍You have a clear, realistic goal: You are seeking a specific height increase (e.g., 5–8 cm) or correction of a measurable discrepancy, and you understand the proportions involved (femur vs. tibia).‍
You are medically and psychologically ready: You are in good health (non-smoker, good bone density) and have the mental resilience to handle months of discomfort, restricted mobility, and slow progress.‍
You can commit to the rehab: You have the time and support system to dedicate 3–6+ months to daily physiotherapy, distraction adjustments, and follow-up appointments.‍
Diagnostic clarity: X-rays and clinical assessment confirm your bone quality and anatomy are suitable for lengthening (internal nail or external frame).

When it might not be the right option (or risks outweigh benefits)

‍Unrealistic expectations: You want an extreme height increase that exceeds safe medical limits or ignores body proportions.‍
Medical contraindications: Active smoking, poor bone quality (osteoporosis), active infection, or severe joint stiffness/arthritis can make lengthening dangerous or prone to failure.‍
Inability to comply with rehab: If you cannot commit to daily physio, strict weight-bearing rules, or regular follow-ups, the risk of permanent stiffness, nerve injury, or bone non-union is high.‍
Body dysmorphia or psychological instability: If the desire for surgery is driven by deep-seated body image issues that surgery won't resolve, reputable surgeons will advise against it.

Do I need a referral?

No, you do not need a referral for aesthetic limb lengthening in Canada. You can book a consultation directly with a surgeon, and they will review your options and diagnostics.

‍

How do I prepare?

Your surgeon’s instructions come first—follow their plan if it differs.

Prehab and health optimization

Maximize flexibility (The "Bank" Strategy): You “spend” flexibility as you lengthen. Start daily stretching now: hamstrings, quads, and hip flexors (for femurs); calves and Achilles (for tibias).
Upper body strength: You will rely heavily on your arms for transfers and using a walker/crutches. Focus on triceps, shoulders, and chest press exercises.
Core stability: A strong core helps you move your legs when they feel heavy and weak post-surgery.
Quit nicotine: Crucial for bone growth. Nicotine constricts blood vessels and significantly slows bone formation (consolidation), increasing the risk of non-union. Stop 4+ weeks before surgery and stay off it throughout the lengthening phase.

Medication review

Share all prescriptions, OTC meds, and supplements.
Review supplements: Ask your surgeon about Calcium, Vitamin D, and K2 to support massive bone regeneration.
Stop blood thinners and anti-inflammatories (NSAIDs like ibuprofen/Naproxen) as directed. NSAIDs can inhibit bone healing and are often banned during the lengthening phase.

Home prep

Safe layout: Clear clutter/rugs to prevent trips with a walker. Ensure wide pathways.
Recovery zone: Set up a main living area on one floor (stairs will be impossible or very difficult early on).
Bed and leg support: Ensure your mattress is firm enough to support your legs. Have multiple pillows or foam wedges to elevate legs (to reduce swelling) while keeping knees straight (to prevent contractures).
Bathroom setup: A sturdy shower chair is mandatory (you cannot stand long). Install a raised toilet seat or safety rails to make standing up easier.

Clothing

Wide-leg shorts/pants: If having external fixators, you need shorts that snap/button on the side or are very wide. Even for internal nails, swelling is significant—loose basketball shorts or tear-away pants are best.
Slip-on shoes: You won’t be able to reach your feet easily. Get sturdy slip-on shoes or sneakers one size up to accommodate swelling.

Food, meds, and surgery‑day prep

The "Bone Fuel" Diet: Your body needs massive energy to grow bone. Stock up on:
- High protein: Lean meats, eggs, protein shakes, greek yogurt.
- Anti-inflammatory foods: Berries, leafy greens, salmon.
Bowel plan: Pain meds (opioids) slow the gut; you will be less active. Have stool softeners, fibre, and hydration ready.

Skin prep

Use the antiseptic wash (Hibiclens/chlorhexidine) as directed the night before.
Do not shave the surgical area yourself within 48 hours of surgery (micro-cuts increase infection risk); let the surgical team do it.

What to bring

Health card/ID, medication list.
Mobility aids: Walker or crutches (if required to bring your own).
Entertainment: You will have significant downtime during the hospital stay.
Loose clothing for discharge.

Practice ahead

Transfers: Practice moving from bed to chair using mostly your arms.
Walker mechanics: If you’ve never used one, get a feel for "step-to" gait rather than "step-through."

Red flags to know

Clot symptoms: Painful swollen calf (unrelated to surgery pain), chest pain, or shortness of breath.
Compartment syndrome: Unrelenting pain that meds don’t touch, creating a feeling of tight pressure.
Nerve signals: Sudden inability to move the foot (foot drop) or burning electrical pain.

What are the risks involved?

Your personal risk depends on your anatomy, the amount of lengthening (cm) attempted, the device used (internal vs. external), and your biology. Discuss your specific risks with your surgeon.

Common and usually temporary

Muscle tightness and stiffness: Very common. As bone lengthens, muscles must stretch. This causes stiffness, especially in the knees (femur lengthening) or ankles (tibia lengthening).
Nerve tension (Neuropraxia): Feeling tingling, buzzing, or increased sensitivity in the legs/feet. This is often a sign to slow down the lengthening rate.
Sleep disruption: Pain and the discomfort of sleeping in a fixed position (or with frames) often disrupt sleep for weeks.
Edema (Swelling): Significant swelling in the legs and feet is expected and can last for months.

Less common

Infection:
- External frames: Pin-tract infections are common but usually manageable with oral antibiotics and local care.
- Internal nails: Deep infection is rare (<1–2%) but serious, potentially requiring nail removal.
Delayed Union (Slow healing): The bone forms too slowly. This may require slowing/stopping distraction or, in rare cases, bone grafting.
Premature Consolidation (Healing too fast): The bone heals across the gap before you reach your target length. This requires a small procedure to re-break the bone.
Hardware failure: The nail or screws can break if weight-bearing limits are ignored.

Procedure-specific considerations

Joint Contractures: Permanent stiffness (e.g., inability to fully straighten knee or bend ankle) if physio is neglected. This can alter your walking pattern permanently (e.g., "ballerina walk").
Axial Deviation (Malalignment): The bone may heal slightly crooked (varus/valgus) causing knock-knees or bow-legs, requiring surgical correction.
Proportion mismatch: Lengthening too much can make the legs look disproportionate to the torso or arms.

Uncommon but important

Permanent Nerve Injury: Foot drop or lasting numbness/pain if the nerve is stretched too far or compressed.
Fat Embolism: Rare release of fat from the bone marrow into the bloodstream, which can affect the lungs.
Compartment Syndrome: Dangerous pressure build-up in the muscle compartments requiring emergency surgery to release pressure.
Deep Vein Thrombosis (DVT): Blood clots in the legs which can travel to the lungs (Pulmonary Embolism).

How you can lower risk

Stop nicotine: Absolutely essential for bone formation and reducing infection risk.
Respect the "Speed Limit": Never lengthen faster than prescribed (usually 1mm/day max). Faster is not better; it increases nerve and muscle risk.
Physio compliance: Do your stretches daily. Range of motion is the key to preventing contractures.
Weight-bearing rules: Follow instructions exactly. Overloading the leg can break the nail/screws; under-loading can weaken the bone.
Nutrition: Maintain high protein and calorie intake to fuel bone creation.

Is limb lengthening surgery effective?

These are broad, real-world expectations synthesized from contemporary limb-lengthening literature and typical reported complication profiles:

Length achieved (bone “union” with target gain): often high (roughly 88–98%+) in appropriately selected patients using modern intramedullary lengthening nails, though some require adjustments, pauses, or additional procedures.
Any complication (minor + major): commonly reported in the 20–60% range depending on definitions and whether “minor” issues (tightness, pin-site infection, delayed regenerate) are counted.
Major complications requiring additional surgery: frequently reported around 5–25% depending on series, bone segment (tibia often harder than femur), amount lengthened, and device type.

What factors most affect “success”

Femur vs tibia: tibias generally have higher risk of ankle stiffness and nerve/tendon tightness.
Amount lengthened: higher gains increase risk (especially beyond ~5–8 cm per segment).
Rehab compliance: stiffness/contracture prevention is a huge determinant of functional outcome.
Smoking/nicotine, nutrition, vitamin D, anemia: all affect bone regenerate quality.
Surgeon/clinic volume + protocol quality: follow-up cadence and “when to slow down” expertise matters.

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