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  • Writer's pictureDr. Yuksel Yurttas

Choosing the Right Limb Lengthening Strategy: Comparing Femur and Tibia Lengthening

If you're planning to undergo cosmetic limb lengthening surgery, it's important to make informed decisions before embarking on this transformative journey. Deciding on the right method, surgeon, and bone segment is crucial for achieving a successful outcome. In this article, we will compare femur and tibia lengthening, outline the maximum height that can be gained in each bone segment, and discuss the recovery time for each procedure. We will also provide guidance in making the best choice based on your unique needs and expectations.

Limb Lengthening Methods and Their Outcomes

Precice Stryde (Stryde Nail)

Precice Stryde was a fully internal limb lengthening method produced by US-based company Nuvasive. Although Precice Stryde is no longer available worldwide, it's important to mention as it provides insight into the evolution of limb lengthening techniques.

Stryde nails were made of stainless steel alloy and could bear the patient's entire body weight, allowing patients to gain up to 6 cm in height in the tibia and 8 cm in the femur.

Precice 2.2

Precice 2.2 (P2.2) is a safe and precise method of limb lengthening that eliminates the need for external fixation and reduces the risk of infection. This technique is also developed by US-based company Nuvasive.

With Precice 2.2, patients can expect to gain up to 6 cm in height in the tibia and 8 cm in the femur. P2.2 nails are made of titanium alloy and cannot support the full weight of the patient, requiring the use of a wheelchair during the lengthening phase.

LON Method

The LON method is a widely accessible and affordable limb lengthening technique that offers a comfortable and safe experience for patients. This method involves the use of both internal stainless steel alloy nails and external fixators. As a result, patients can perform physical activities such as walking during the lengthening phase.

With the LON method, patients can expect to gain up to 6 cm in height in the tibia or 8 cm in the femur. Unlike Precice 2.2, the LON method allows for a greater height increase (1 to 2 cm) beyond the above limits. However, the final height increase achieved will depend on the patient's ability to adapt to the new height through the functioning of their muscles, nerves, and tissues.

Femur vs Tibia lengthening

Leg lengthening surgery is performed in the lower leg (tibia) and-or upper leg (femur). Both bone segments offer some conveniences and challenges to patients.

Femur Lengthening: Pros and Cons

The femur is the longest and strongest bone in the human body, extending from the hip joint to the knee joint and playing a crucial role in standing and movement. It also supports many vital muscles, tendons, and ligaments in the circulatory system.

In femur lengthening surgery, the femur is cut and a device is inserted to gradually separate the two ends of the bone, allowing the body to create new bone tissue to fill the space.


  • Maximum height gain in one procedure: The femur is a larger bone compared to the tibia, allowing for a greater length to be gained in one procedure, reducing the overall treatment time and allowing patients to achieve their desired height in a single treatment.

  • Lower risk of complications: The femur is a larger, stronger bone with a better blood supply, reducing the risk of complications such as infection and non-union.

  • Quicker rehabilitation: The femur can bear more weight, enabling patients to start rehabilitation and weight-bearing activities sooner after the procedure.

  • Faster healing time: The better blood supply to the femur helps it heal faster than the tibia, reducing overall recovery time for patients.


  • Temporary Challenges in the Early Recovery Phase: Femur lengthening is more challenging in the first week after surgery due to increased pain and difficulty walking. The femur is a larger, stronger bone and can be more sensitive to pain, making it harder to manage in the first week. Plus, it's the main weight-bearing bone, making it tougher for patients to move around. After the first week, recovery from femur lengthening surgery is similar to that of tibia lengthening, with patients typically experiencing improved mobility and reduced pain levels.

Tibia Lengthening: Pros and Cons

The tibia is the larger and stronger of the two bones in the lower leg (the other being the fibula) and connects the knee to the ankle.

Tibia lengthening is performed by surgically cutting the tibia and inserting a device that gradually separates the two ends of the bone.


  • Reduced pain: Tibia lengthening is often less painful than femur lengthening as the tibia is a smaller bone and is located further from the hip joint.

  • Aesthetically pleasing outcome: The tibia is located further from the hip joint and closer to the knee, making changes to its length or shape less noticeable than with femur lengthening.

  • Shorter treatment period: Patients can typically only gain up to 6 cm through tibia lengthening, resulting in a shorter lengthening phase and earlier completion of treatment.

  • Correct bowlegs (genu varum): Tibia lengthening can correct bowlegs by lengthening the tibia, improving overall leg alignment.


  • Slower healing process: The tibia takes longer to heal compared to the femur due to its location and the fact that it carries less weight during movement.

  • Ballerina Syndrome (Achilles tendon tightness): Another disadvantage of tibia lengthening is the risk of developing Ballerina Syndrome. This condition occurs when the lengthened tibia puts excessive strain on the Achilles tendon, causing it to become tight and limiting the range of motion of the ankle. This can result in difficulty with activities such as walking, running, and jumping and may require additional physical therapy and rehabilitation to manage. The Achilles tendon can be lengthened for greater tibial lengthening. Surgical lengthening of the Achilles tendon can lead to permanent muscle weakness. For this reason, we do not recommend lengthening the Achilles tendon to allow greater lengthening.

Lengthening Strategies

Option 1 – Bilateral Femur Lengthening

Max. lengthening amount: 8 cm / 3.25 inches

femur lengthening

If you want maximum height gain with a single procedure, you should have femur lengthening surgery.

Option 2 – Bilateral Tibia Lengthening

Max. lengthening amount: 6 cm / 2.35 inches

tibia lengthening

If your tibia is shorter than your femur and you think longer lower legs will look more proportional, or 5-6 cm height gain is enough for you, you should have tibia lengthening surgery.

Option 3 – Femur Lengthening after completion of Tibia Lengthening

Max. lengthening amount: 14 cm (6 cm/2.35 inches + 8 cm/3.25 inches)

Femur + Tibia lengthening

If you are determined to have two lengthening surgeries, you should first have tibia lengthening and then femur lengthening. Thus, your tibia bone heals while your femur is lengthened.

Option 4 – Tibia Lengthening after completion of Femur Lengthening

Max. lengthening amount: (14 cm) 8 cm / 3.25 inches + 6 cm / 2.35 inches

Tibia + Femur lengthening

If you are undecided about whether to have a second lengthening surgery or if you do not have time to have a second surgery right away, you should first have Femur lengthening and then tibia lengthening to achieve maximum height gain.

Is it possible to simultaneously lengthen the tibia and femur? (Quadrilateral Limb Lengthening Surgery)

It is theoretically and practically possible to simultaneously extend the tibia and femur bone at the same time. However, this option increases the risks of surgery (fat embolism) and provides a more painful and uncomfortable leg-lengthening experience for patients. Dr.Yuksel Yurttas prioritizes patient safety and implements limb lengthening procedures by minimizing risks. Therefore, he does not perform quadrilateral limb lengthening surgery and does not recommend it to his patients.

Nicolas is one of our patients who first had tibia lengthening surgery and then had femur lengthening surgery after the lengthening was completed.

I am still undecided about which bone segment to choose for lengthening. What should I do?

Before limb lengthening surgery, we undergo a series of tests and examinations. One of these tests is the Ortho X-ray, which gives precise anatomical tibia and femur lengths. You can decide the most proportional lengthening strategy for you with your surgeon after you have this test done.

You can also book a free consultation and get support from us in choosing the right limb lengthening strategy for you.


Telephone/WhatsApp: +905339735289

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