Gait, aka the way we walk, and posture, the way we hold our bodies, affect whether or not we move comfortably as well as how we present ourselves to the world.

When something disrupts the natural mechanics of our stride or the alignment of our spine, it can cause a litany of issues like chronic pain, reduced activity, and even further complications down the line.

A limb length discrepancy (LLD) can throw gait and posture off balance. This condition, where one leg is noticeably shorter than the other, negatively impacts balance, gait and the overall alignment of the body. 

From a subtle limp to debilitating back pain, LLD can impose substantial burdens. Fortunately, today’s innovative solutions like the PRECICE Max system leverage a revolutionary approach to correcting LLD to improve gait and posture over time.

Gait and Posture Problems from Limb Length Discrepancy

Limb length or leg length discrepancy not only causes a difference in physical appearance; it creates a cascade of biomechanical issues throughout the body. The causes of LLD can vary widely, including:

• Congenital differences from birth
• Trauma
• Growth plate injuries
• Uneven healing after fractures

The mal effects of an uncorrected limb length discrepancy are far-reaching and can impact daily life in numerous ways. These include limping or gait deviation, pelvic tilt, back pain, joint strain, which can lead to arthritis, and uneven wear and tear on the hips and knees. 

Beyond physical symptoms, there's often a significant psychological impact from the condition. People with LLD may experience self-consciousness about their limp or uneven appearance, potentially impacting social interactions, sports participation, and well-being.

What Is the PRECICE Max System?

The PRECICE Max system leverages a leap forward in technology for limb lengthening surgery. Unlike older, more invasive methods with bulky external frames, PRECICE Max uses an internal nail system that is surgically implanted into the femur in the thigh or the tibia in the lower leg.

Once implanted, the patient uses an external remote controller to activate the magnetic mechanism within the nail that very gradually and precisely lengthens the nail by a tiny fraction of a millimeter each day. 

As the nail lengthens, it slowly separates the two segments of the bone, stimulating the body's natural healing processes to grow new bone tissue in the gap. This process, known as distraction osteogenesis, results in controlled, incremental bone growth.

The biggest benefits of PRECICE Max compared to older methods like external fixators include:

• Precision - Incredibly precise lengthening, often down to sub-millimeter adjustments.
• Reduced scarring - Minimizes extensive pin sites and associated scarring often seen with external fixators.
• More comfortable recovery - Less pain, greater mobility during the lengthening phase, and a generally more comfortable rehabilitation.
• Reduced infection risk - Reduces the risk of pin-site infections, a common concern with external devices.

How Does PRECICE Max Improve Gait?

The goal of correcting a limb length discrepancy with PRECICE Max is to restore the body’s natural, symmetrical movement. By achieving equal leg length, the system profoundly improves gait in several ways:

Restores equal leg length for smoother walking mechanics

When legs are different lengths, the body has to contort to compensate. Lengthening the shorter leg eliminates the imbalance for a more natural, fluid walking pattern. The footfall becomes more even, and the propulsion phase of walking is normalized.

Less compensatory habits

Over years of living with LLD, patients develop various compensatory movements to manage the height difference. These can include hip hiking, toe-walking, or bending the knee of the longer leg. PRECICE Max helps muscles relax and re-learn correct, efficient movement.

Improved stride length, balance, and coordination

With equal leg lengths, a person can take longer, more symmetrical strides. This not only makes walking more efficient but also promotes overall balance and coordination, reducing the risk of falls.

Long-term relief from muscle strain and joint overload

The constant compensatory movements required by LLD lead to chronic muscle tension and unequal loading on joints. By correcting the fundamental length difference, PRECICE Max offers lasting relief from pain and prevents accelerated wear and tear on the hips, knees, and ankles.

How PRECICE Max Enhances Posture

The impact of limb length discrepancy isn't confined to the legs, since it ripples upwards through the entire kinetic chain, significantly affecting posture. Correcting the leg length with PRECICE Max has been shown to provide dramatic improvements in overall body alignment:

Corrects alignment & reduces spinal curvature

A common postural adaptation to LLD is the development of a functional spinal curvature or scoliosis as the body attempts to keep the head level. By re-establishing a level pelvis, PRECICE Max provides a stable base for the spine, so it can straighten and reduce unnatural curves caused by uneven legs.

Better weight distribution across hips, knees, and ankles

When legs are of unequal length, weight is unequally distributed. The longer leg usually bears more load, while the shorter leg's joints may experience different types of stress. Lengthening the shorter limb creates balanced weight distribution, reducing stress points and promoting healthier joint function.

Reduction in chronic pain tied to poor posture

Many people with LLD suffer from chronic pain in their lower back, hips, or even neck and shoulders due to constant postural compensations. By restoring natural alignment, PRECICE Max can alleviate or even eliminate this pain for a much higher level of day-to-day comfort.

Improved stance and overall body symmetry

Beyond pain relief, visual improvement in posture is often profound, as patients stand taller, more evenly, and with greater confidence, reflecting an overall improvement in body symmetry and alignment.

Recovery and Rehabilitation

The journey with PRECICE Max goes way beyond the surgical procedure itself with a specific, rigorous recovery and rehabilitation process, beginning with physical therapy, imperative for healing throughout the lengthening and consolidation phases. 

Therapists work closely with patients to prevent muscle tightness, maintain joint range of motion, retrain muscles, and correct movement patterns developed due to the LLD. They guide exercises designed to strengthen the lengthened limb and surrounding musculature.

Recovery is gradual; initial milestones include controlled weight-bearing, progressing to walking with crutches, eventually walking unassisted, and then gradually resuming activities like sports once the bone has fully consolidated and gained sufficient strength. 

The total process from surgery to full activity can take many months, often up to a year or more, depending on the amount of lengthening.

Final note on recovery and rehab: Patient compliance with the prescribed lengthening schedule, daily exercises, and regular follow-up appointments with the surgeon and physical therapist is non-negotiable for a successful outcome.

Long-Term Benefits of PRECICE Max

• Permanent correction - Once the new bone growth consolidates and hardens, the correction of the limb length discrepancy is permanent.
• Higher quality of life - Patients experience vastly improved mobility, reduced pain, and increased confidence. 
• Prevention of long-term issues - PRECICE Max helps prevent or mitigate the progression of secondary issues like accelerated arthritis in weight-bearing joints, uneven joint wear, and the worsening of scoliosis.

Risks and Considerations

During the lengthening phase, patients may experience muscle tightness, which requires diligent stretching and physical therapy. There can also be nerve irritation, causing temporary numbness or tingling. 

Delayed healing where the new bone takes longer to harden is also a possibility, though the internal nail often supports faster consolidation than external frames.

The success of the procedure heavily relies on patient compliance with the daily lengthening schedule and rigorous rehabilitation program. Missing lengthening increments or neglecting exercises can create complications.

Continuous, careful monitoring through X-rays and clinical assessments throughout the lengthening and consolidation phases by your orthopedic surgeon make sure the process is proceeding safely and effectively.

Is PRECICE Max Right for You?

The PRECICE Max system offers more than just a cosmetic solution for height gain, as it’s a powerful functional tool designed to restore natural mobility. It meticulously corrects leg length to form a balanced gait and posture improvements, making the long-term physical and psychological benefits immense. 

If you or a loved one are experiencing gait abnormalities, chronic pain, or postural issues due to a suspected limb length discrepancy, request an appointment today with Dr. Shahab Mahboubian, D.O., MPH at Height Lengthening in Los Angeles.