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Showcasing Our Commitment to Innovation in Treating Limb Length Discrepancies

Physical therapy combined with an ellipse nail can help create the best quality of life for a child with a limb length discrepancy.

The process begins during limb lengthening surgery with what's called an osteotomy, during which a skilled Shriners Children's orthopedic surgeon cuts the bone to be lengthened. The surgeon then stabilizes the limb using an internal lengthening rod called an ellipse nail.

Shriners Children's physicians have been pioneers in using this device, which eliminates the need for an external fixator. Because there are no pins going through the skin into the bone, the risk of infection is reduced.

This treatment is most commonly used on legs, but in some circumstances it can be done on arms as well.

Parents Participate in After-Care

After surgery, parents take an active role in their child's rehabilitation. Using an external remote control that comes with the ellipse nail, they gradually and carefully lengthen the gap between the two sections of the bone that was cut during surgery. New bone grows in the middle as the gap widens.

This personalized treatment is combined with physical therapy, led by one of our skilled therapists. They work hand-in-hand with you and your physician to develop a care plan personalized for your child's needs. Coordination is easy because the entire team works under the same roof. This also means you don't have to drive to multiple locations for your child's treatment. You will be taught your child's therapy routine so you can help at home between appointments.

Therapy begins just one day after surgery for most children and combines stretching and strengthening exercises.

Though this sometimes can be a years-long process, what you will find here at Shriners Children's is a family – both in your medical team and with parents and children who are at different points along the same path you now walk.

Specific treatments and services may vary by location. Please contact a specific location for more information.


Common Questions Kids Ask

Initially after surgery, children may feel afraid to move their limb with the ellipse nail. As the lengthening process begins, their muscles will tighten and weaken somewhat. This is to be expected. The goals of physical therapy are to help keep their muscles flexible and strong, and to help them stay as active as possible throughout the rehabilitation process.

Here are some answers to common questions and concerns your child may have.

When does physical therapy start? Physical therapists will begin working with your child the day after surgery. Your physical therapist will provide an exercise program that you will help your child perform in their room on weekends. Most children are able to go home the Monday following surgery.

If it seems too difficult... At first, your child may need help moving their limb in bed. If it involves their leg, this will include standing and taking a few steps with a walker or crutches. He or she will likely require a wheelchair to get to physical therapy. This is perfectly normal and you will work with your child to help them regain their independence. Most patients are up and walking with a walker or crutches by the time they leave the hospital, using a wheelchair only for long distances outside of the home.

How does physical therapy work? While in physical therapy, your child will work on strengthening and stretching exercises. Your physical therapist will provide an exercise program designed specifically for your child and will make recommendations on whether a walker, crutches or cane is best for them. If your child is able, your therapist will teach them how to walk up and down a small flight of stairs in the physical therapy department as well. Things may go slowly the first day or two, but it will get easier.

Will I have to do this at home? Before your child leaves the hospital, their physical therapist will ask you to demonstrate that you're comfortable assisting him or her with their home exercise program and supervising them while walking. You'll also be asked to show that you can adjust your child's ellipse nail. You will be given a written copy of your child's home exercise plan, including your therapist’s contact information in case you have any questions after you leave. It is very important that you encourage your child to continue to perform their exercise plan as instructed and follow all therapy instructions. This is the proven method to give your child the best quality of life.

The therapists could not have been better.
Evan, St. Louis
male patient and physical therapist during physical therapy session

Convenient, Skilled Physical Therapy

No two patients who walk in the doors of Shriners Children's are the same. That's why rehabilitation plans are personalized specifically for your child after their limb lengthening procedure. It's easy for your physician to work closely with the therapy team because they're all under one roof. That means your child's care with Shriners Children's is all under one roof.

Services We Provide

View All Related Services

Limb Lengthening

Shriners Children's experienced orthopedic surgeons are known throughout the country and the world for their skill in performing limb lengthening surgeries.

Physical Therapy

Physical therapy at Shriners Children's helps children build confidence and strength, focusing on what is important to them and what they love to do in their daily lives.

Occupational Therapy

Occupational therapists at Shriners Children's help kids be as independent as possible, focusing on what is important to them and what they love to do in their daily lives.

Motion Analysis

The specialists in Shriners Children’s motion analysis centers collect and analyze movement-related data, like gait analysis, to help treat children with neuromuscular, acquired or congenital disorders.

Pediatric Orthotic and Prosthetic Services

Shriners Children’s Pediatric Orthotic and Prosthetic Services designs, fits and manufactures orthotics and prosthetics for children from infants to young adults.

Pediatric Rehabilitation

Shriners Children's specializes in supporting your child physically, developmentally and emotionally to reach his or her pediatric rehabilitation and therapy goals.

Care Management

The care management team at Shriners Children's consists of registered nurses and social workers who act as resources for families throughout their plan of care.

Psychiatry & Psychological Services

Our psychologists at Shriners Children's specialize in evaluating and providing support to children and their families who are adjusting to a new diagnosis or having difficulty in their everyday lives due to trauma.

Next Steps

Request an Appointment

Families and caregivers seeking treatment should start by contacting us for an appointment.

Log in to the Patient Portal

Parents and guardians of existing patients can email, request records, schedule appointments and more.

Refer a Patient

Physicians and healthcare providers can request appointments, start transfers or contact us with questions.