Amputations are performed for many different reasons. Once the operation is performed, there is a recovery period that is determined by many factors including age, cause for amputation, overall health and compliance on the postoperative protocol by the patient themselves. It is important to have training and information prior to your surgery so that you can properly care and protect your residual limb and begin the healing process as quickly as possible. The doctor and hospital will typically provide wound care post-op, but after that it typically falls on the patient or therapist to continue the pre-prosthetic care for the patient.
There are a few things that can be done to reduce the limb’s volume in preparation for the prosthetic limb. There is trauma to the limb after surgery like swelling and edema. Also, the scar line needs to heal properly prior to any prosthetic intervention. There are many philosophies and protocols that people use to achieve this. The most common method of shrinking the limb is the use of stump shrinkers. This is an elastic sock put over the limb and is typically worn for 23 hours a day, or whenever the limb is not being cleaned or attended to. When it all possible, it is our philosophy to use an extra long Ace wrap instead of a shrinker for several reasons. The first reason is that we have found that Ace wraps help promote healing on the scar line. Tension can also be adjusted throughout the day when you unwrap and rewrap as recommended. You can also typically wrap a limb much higher than a stump shrinker would allow. A stump shrinker, on the other hand, is a static sock that does not keep tension as well when the volume in your limb fluctuates. The residual limb volume shrinks due to water loss, edema loss, and atrophy. Atrophy is muscle loss caused by inactivity of the limb. Limbs shrink quickly after surgery and continue shrinking for approximately two years after amputation.
A preparatory prosthesis is a first prosthesis used after amputation. These can usually be worn 8 – 10 weeks post-op provided there are no other complications from the surgery. This can vary depending on the reasons for amputation and other factors. These prostheses are usually inexpensive with basic components for the sole function of getting the patient walking. Inexpensive and easily modified materials are used because the limb is shrinking rapidly at this time. Socks are added to the residual limb to take up the space. Typically, these prostheses might last anywhere from 1 to 3 months post-op. By the end use the patient may be wearing many socks in order to maintain the fit. At Prosthetic Orthotic Designs, we usually do not use a preparatory prosthesis but rather go straight into a definitive prosthesis. We feel that the inexpensive components coupled with the use of a high amount of socks is detrimental both physically and emotionally on many patients. Towards the end of a preparatory prosthesis’ life, they become quite unstable and the inexpensive components limit the patient’s progress. We prefer to start with normal components that the patient will use over the first year or two. Periodical socket changes will keep the patient in a stable environment and steady progression rather than changing the entire prosthesis as it is outgrown. This is important physically and emotionally and we feel it is a more positive and beneficial approach.
Phantom limb pain is a situation that many patients experience on different levels of severity. Phantom limb can manifest itself in different ways such as burning, tingling or electrical shock sensations. Sometimes just the feeling that the limb is still there can feel like pain below the amputation. The severity of the pain is personal and is addressed both medically and by the patient themselves. Your doctor can prescribe you medications, however, we have seen that proper wrapping of the limb with our when not wearing the prosthesis has been the most effective way to reduce or eliminate phantom limb sensation. The wrapping of the limb supports the tissue and can reduce or eliminate these sensations. Phantom limb pain can reside over time but for others it can be a persistent issue.
This is a common question many people ask and the answer is that there is no definitive timeframe. It depends on the person. If everything goes well surgically and with the proper pre-prosthetic care, a person can typically begin to ambulate eight to ten week post-op. A consultation with your prosthetist can give you a more specific projection of when you will most likely be able to walk. A simple interview can usually give us enough information to provide you with a timeframe. The process of prosthetic rehabilitation takes time and the goal is to have a steady and constant progression during your rehabilitation process. Many patients are able to walk independently (without the use of canes, walkers or crutches) a few months after their surgery. Some people can return to sporting activities as soon as six to nine months. Again, everyone’s experience will be unique to them.
Absolutely. Prosthetic Orthotic Designs specializes in the active patient and specialty sports prostheses are part of our practice. We take great pride and interest in returning patients to their sporting activities and have built many custom and activity-specific prostheses for our clients. There is no one prosthesis that is perfect for everything. Typically, many of our athletic patients have multiple prosthesis so that they can compete in their chosen sport at the highest level. A prosthesis that may be good for leisure and cosmetic reasons may not be the best prosthesis to use for running a marathon or motorcycle racing. Activity-specific prostheses are highly customized to the individual user. We spend time at the field, track or beach to tweak and customize these prostheses for the patients so they can return to their chosen sports. Many of our patients have taken on additional sporting interests after their amputation than prior to it. We are very proud of the level that many of our patients have achieved in sports. One of the reasons that our patients can compete at the highest level is that they are able to train on a regular basis in comfort without skin or socket issues due to our specialized socket design called the PODI Socket Design.
It can be argued that learning to walk is similar in analogy to learning how to ride a bike, in that we have been doing it our whole lives so the process is familiar. This is true to some degree. It depends on many factors like the level of amputation and the learning process of the individual. There are some patients who can literally put on their prosthesis for the first time and walk out the door. For the typical amputee, there is usually some discomfort in the early stages that limits the progression. As the level of amputation gets higher, the skill has a greater requirement. Some patients do require and benefit from some gait training. This is something we can provide during the fitting process. We also work closely with Dr. Robert Gailey, PT, Phd. who has developed some of the most advanced gait training techniques and processes that are in use today.
In today’s world, prosthetic components such as hands, elbows, wrists, knees and ankles are electrical or computer controlled. They either monitor your situation or accept input from your muscle signals to cause a reaction in that joint. Computer controlled joints have revolutionized the industry as they can adapt to your input and/or the environment giving a safer and more fluid experience for the user. Mechanical joints depend entirely on the inputs from the patient. These have been used for many years and are applicable in some situations. Technology is advancing rapidly and Prosthetic Orthotic Designs is always on the front line of technology development. We offer the newest technology available today and work with some manufacturers to test out pre-production components from time to time.
Prosthetics is a highly individualized application. There are common types of amputations and then there unusual or asymmetric types of amputations that we see from time to time. We specialize in hard-to-fit, unusual amputations or congenital situations. We think outside of the box and apply principles rather than rules or laws. Our approach to these cases is very individualized and is designed specifically for each patient. We take the whole client into consideration including their physicality and activities in order to develop a plan to maximize that patient’s particular potential.
This is a very difficult question to answer in a short paragraph due to the vast options and technologies we use today. At Prosthetic Orthotic Designs we are able to work with all technologies available on the market today. These options all affect price. Our staff are experts in dealing with insurance companies and third party payors and will do everything we can to accommodate your specific needs and insurance benefits. In order to get a more accurate idea of cost, a simple evaluation is recommended and a custom plan will be developed for you. We can also do long distance evaluations via Skype or a telephone call to get a better idea of your situation and give you a more accurate estimate.
Due in part to our use of advanced scanning technology, CAD/CAM and our clinical techniques, we are extremely fast in our delivery times and can work with short timelines. Delivery times can vary from patient to patient, and depending on what level of amputation is presented. In many cases, we work within short timelines of a few days to one to two weeks depending on the complexity of the prostheses developed and delivered. The majority of our clientele travel to see us from all over the US and foreign countries. As such, we are used to working under very short timelines that are way faster than industry standards. After a simple evaluation we can give you a better idea of expected timelines for your prosthetic care.
A large portion of our clientele are interested in waterproof prostheses. We have done many of these for general water activities as well as specific prostheses for water sports. We typically build water sports prostheses that are for high activity. These utilize special waterproof components and as such, can be submerged in both fresh and saltwater. We made numerous water style prostheses ranging from shower prosthesis to high-performing activities such as wakeboarding and scuba diving. We have patients participating and competing in water sports to include waterskiing, scuba diving, kiteboarding, wakeboarding, surfing and beach going.
We offer many options for cosmetic coverings. We offer everything from the simple, to the most advanced high definition cosmetic covers in the market today. There are options for pull on cosmetic skins over foam as well as spray-on skins. A higher level of detail would be a high definition silicone restoration. We are one of the few facilities in the world that offers this option for lower limb prosthetics. We specialize in providing high definition covers to below and above knee amputees. We have also developed a technique to use high definition in waterproof prostheses. We are also proud to offer Aqualimb prosthetic covers which are specially designed for use in the water.
The socket is the foundation to any successful prosthetic fitting. Without a good foundation, the rest of the prosthesis and components have little to no benefit to you. The socket design is very specific to the person in charge of your prosthetic management. This is an individual skill and design process that makes all prosthetists unique from one another. No two sockets are generally the same and they vary greatly across the industry in general design and materials. The PODI socket utilizes socket design and materials that are unique in our industry. Through many years of research and design, we have come up with socket designs that provide maximum support and allow your muscles to still remain active in the socket. This makes for a stronger residual limb which translates to stability, power and comfort when using the prosthesis. The materials are semi-flexible to allow muscle expansion and growth. Rigid sockets tend to inhibit the natural muscle expansion and cause muscles to atrophy over time making the residual limb weaker. We find this is not the best case scenario for most clients and do everything in our power to facilitate a healthy and strong residual limb. This can be achieved with PODI design sockets and can be explained in great detail during your evaluation.
There are multiple methods for suspending a prosthesis on your residual limb. All options are available to you through PODI, however, there are suspension methods that are preferred over others. In most cases, we prefer to use a suction socket that achieves a negative pressure without any moving parts, pumps, batteries or added weight. The PODI design socket achieves negative pressure within the socket by nature of the materials and the dynamics of the socket design. In some cases, other suspensions are used as well. Your specific situation will dictate what suspension method is best for you.