Lower Limb Prosthetic Fitting
[ photo by Victor Dompablo ]
Find the right prosthetist.
I have spent two of my three previous posts discussing lower extremity amputation. I wanted to finish out the series discussing the process of obtaining a prosthetic.
(Related blog post: Coping With Amputation)
Let’s start this with me reiterating the importance of finding a prosthetist (the person that makes the prosthetic) that you and your loved one receiving the prosthetic feel comfortable with. You will be spending a lot of time with this person. Your loved one needs to be able to voice any questions or concerns he might have with the prosthetic and feel that the prosthetist is listening and responsive to his needs.
An ill fitting prosthetic can lead to a long list of issues that all have the same ultimate outcome, which is the inability to use the prosthetic. I said it before in a previous post, and that is, if you or your loved one are not happy with your prosthetist, try someone else!
Obtaining a prosthetic.
Assuming you are with a prosthetist you are comfortable with, he or she will help you decide the best type of prosthetic that fits your loved one’s activity level. The first step of obtaining the prosthetic is having the order from the physiatrist or the orthopedic surgeon for the prosthetic.
The fitting process cannot begin until the surgical site is fully healed. In addition, the residual limb should be shaped into the cylinder (below knee amputation) or cone-like shape (above knee amputation). A common misconception at this stage is that the first appointment will happen and the prosthetic will be ready to go on that day. Unfortunately, that is far from the truth.
First, the prosthetist will have a discussion with your loved one regarding his activity level and goals for function. As you might imagine, and have likely seen, there are a wide variety of types of lower extremity prosthetics, with each type being made for a particular activity level. Understandably, the prosthetic of someone who walks only short distances in the home is going to look quite different than the person who runs daily or walks 18 holes of golf on a regular basis!
(Related blog post: Celebrate The Paralympics!)
Lower limb prosthetic fitting.
Once the goals have been established, the measuring for the socket (the part of the prosthetic the residual limb fits into) begins. There are many different ways of obtaining these measurements, with the most common being forming a plaster cast of the limb to use as a positive mold to create the socket. This custom mold that is created is then used to create the socket.
Usually, a practice socket is made first. This is often clear so that the prosthetist is able to see how the limb fits in the socket. This allows the user of the socket and the prosthetist to know if the right fit is made with that trial socket. In addition to the socket, a custom liner is made. This liner goes over the residual limb and serves as a cushioned barrier between the limb and the socket. The above-mentioned takes place over multiple appointments spanning several hours.
Once your loved one and the prosthetist are satisfied with the fit of the temporary socket, the permanent socket is then crafted and the appropriate components are then attached. These components include the necessary joints, including the knee if an above or through knee amputation and the foot/ankle. Again, once these components are attached, there are multiple visits with the prosthetist to make adjustments to the components to ensure the best fit.
On average, the time from amputation to a final prosthetic ranges from six to twelve months!
Learning to walk with lower limb prosthetic.
The final step of fitting the prosthetic is the physical therapy that takes place. This is when your loved one will relearn to walk with his prosthetic. It takes awhile for your loved one to build the trust that his prosthetic will keep him standing! Once the trust is established, the physical therapist will work with him to ensure that his gait mechanics are working correctly. Again, this takes time, but with patience, it will come.
As you have figured out by now, lower limb prosthetic fitting is not a quick process, as with most things rehab-related. With patience and good effort, however, your loved one should be able to regain the function that he lost with the amputation.
Feeling overwhelmed with the process?
Afraid you may not make the right decision at the right time? This stage of life for you and your aging parent often brings more questions than answers. Reading information from a trusted source like me can help guide you in the process. However, if you still feel overwhelmed, don’t hesitate to reach out to me. I am happy to help with a personalized plan for your unique situation.
© 2021 Jessica Kluetz, DO