Shrinker socks, and volume control:

We will begin volume control and residual limb shrinkage within 1-3 weeks after your amputation surgery. Once your limb has begun the initial stages of healing and some of the initial tenderness has resolved, it is important to begin using a residual limb compression device. The 2 most common are an elastic bandage/Ace wrap or a stump shrinker compression sock. If you physician or therapist has told you to start wrapping your limb with an Ace wrap – you should begin wrapping your residual limb with a “figure eight” pattern.   We can give you diagrams and instructions on how to do this properly. It is also important not to wrap your residual limb too tightly above the end of the amputation because it will restrict circulation. The bandage should be inspected, and if necessary, removed and rewrapped several times each day, because it will become loose and fail to provide adequate support as the limb shrinks.

Often the use of a shrinker sock is prescribed and recommended by your surgeon. It can be fit and applied over your dressing and helps to protect the area around the incision until the sutures are removed, again this should be discussed with your physician. Once the incision is healed a shrinker sock is usually all that is needed to help further the shrinkage of the residual limb to prepare the patient for their prosthesis.

Even after you get your temporary prosthesis, you should use a shrinker when not wearing your artificial limb to keep swelling to a minimum. Some amputee patients continue to wear them throughout their lives, finding the support from a shrinker particularly comfortable at night.

Rigid Removable Dressing (RRD):

Usually the day of, or the day after your amputation surgery, we will be called to the hospital by your surgeon to cast for and fabricate a custom Rigid Removable Dressing, (RRD). The RRD is a removable custom made protective dressing that serves 3 purposes:

  • It protects the incision and the end of your limb. In the case of a fall, or even when transferring from bed to a wheel chair or toilet, it helps to protect the end of your limb from further trauma.
  • It keeps the knee straight and extended, and your muscles stretched to their normal length. After an amputation, it is normal for the knee to flex. If the knee muscles flex too much they can shorten. This can cause an issue during prosthetic fitting.
  • It aids with edema and swelling control. It often also helps with decreasing phantom pains and sensations.

The RRD helps to prepare the amputee’s residual limb for fitting of the future prosthesis. This device can even be furnished prior to waking from surgery to assist with the physical and mental transition of your limb loss. It is adjustable for fit and comfort as your residual limb undergoes the normal changes in shape and volume post surgical. Once you have healed and your doctor is satisfied with the residual limb’s condition, we work with your physician to obtain a prescription for treatment. Once the doctor has issued a done the proper prosthetic evaluation, and issued a detailed prescription, we then move ahead with the fitting of your custom prosthesis.

Lower Limb Amputations:

There are many factors that determine how much of the limb is amputated. Generally, the longer the remaining limb and the more joints that are kept intact, the easier it is to fit and use a prosthesis.

The major categories of lower limb amputations are:

  • Foot Amputations – Amputation of any part of the foot. This includes mid tarsal amputations, Lisfranc amputation, Boyds amputation & Symes amputation
  • Transtibial Amputations (below the knee) – Amputation occurs at any level from the knee to the ankle
  • Knee Disarticulation – Amputation occurs at the level of the knee joint
  • Transfemoral Amputations (above knee ) – Amputation occurs at any level from the hip to knee joint
  • Hip Disarticulation – Amputation is at the hip joint with the entire thigh and lower portion of the leg being removed

Syme’s/Ankle Disarticulation Amputation

The Syme’s amputation is an ankle disarticulation or basically through the ankle amputation. It is primarily performed on younger and more active patients who have good overall blood flow, but have non-healing ulcerations or gangrene limited to the fore foot. It will also be performed for localized foot issues, such as; congenital abnormalities, severe foot deformities, skeletal malalignment, frost-bite, or a local tumor. The benefit of this type of amputation is that it retains the distal weight bearing aspect of the lower leg bone. This allows for allows weight bearing on the remaining part of the foot, which means that the person can put weight on the bottom of the foot and is able to walk short distances, stand in the shower, etc. without the assistance of a prosthesis. There is inherent prosthetic suspension due to the shape of the ankle bones at the end of the leg (i.e. the malleoli).

There are a couple disadvantages to this level of amputation: it is sometimes more difficult to produce a prosthesis that is cosmetically appealing; there are less available options for prosthetic foot componentry, and there is a tendency for the heel pad to migrate post-operatively thus reducing the weight bearing characteristics of the limb.

Partial Foot Amputation:

This level of amputation is a catch all term that refers to any surgery that removes a portion of the toes and/or foot, while not having the amputation go above the ankle. Partial amputations of the foot include: toe amputation; mid foot amputation (metatarosphalangeal, transmetatarsal); Lisfranc amputation; and Chopart amputation. A partial foot amputation allows for retention of some of the bottom of the foot and therefore some retention of the weight bearing area of the plantar aspect of the foot. We must be observant of the range of motion of the patient, as well as the location of boney prominences. We must also asses the condition of the remainder of the internal arches of the foot must be taken in into consideration when fitting a prosthesis. The biomechanical forces transferred to the foot while walking is of paramount importance, and will be assessed during our evaluation and during various follow-up appointments. Prosthetic options include: no prosthesis; rigid footplate with arch support combined with a rocker bottom shoe sole; custom-molded foot orthosis/ prosthesis; custom-molded shoes; modified ankle-foot orthosis with a toe filler; foot prosthesis (a custom-molded socket attached to a semi-rigid foot plate with a toe filler).

Trans-Tibial (Below Knee) Amputation:

This amputation level is the most common amputation performed in the USA. It refers to a surgery that involves the removal of the lower leg, while retaining the patients anatomical knee joint. There are several designs for below knee prostheses. The style of prosthesis that a patient is fit with will depend on their activity level, residual limb length and shape, as well as your diagnosis and prognosis. The Trans-tibial amputee must bear their weight during ambulation through the peripheral soft tissues of the residual limb, and not the remaining bone. The peripheral or soft tissue must be taken advantage of fully and we must increase the weight bearing surface area in order to facilitate weight bearing through tissues that are well suited for weight acceptance, but not intended for it. Proving a custom fabricated flexible inner liner will increase the weight bearing surface area and allow for internal differential weight bearing to unload the boney areas and areas of concern. Further, this soft insert will help in controlling volume changes and adjustability, reduce stress on the skin, and increase comfort for improved ambulation and improved suspension. Ultra-light materials will include carbon fiber and fiberglass reinforcement in the socket design and use of light weight components like titanium and aluminum. Further, it is lighter and also improves the patient’s ability to ambulate further because of the decreased weight of the material, reducing energy consumption as the patient ambulates, and allows the patient to ambulate further. The prostheses will also incorporate alignable componentry in order to aid with minor angular changes in order to reduce internal socket pressures, and to provide for clinically indicated alignment changes during gait. As we custom fabricate every prosthesis that is delivered in our office, we can easily state that we are able to accommodate any patients request for any style or type of prosthetic device. This includes customizing the external appearance of the prosthetic socket to match your individual personality. Some of the things that your prosthetist will consider when designing your prosthetic device are:

  • Your weight and activity level.
  • The necessary weight and strength of your prosthesis to allow you to accomplish your activities without worrying about any type of failure.
  • Socket design. Including socket lamination materials.
  • Interface material. Inside the socket as well as against the skin
  • Use of a flexible inner socket
  • Ability to adjust fit and volume post fitting
  • Suspension system options.
  • Alignment componentry
  • Foot type and material. This can include such things as Energy Storing capabilities, multi-axial ankles, Micro-processor ankles, and Sports specific devices.

Trans-femoral (Above Knee) Amputation:

This is an amputation that occurs through the femur bone. It is referred to as a trans-femoral or above knee (AK) amputation. This is the second most common amputation level in the USA and is common level for diabetics who have battled non-healing ulcerations for a long period of time as well as oncology patients. The complexity of this level of amputation is that the patient now has to control two joints (knee and ankle) while standing and walking through mechanical means. Suspension of the prosthesis and comfort of the socket are paramount concerns that need to be addressed to have successful fitting and function at this level. There are many types of above knee prostheses. The type that an amputee is fit with depends on the shape of the residual limb, the length of the residual limb, activity level, prognosis, and individual preference. A trans-femoral amputee is unable to bear weight on the bottom of the residual limb. In order to keep the weight off the bottom of the limb, traditionally, the amputee must support his body weight on the ischial tuberosity (seat bone) of the pelvis, as well as the soft tissue of the limb, and the gluteal tissues (butt muscles). Traditionally the AK amputee always felt some pressure in the back of the socket because they are essentially sitting on top of the socket. The staff at TSOP have attended many advanced fitting classes, and through the use of new socket technology and circumferential gradient pressure distribution and advanced interface systems, this pressure is being minimized if not all together eliminated. As we custom fabricate every prosthesis that is delivered in our office, we can easily state that we are able to accommodate any patients request for any style or type of prosthetic device. This includes customizing the external appearance of the prosthetic socket to match your individual personality. Some of the things that your prosthetist will consider when designing your prosthetic device are:

  • Your weight and activity level.
  • The necessary weight and strength of your prosthesis to allow you to accomplish your activities without worrying about any type of failure.
  • Socket design. Including socket lamination materials.
  • Interface material. Inside the socket as well as against the skin
  • Use of a flexible inner socket
  • Ability to adjust fit and volume post fitting
  • Suspension system options.
  • Alignment componentry
  • Knee joint. It is imperative that we provide the patient with a knne joint that allows for maximum stability during the stance phase of gait, while allowing for optimum swing characteristics during swing. The use of Micro-processor technology is assessed if it is applicable and medically necessary for each individual patient.
  • Foot type and material. This can include such things as Energy Storing capabilities, multi-axial ankles, Micro-processor ankles, and Sports specific devices.

Hip Disarticulation / Hemipelvectomy Amputation:

This is a very high amputation level that involves the amputation of the entire lower extremity at or above the hip joint. A hip disarticulation (HD), Hemi-pelvectomy or trans-pelvic (TP) prosthesis typically consists of a custom-made, flexible inner socket with a rigid outer frame, a hip joint, rotator, knee unit, pylon, and foot. HD and TP sockets cover the amputated side and also wrap around the person’s sound buttock and torso, with secure straps fastening the two sides together. Due to the nature of this amputation, the prosthesis for this level of amputation involves the use of a mechanical hip joint, and knee joint, and ankle/foot.   The challenges of learning to use a HD or TP prosthesis call for an extra measure of perseverance from the patient, the prosthetist and the physical therapist. It usually takes several weeks of physical therapy and daily use for the user to feel independent and confident.

A Hemipelvectomy amputation involves removal of the entire lower extremity and half of the pelvis, separation generally being effected at the sacroiliac and symphysis pubis joints. Whenever possible the gluteus maximus and oblique abdominal muscles are preserved and usually are sutured together along the lower anterior aspect of the abdominal cavity. Because of disease or trauma, it is often necessary to remove the gluteus maximus, in which case the “stump” consists simply of a skin-covered abdominal cavity. However, it has been found that it is entirely feasible for the “stump” to carry the loads if the socket is designed so that the semisolid abdominal mass of the stump is upward and medially toward the somewhat firmer area of the lower rib cage. Sometimes it is possible to utilize the sacrum for some support but relief for the coccyx must be provided because pressure on this sensitive bone almost always results in pain. Some additional support can often be achieved by utilizing the area of the gluteus maximus on the unaffected side.