Designing, fabricating and fitting your prosthesis is a 100% custom undertaking. A prosthesis built for one person simply will not fit or work for another person. This is true even if you have the same type of amputation on the same side or even the same length.
Why? Because the variables in the fitting of your residual limb into a socket are myriad. How strong are your muscles? Where have they been cut? How and where have then been reattached (if they have)? Where have the cut nerves and arteries been located? How prominent are your muscles, tendons and ligaments? These and many more factors are taken into consideration when your prosthesis is built.
How the process begins
If you are a new amputee, we usually start by fabricating what is called a “preparatory prosthesis”. We do this because your remaining leg or arm is going to become significantly smaller in size over a short period of time. This happens for several reasons. Following surgery, most people have a certain amount of edema (swelling and fluid retention) in their limb. This is a natural part of the healing process, but may be greater in some people than others for many reasons.
We can often help your edema reduce quicker with a “shrinker sock” that fits over your limb. We follow this by having you wear a liner (a soft rubbery type of sock that is an interface between your own leg and the socket (the hard shell of the prosthesis you put your leg into) for a slowly increasing amount of time. Additionally, your leg will also reduce in size because the muscles in your leg will atrophy, which means they will become smaller because they are not used as much. This happens because the muscles in your leg are no longer able to do the work they once did. This is normal. This happens with everybody, and will not have a great impact on your ambulation.
It will however, have an impact on the fit of your leg into the socket (the part of your prosthesis that you put your leg into), and the greatest amount of shrinking will happen in the first few weeks of wearing your prosthesis. Your preparatory prosthesis also allows us to evaluate your potential for ambulation this helps us to select the best type of permanent prosthesis for your specific style of walking and ambulatory capability.
There are many, many options to choose from, and once we have selected the best components to use to build your permanent prosthesis, you will likely live with it for several years to come! The period of time you use a preparatory prosthesis usually ranges from about twelve to twenty weeks, depending on a wide range of variables.
Once we feel your leg is stable in size and shape, and we are satisfied that we have together picked the most suitable components (hand, foot or knee type for example) and together decided upon the best socket design we will create your permanent prosthesis.
Steps To Creating Your Limb
- First we talk with you to determine your needs. At the same time we review your medical history and evaluate your current physical condition.
- Then we explain the various prosthetic options based on the information we’ve collected.
- Next we work with you to develop a prosthetic plan based on your goals and our findings. This plan may include coordination of services with your therapists and doctors.
- We then begin the process of fitting you with a detailed examination of your residual limb to determine tissue density, scaring, bony structure, and a long list of other information that may be pertinent to comfortably fitting your leg into a socket (the part of the prosthesis you put your leg or arm into).
- We take precise measurements of your limb, usually in conjunction with a making a plaster duplicate of your arm or leg.
A mold of your limb is created and then that mold is used to make a cast as shown here. That cast is then modified by a skilled prosthetist so the mold created will fit perfectly.
- We modify this plaster duplicate here in our own facility to create a mold that will be used to fabricate the custom socket for your arm or leg to fit into. Crafting this socket is of critical importance to the comfort and long-term health of your arm or leg. It is the part of your new limb that will bear the weight and pressures in the correct places to ensure a comfortable fit of your arm or leg. This is why we craft every socket in-house. No outside source can know better then the experienced prosthetist in our office (who measures you) how best to adjust the fit of your arm or leg into the socket.
- We also order whatever outside parts that may be necessary to build your completed prosthesis.
- Next we fabricate and modify a “check” socket. This looks like a piece of glass that you slide your limb into. This is another critical part of the process and we may fabricate one or many check sockets before we determine we have the best possible fit. Unlike some prosthetic facilities, we fit all of our check sockets in real life situations – that is, we attach your new hand or knee or foot components to your check socket and have you use it to best determine the all-important fit of the socket. Only in a dynamic situation can you truly know if it fits.
- After we have determined we have a good fitting socket, we assemble and fit your permanent prosthesis. But we don’t stop here. Wearing a prosthesis and walking or using it in our office does not ensure a good fit., And, you yourself can’t really tell if the fit is as good as it can be in just a few hours of wearing it in our office. So, we assemble your prosthesis and send you home with it for a few days for a “trial fitting.”
- If you or we determine there are any problems, or even if we determine that we can simply provide a better fit by making a change in how your socket fits, we do it now. Once we are both satisfied your prosthesis fits and performs the best it can, and that the components we have chosen are up to the task we finish your prosthesis making it as lightweight and strong as possible.
- Again, we don’t stop there, but bring you back again periodically to make sure everything is performing as well as we have hoped, and handcraft any minor touches on-site, while you wait, to ensure a perfect fit.
For Medical Professionals
Getting Used To Your New Prosthesis
To help your leg become used to wearing a prosthesis, and to be able to maintain the best fit, we begin the process of wearing your prosthesis gradually. You will slowly begin to wear your prosthesis longer each day with a gradually increasing amount of weight bearing on your prosthesis.
During this period we will evaluate you along with your therapists and doctor and will set a goal for ambulation that you agree with us is reasonable to achieve. For many people this is full, weight-bearing ambulation with no outside help such as crutches or a walker. For some it may mean ambulation with a walker, cane or crutches to help perform your daily living needs. For others this may be participating in vigorous athletic or outdoors activities.
Whatever goal we set, it will be set with your input, and we will encourage you to achieve your maximum potential, which may very well increase as you become ambulatory and increasingly active again.
Even A “Definitive” Prosthesis Will Not Last Your Lifetime
Keep in mind that you may need to replace your socket as your limb changes size and shape over time. Maintaining a good fit is the most essential part of wearing a prosthetic! We will follow up with you on a regular basis to make sure you maintain the best possible fit.
You will also find that your components (the foot or knee as well as all of the connecting pieces) will wear out over time and need replacement. This will vary depending on weight and activity level among other considerations.
This is not a bad thing however, as every few years components available for your prosthesis will evolve and improve as the technology changes. So, as your old components wear out, replacement with new components will help to improve your comfort and ambulatory capability,