Below the knee amputation

[boxman55]

I have been going to therapy to learn how to walk with my prothesis. I went on Thursday and for about 45 minutes I did various walking with the last 15 minutes using a 4-prong cane. When I was done, my shin bone right at the bottom and up about 2 maybe 3 inches stung to the touch. It is a very sharp pain. But anyway, the therapist told my to start wearing it everyday for a period of time. Well so on Friday, I put it on and went to dialysis. Everybody was excited to see me standing up as it was my first time there with it on. The problem was my shin started hurting so bad I took my "leg" off while I was in the chair. I dealt with knife type stabs on my shin all through dialysis and could barely walk out of there and walk up my drive and into the house it hurt so bad. I took it off when I got home and dealt with the pain the rest of the day and into the nite. Today Saturday it is a little better it is still sore to the touch.

So, my question is do you think it is the prothesis rubbing on that area or it is because I am putting all my weight on the end of it while I walk and the bone is getting sore. Either way it hurt  ...Boxman

[kitkatz]

This answer is from first  hand experience. From my husband Victor to you Boxman.  I hope it helps.

Kitkatz

Evening Mr. Boxman :

I am Katherine's husband and she asked me to talk to you regarding your prosthesis problem. I presume that this is your first / training leg, if so it is a model that has a strap that goes around above the knee ?.
If that is what you have you should have been issued a number of different thickness socks. Am I right ?. How many socks are you putting on ?.
Mine I had to use a six ply, the plastic insert, a one ply over the insert and that into the socket of the leg. I began by just standing around the kitchen counter and stepping forwards and backwards, little steps at first. Once comfortable i began using a two wheel folding walker and just walked around the house.
About a month or so I started rehab therapy, for not only learn to balance and walk, nut also to to correct as the amputated knee would not straighten. It took 4 therapy sessions in a six month period to correct the knee and put a lot of exercises to make me walk from, walker to cane to nothing. Learned steps, curbs, stairs, threadmill, exercycle. Was made to walk forwards, backwards, sideways, learn to get up if I should fall and so on.
After 16 moths with my training prosthesis I was finally issued the final one in Feb. of this year and am having pain and difficulty once again so am back on therapy to work with the new leg.
Two things may be happening, you are going too deep into the leg socket. When fitted and adjusted correctly the weight is carried by the knee just below the cap, and part by the meaty part ( the fold ) of the stump. There was only a brief explanation given me that if I felt I was too deep in the socket I needed to add more socks to the stump. Also as you begin to use that prosthesis the stump will begin to shrink some making the fit that you started with loose.
Things to be aware of. if you do not use the shrink socks at night or when without the leg the stump will regrow some. Just because it fits tight in the morning it may be loose by mid-day and you will have to adjust to keep a good tight fit.
These days when I use my old leg I use a 3 ply, 5 ply gel sock, and a one ply before slipping on the plastic insert, then another one ply and then slip all that into the leg socket. What that means is that my stump has quite a bit.
If adjusted snud while sitting you should be able to lift the leg upwards and it should not froop at the knee, if it does it is too loose still. Don't be afraid to experiment with different combinations of plies to get a good snug fit.
Something elase some of the socks are made from different materials, some make you sweat more. I prefeer a 1 to 3 ply soft sock against the stump, then the heavy duty 5 to 6 ply sock. Another thing there are 5 ply "gel socks", these are made up of two thin layers with a gel material in the middle, it really does cushion that ole stump real good, I use it instead of the heavy duty 6 ply. Only bad thing about it is that when you walk it makes a fart like sound, and if you wear it against your skin it will make it sweat like crazy. That is why I use a 1 to 3 oly soft sock forst and then the gel sock, then one more 1 ply over that before slipping it into the plastic insert and then another one ply before going into the socket.
When fitted correctly the weight is distributed all around the stump and not just by the bottom.
The orthopedic people have had to layer in the plastic insert in places to accomodate and transfer excessive pressure away from the bones, have had to make room on the socket itself to provide bone clearance. Also many adjustments to height, toe in and out, compensate for different shoes and so on. They are your best friend to make your walking a success. When you go for a check up or to make adjustments tell them where it hurts, they can see also the skin coloration when there is excessive pressure. It also takes time for the flap on the bottom of the stump to toughen up. It will take anywhere between 6 months to a year before it becomes a part of you, you have to put a lot of miles to really get used to it.
I hope some of what I have said may be of help to you. If you need to talk or to ask questions just write me directly to:  vicasoto99@yahoo.com
Victor

[G-Ma]

Great explanation..just my     .my hubby also kept a log from beginning on with basic drawing and marking where it hurt if it did or what exactly the feeling was/what socks he was wearing etc and the rehab and prosthesis people were able to get a better idea of what was going on.  Good luck Boxman.  I know this is a difficult journey for you but you will make it.
Ann

[boxman55]

Wow, thank you Victor for your input. My set-up is a little different but even still I do have to adjust to my leg thickness
at the time I put it on. Because I have not worn it for a real long time I have not experienced shrinking during that period.
Let me try an explain my leg first and then what I was given for socks and such. The leg is a hard plastic design somewhat
shaped like a lower leg that comes up to my knee with its design it is indented to fit under the knee to use support there. I have no straps. Down
at the bottom of it (inside) just above the ankle mechanism is a socket that receives a five click steel post that has screw like ridges.
To get into the leg (first, I do wear the shrinker socks when I am not wearing the prothesis. So I wear them a lot. Because of
the fact that I retain my fluid in my lower legs it effects the prothesis fit and the shrinkers help to reduce the size of the lower
stump) What I do is first remove my shrinkers, then I have what they call a "Alpha Liner" it is a neoprene like liner similar in thickness
of a neoprene knee brace. I roll this thing on and it comes all the way up to the top of my leg. On the bottom of it there is a
bolt attached. When I put the leg on the bolt clicks into the socket of the hard plastic leg. Depending on how easy it is to slide
in the leg and "lock in" will determine the type of sock or socks, I will put over the neoprene. I was given socks made by Royal Knit "Cool Max"
prosthetic socks. They gave me three thicknesses and also a handfull of real thin ones. I usually start with the thickest one I have
and if I can't get the bolt to lock in because my stump is to thick to push it all the way down to the socket I change to the
next size, and so on. The leg was designed to fit shoes that have similar height and a few adjustments in the ankle have
already been made for foot position. In therapy we have been doing similar things that you mentioned. So there is my leg type and
how I wear it. I don't know if the inside of the plastic leg needs shaving down in area's or maybe even during the short time
I am wearing it the stump shrinks and I should try on a thicker sock or add a few of the real thin ones. But I will say this, today
is Sunday and the shin bone is still sore to the touch and the last time I had the leg on was Friday...Boxman

[kitkatz]

More from Victor:


 Morning Boxman :

Wow they have outfitted you with a "final prosthesis". By that I mean that your style leg and suspension was one of two possible designs offered me as final prosthesis, the other being the one I have had since February. Mr Golay my ortho man said that the one you describe is an older design and in use tends to pull hard on the bottom of the stump. Therefore the one he recommended and I accepted is the one being used on our vets from Iraq, it consists of a sleeve canvas on the outside and a soft plastic on the inside. You roll this onto the stump, an inch or so from the bottom on the outside is a wide flange like an "o" ring.
So you spray a mixture of water and alcohol around the flange and insert it into the leg socket, stand and stump down a few times to force the trapped air out the valve on the bottom of the socket. You are now ready to walk, the leg is now retained by vacuum. You can pull it away and it won't come off as you are pulling on the entire leg where covered by the sleeve. The problem for me is that there is only 2 mm of sock between the stump and the socket, it fits so damned tight that I can feel it pulling on the stump. Wes did place a thickness of foam at the socket bottom to keep from going too deep, and more recently added some in the forward area of the socket to keep it from slapping.
So my accident was on May 25 2006, my training leg was issued in November '06, my final in February '08. So I have had more than a year to settle down and work with my training leg, heal, and given the stump time to shrink some, get used to a diet and learn to keep my weight under control; those are some of the variables taken out of the equation, now I have to deal with the changes that occur daily as well as the ones due to the seasons of the year.
From what you describe you have gone from the freezer to the frying pan, if it is correct that this is your first prosthesis. Maybe your team ( doctor, orthopedist, case people, insurance ) feel that is the best for you based upon your circumstances or medical needs, but also it could be a cost saving measure and you be damned, put up and shut up !. (
You need to talk to the team about your difficulties and see if there are options or extra help they can provide you. My visits to the othopedist were every couple of weeks at first, then once a month, and lately is whenever I have problems or need adjustments, ask if there are other products in that line of leg that maybe of help beyond and above what they have issued you. Do you feel a kind of pain and rush when you first get on your feet ?, I always have that uncomfortable feel when I get up. Once I start to walk it is gone, what I think it is the blood and fluids leaving the stump as weight is applied. After a few minutes remove the leg and recheck the fit, bet it will be looser and you need to add a thin sock or two and go on your way. Say you been out all morning, at noon you will need an adjustment again. This sequence may go on till you become one with the leg. That was one of the things my ortho people told me, you will need to readjust the fit more than once a day; that is why you should carry extra socks with you when you go out.
But if you leave the leg off for any length of time at home or at work you will have to readjust all over again. I only seen one man a double amputee who took off both legs and was relaxing at the hospital waiting area, we talked while he massaged his stumps. Then his wife came by and said they had to go get the prescriptions, so he installed each sock with the metal spike inserted it into the socket and made sure it locked, same with the other. He swung backwards once and forward got up and walked away just like that. That was a lesson to me, if he could do that with two I could do it with one, this was two weeks after my accident.
Victor

[boxman55]

Thanks, Victor yes this is my first ever and only prosthesis, I was not aware of any other choices and not aware of training legs. This is such great information. I am truly appreciative. I am going to print this out and have my leg guy read it and see what he says. Thanks so much...Boxman

[G-Ma]

Yes, you need to be the squeeky wheel and get yourself a "new" prosthesis...they should be ashamed of themselves giving you a dinosaur...I talked to a friend of mine in ND who was in a horrific auto accident 11/06 and in Jan 08 was given his possible last prosthethis and he has had about 5 in between...the one he has now is the 2nd one in ND...it is below the knee computer operated...I believe he just shifts his knee and his ankle will click and move..it is really wild..and he has a seperate one for going swimming as the computer one can't get wet...he has been going to rehab once a week since last April as he was in a coma from Nov 06 until Mar  07 and now is doing good...not great but he is able to walk and drive now..so yes you have many choices..don't let them push something less than perfect on you...you are not old and just willing to sit and veg.  If your leg man can't do it, there are others...this is me Bulldog G Ma...I fight for everyone except myself...not sure why that is but if you need help writing letters about this or anything let me know..I also involved TN Senators when George had his amputation and wasn't getting what I felt was appropriate care...and think of it, this is an election year and they will move mountains for you.
Ann

[boxman55]

Thanks G-Ma the more I ponder Victor's and now your experience the more I need to look more into this. If I need your help I will come calling...Boxman

[twirl]

Boxman
I am so proud of you
Cheryl