Difficult bk fitting, suggestions?

Difficult bk fitting, suggestions?

andy d'entremont C.P.(c)

4/24/1998

Dear list;

I have client whom I would like to make a more comfortable prosthesis
and one as functional as possible. (Obvious goals)

He is a bk amputee who had polio as a child and had shoe lifts and
kafo's until 15 years of age when he opted for a bk amputation. He is
now mid 40's. He has always used a prosthesis - ptb, pelite with side
joints and ishial/gluteal bearing thigh lacer with a standard sach
foot.

His prosthetic side is a basically well atrophied, flaccid limb. He
has no muscular control whatsoever. All of his prostheses in the
past have had free outside knee joints with a back check and the foot
aligned in a great amount of plantar flexion to provide a knee
extension moment to 'lock' or stabilize his knee. He also depends
solely on the thigh lacer for suspension. This has never been very
adequete, as he pistons a good half inch or more. He always has worn
at least 12 ply of socks.

I recently tried a Icecast technique, with a distal cup, then an
iceross sleeve. Distal cup needed due to a tapered shape. He also
wore a 3 ply sock over the sleeve and then into the shuttle cock for
suspension. I tried a reflex vsp, then a modular 3 flexfoot. on him.
I used outside joints and thigh lacer. He has always refused to wear
a waist belt in the past, and I could not convince him to use one as
an auxillary suspension in this prosthesis.

He has given this system a very good try, but cannot get used to the
suction, pull on his distal stump. The weight of the joints and lacer
add to the equation. I really would like him to wear a waist belt,
but he refuses. He wishes to stay with the modular 3 foot, but
wants to abandon the iceross suspension and go back to a pelite liner
with at least 9 ply.

I have therefore recasted him for such a socket and will try a
silicone sheath to give him more comfort due to the pistoning I
expect to see. I have also showed him an alpha liner, but he thinks
he would like his tissue to 'breathe'. He feels the active silipos sheath
may help because of the sheath on the inside.

I wonder if anyone has any other suggestions?

Andy d'entremont C.P.(c)
Saskatchewan, Canada