Re: Difficult bk fitting, suggestions?

Re: Difficult bk fitting, suggestions?

Thomas Wickerson

4/25/1998

In message < <Email Address Redacted> >, andy d'entremont
C.P.(c) < <Email Address Redacted> > writes
>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

My friend,

May i suggest that you try an articulated (poly prop or GRP) moulded
supra-condylar thigh section. Velcro return fastenings should suffice.
This is acheived by casting the patient as you would for a weight
bearing KAFO and rectifying the cast proximally for the seating and
distaly for the supra-con suspension. The thigh section is
manufactured by draping or forming OVER the cast WITH the PTB section
already on it so that you get an overlap between the two sections.
Side steels/joints can then be incorporated to suit, though i have found
large swivels do the job nicely. This will provide excellent intimate
fitting and stabilisation and at the distal portion of the thigh piece
you will get a good supra-condylar suspension and thus may avoid having
to use any additional belts and straps etc.

I have used this method with success on difficult BK
fittings/suspensions, but have not tried it on a polio patient.

Best of luck...

--
Thomas Wickerson MBAPO