Reply to Amputee Seeks Help
Description
Collection
Title:
Reply to Amputee Seeks Help
Date:
11/29/1999
Text:
Followup to Stacey Asby's request for assistance: Originally posted here
and on AMP-L
Wayne Renardson
-----------------------------------------------------------------------
Original request:
=================
Subject: BK Amputee Needs Advise
Sender: <Email Address Redacted>
< <Email Address Redacted> > Wayne Renardson
To: Amputee Information Network < <Email Address Redacted> >
As many of you know, I have been battling to get my new leg aligned for
almost a year. Unfortunately, the difference between the last two legs,
both of which took a similar amount of time to nail, by different
prosthetists, is that we are making no headway and we (me and the two
prosthetists who have worked on it) are equally frustrated and confused
about where to go from here.
I understand the difficulty trying to make suggestions without the
person in front of you, but in this case any SUGGESTIONS would be
welcome, whether on the list or privately, so I can answer questions
that may help you understand the situation. Here is the best description
I can offer.
I am R-BK. RL is 6 inches in length. At 5'4 + and about 110 lbs., I use
a total contact socket with a semi-supracondular support to minimize
movement.
The socket is snug to within 1-ply of sock and I am using an Alpha liner
(6mm) with pin, and finally, a silipos sleeve to minimize movement. The
movement I feel in the socket and in all planes of alignment is
immeasurable, with the closest increment less than 1/10 mm.
These increments off aren't tolerable because of a gap in the hips
(arthritis) plus some back problems in the L4-L5 region. (We are talking
Percosets after an hour or two of misaligned walking because the back
goes out!): Been there--done that, and AM NOT doing it again if at all
possible! :o)
The foot we are trying to get working is the Vari-flex for flexibility,
low maintenance, and cosmesis. According to my CP, the socket is aligned
about 1-1/2 inches anterior (forward) more than normal, and is also
about an inch inset more than normal.
This situation, apparently and seemingly contrary to the laws of physics
and prosthetics, has me feeling I am sitting sloped back on my heel and
that I have to fight somewhat to push UP TO the ball of the foot, at
which point I receive the response of the foot that I should, and then
fall over the toe. The foot is comprised of a cat. 4 with the thinnest
wedge in the heel and cat. 2 in the toe. We started at cat. 1 all the
way around, according to FF specs, and progressed to this because of my
very hard heel strike.
We also tried increasing the wedges in the heel, but lost all
responsiveness in the foot.
Now, trying to visualize this, so far, according to almost every CP who
has worked on this little problem to date (all very competent and
respected in their field), I respond the opposite to most normal
adjustments, for some reason. I can feel the slightest changes.
We have tried other feet during this process including: the College Park
(no response, heel too soft), Genesis 2 (same inflexibility to inclines
that my current set up has, which is a Seattle Lite foot with Endolite
ankle), the Chiles Campbell, and the Safe foot (very similar to the
college park).
All these feet resulted in me falling forward to the outside, or tilted
back, as I do on the Vari-flex, when attempting to align them. Oh yes,
and not that I think it has much relevancy to this issue, but the lack
of a good, working prosthesis for a year is putting additional stress on
my sound foot, which is in the beginning stages of the Charcot joint
disease (diabetes complication) which took the right foot, and the now
too-large socket of my current leg has caused an open area on the RL,
but I do have a lifetime of diabetes to contend with, which also causes
a bit of fluid retention in the limb.
So how many of you brave souls would like to have a crack at this
problem? In the words of Popeye, I've about had alls I can take!!
Oh yes: I am poor and have two small children, so the possible
suggestions can not include a requirement of large sums of money or
travel. :o)
So this means ask your amputee friends, colleagues, technicians,
prosthetists, and pets if you think of a possible solution or if you've
resolved a similar problem yourself, please!! :o)
Stacey Asby
-----------------------------------------------------------------------
Several months ago I posted a plea for help in resolving a year-long
problem which concerned finding a prosthetic foot for my RBK limb. While
I received many suggestions and was privileged to discuss the situation
with very patient persons, it seemed obvious over time that my only
solution was going to be found in person---where someone could observe
the various and unusual responses to adjustments in alignment. As
promised to all who responded to me, I am posting the final solution
which finally has me walking again in a comfortable alignment.
The socket was finally imaged using a CAD/CAM, tracing my previous
socket, only sizing it down by the 10 ply difference in size, and NOT
trying to lock in by contouring in around the bones of the RL. We also
left the semi-supracondular brim to the socket. This worked wonderfully
with the 6 mm Alpha liner and shuttle lock and the Silipos sleeve over
top for final minimization of movement.
The Vari-flex foot, despite the wonderful responsiveness, seemed
impossible to align, and we finally decided to try a Seattle Voyager
foot after my CP spoke with some colleagues. He evaluated the heel to be
too soft to even warrant a try, and we opted to try the Century XXII
Total Concept foot, which I requested to try that same week. I have been
looking at this foot since its inception, but have avoided it due to the
controversy about being able to cover the components cosmetically and it
being classified as a low impact foot.
The foot is IDEAL for someone having similar problems as myself. It took
us less than 30 mins. to align nearly perfectly, (also bringing it much
closer to a more normal center on the socket once again) and I was able
to make small adjustments at home with a 4 mm wrench. The foot comes
across as very user friendly and, according to my CP, is also very
simple and efficient to adjust in house. He was astounded at the lack of
time in which we were able to align the foot after everything we'd been
through as well.
I found very quickly that not only could I adjust the alignment of the
foot as normally would be done, but also by using the push button heel
adjustment I could alter the feel of the alignment and the load of the
foot and hence the responsiveness of the foot which also affects my
alignment perception. There are three bumper settings in the front and
heel of the foot respectively, and after starting in the middle, I opted
to have the bumpers switched now using the softest bumper in the front
foot and the stiffest bumper in the heel. This gives me the strength and
balance I need in the heel, being that my sound foot is not very stable,
and it gave me the flexibility in the toe I need to ascend inclines well
enough.
Uneven terrain was very impressive so far as the response of the
foot. I walked over heavy gravel (previously one of the worst terrains
for me) only two days after getting the foot and walked as though I were
on regular pavement. Climbing up slopes was not a problem for my
prosthetic foot as near as I could assess due to the difficulty I was
having with the sound foot due to the tight heel cord and drop foot on
that side.
Now the less important qualities, technically speaking? The ability and
reliability of the Total Concept's claim to fame: the ability to adjust
heel heights and still walk normally. LOL! Now you know I HAD to test
this to the maximum!? =) Wonderful!!! I can now switch to flat shoes
(that's right folks, you can wear those slippers around the house again)
and then to 3 inch heels and have no problem walking or getting
responsiveness from the foot. (other than the muscles in my ankle which
haven't been used for this in too many years and will need to be
rebuilt) As I said, this feature has also been extremely helpful in
adjusting the alignment on a daily basis as the heel cord tightness on
the sound side seems to effect the response of my prosthetic foot in
feeling balanced and even height-wise on both sides with the difference
in the roll over of the foot varying on each side. I can adjust the heel
slightly to vary or compensate for this.
Cosmetically, the foot was a bit of a challenge. The foot shell
is obviously a Kingsley, which is rarely seen, and which in women's
shoes works extremely well with a narrow ball and toes formation. While
it doesn't match my sound foot nearly as well as the Seattle lite foot,
it does work far better in shoes! Cosmesis was done by sculpting a
stiffer foam over the leg, except for the ankle area, which moves. Here
we used a soft foam and carefully blended the edges while having the
foot set to the most used heel height, which is 3/4 of inch. Then a
stocking and the new stretchier spray-on skin was used. Finally the
paint was matched and airbrushed as usual, while toes were hand painted
and we applied a beauty mark to center the button for heel adjustments
due to reduced feeling in my fingertips from neuropathy.
When adjusting the heel there is a slight wrinkling in the cosmesis, but
nothing that obvious unless searching for it. The paint is holding up to
the adjustments as well, except for the button area, where the skin is
lightening up already. I haven't yet tried it, but think a little of
that difficult to remove type color stay makeup can be applied to
cover and actually stain the wear spot if it gets obvious enough. For
the first time in about 6 years I've been able to wear sneakers
comfortably without umpteen shims in both shoes, and walk on a pair of
heels to dress, and all only takes a minute to adjust and maybe one or
two more after taking steps to feel out the response. My continually
fluctuating alignments are tolerably compensated for by adjusting the
heel as well. The cosmesis was even put to test when visiting a new
doctor unfamiliar with my amputation. Routinely, she attempted to check
pulses in BOTH legs. LOL! The true sign of a good leg guy! :o)
I think this is an outstanding foot, in particular for women and quite
frankly the only improvement I could foresee in the foot would be
devising a way to develop a cosmetic split toe to allow thong type
sandals without compromising the safety of the foot. Great job Century
XXII, and I will be living testimony to resolve the debate about the
ability to cover the foot well! Prosthetists: I think this is an
excellent option for your difficult to align clients/patients, in
particular those with foot problems on the sound side which make
matching gaits and balancing planes difficult.
Thanks again to all who responded in the past with their attempts to
assist. :o) While the fluctuation is RL size is still an ongoing battle
with the diabetes, this makes other aspects of the prosthesis much
easier to compensate and cope with! Ladies who have been asking, there
is the final evaluation to date on this foot. Give it a try! While
everyone's needs and responses are different, I don't think too many, if
any, will be disappointed with this foot!
Sincerely,
Stacey Asby
RBK 1/29/96 due to Charcot Joint Disease
(Yet another complication of diabetes)
Amputee Foundation of Greater Atlanta-North
------------------------------------------------------------------------
********************
OANDP-L is a forum for the discussion of topics related to Orthotics and
Prosthetics.
Public commercial postings are forbidden. Responses to inquiries of a
commercial nature should not be sent to the entire oandp-l list. Responses
should be collected and reposted by the person asking the question.
Send a message to the list by sending to: <Email Address Redacted> To unsubscribe,
send a message to: <Email Address Redacted> with the words UNSUB OANDP-L in the body of the
message. All postings related to US-politics must use a subject line
starting with US-Politics:
Any questions should be directed to Paul E. Prusakowski, CPO at
<Email Address Redacted>
and on AMP-L
Wayne Renardson
-----------------------------------------------------------------------
Original request:
=================
Subject: BK Amputee Needs Advise
Sender: <Email Address Redacted>
< <Email Address Redacted> > Wayne Renardson
To: Amputee Information Network < <Email Address Redacted> >
As many of you know, I have been battling to get my new leg aligned for
almost a year. Unfortunately, the difference between the last two legs,
both of which took a similar amount of time to nail, by different
prosthetists, is that we are making no headway and we (me and the two
prosthetists who have worked on it) are equally frustrated and confused
about where to go from here.
I understand the difficulty trying to make suggestions without the
person in front of you, but in this case any SUGGESTIONS would be
welcome, whether on the list or privately, so I can answer questions
that may help you understand the situation. Here is the best description
I can offer.
I am R-BK. RL is 6 inches in length. At 5'4 + and about 110 lbs., I use
a total contact socket with a semi-supracondular support to minimize
movement.
The socket is snug to within 1-ply of sock and I am using an Alpha liner
(6mm) with pin, and finally, a silipos sleeve to minimize movement. The
movement I feel in the socket and in all planes of alignment is
immeasurable, with the closest increment less than 1/10 mm.
These increments off aren't tolerable because of a gap in the hips
(arthritis) plus some back problems in the L4-L5 region. (We are talking
Percosets after an hour or two of misaligned walking because the back
goes out!): Been there--done that, and AM NOT doing it again if at all
possible! :o)
The foot we are trying to get working is the Vari-flex for flexibility,
low maintenance, and cosmesis. According to my CP, the socket is aligned
about 1-1/2 inches anterior (forward) more than normal, and is also
about an inch inset more than normal.
This situation, apparently and seemingly contrary to the laws of physics
and prosthetics, has me feeling I am sitting sloped back on my heel and
that I have to fight somewhat to push UP TO the ball of the foot, at
which point I receive the response of the foot that I should, and then
fall over the toe. The foot is comprised of a cat. 4 with the thinnest
wedge in the heel and cat. 2 in the toe. We started at cat. 1 all the
way around, according to FF specs, and progressed to this because of my
very hard heel strike.
We also tried increasing the wedges in the heel, but lost all
responsiveness in the foot.
Now, trying to visualize this, so far, according to almost every CP who
has worked on this little problem to date (all very competent and
respected in their field), I respond the opposite to most normal
adjustments, for some reason. I can feel the slightest changes.
We have tried other feet during this process including: the College Park
(no response, heel too soft), Genesis 2 (same inflexibility to inclines
that my current set up has, which is a Seattle Lite foot with Endolite
ankle), the Chiles Campbell, and the Safe foot (very similar to the
college park).
All these feet resulted in me falling forward to the outside, or tilted
back, as I do on the Vari-flex, when attempting to align them. Oh yes,
and not that I think it has much relevancy to this issue, but the lack
of a good, working prosthesis for a year is putting additional stress on
my sound foot, which is in the beginning stages of the Charcot joint
disease (diabetes complication) which took the right foot, and the now
too-large socket of my current leg has caused an open area on the RL,
but I do have a lifetime of diabetes to contend with, which also causes
a bit of fluid retention in the limb.
So how many of you brave souls would like to have a crack at this
problem? In the words of Popeye, I've about had alls I can take!!
Oh yes: I am poor and have two small children, so the possible
suggestions can not include a requirement of large sums of money or
travel. :o)
So this means ask your amputee friends, colleagues, technicians,
prosthetists, and pets if you think of a possible solution or if you've
resolved a similar problem yourself, please!! :o)
Stacey Asby
-----------------------------------------------------------------------
Several months ago I posted a plea for help in resolving a year-long
problem which concerned finding a prosthetic foot for my RBK limb. While
I received many suggestions and was privileged to discuss the situation
with very patient persons, it seemed obvious over time that my only
solution was going to be found in person---where someone could observe
the various and unusual responses to adjustments in alignment. As
promised to all who responded to me, I am posting the final solution
which finally has me walking again in a comfortable alignment.
The socket was finally imaged using a CAD/CAM, tracing my previous
socket, only sizing it down by the 10 ply difference in size, and NOT
trying to lock in by contouring in around the bones of the RL. We also
left the semi-supracondular brim to the socket. This worked wonderfully
with the 6 mm Alpha liner and shuttle lock and the Silipos sleeve over
top for final minimization of movement.
The Vari-flex foot, despite the wonderful responsiveness, seemed
impossible to align, and we finally decided to try a Seattle Voyager
foot after my CP spoke with some colleagues. He evaluated the heel to be
too soft to even warrant a try, and we opted to try the Century XXII
Total Concept foot, which I requested to try that same week. I have been
looking at this foot since its inception, but have avoided it due to the
controversy about being able to cover the components cosmetically and it
being classified as a low impact foot.
The foot is IDEAL for someone having similar problems as myself. It took
us less than 30 mins. to align nearly perfectly, (also bringing it much
closer to a more normal center on the socket once again) and I was able
to make small adjustments at home with a 4 mm wrench. The foot comes
across as very user friendly and, according to my CP, is also very
simple and efficient to adjust in house. He was astounded at the lack of
time in which we were able to align the foot after everything we'd been
through as well.
I found very quickly that not only could I adjust the alignment of the
foot as normally would be done, but also by using the push button heel
adjustment I could alter the feel of the alignment and the load of the
foot and hence the responsiveness of the foot which also affects my
alignment perception. There are three bumper settings in the front and
heel of the foot respectively, and after starting in the middle, I opted
to have the bumpers switched now using the softest bumper in the front
foot and the stiffest bumper in the heel. This gives me the strength and
balance I need in the heel, being that my sound foot is not very stable,
and it gave me the flexibility in the toe I need to ascend inclines well
enough.
Uneven terrain was very impressive so far as the response of the
foot. I walked over heavy gravel (previously one of the worst terrains
for me) only two days after getting the foot and walked as though I were
on regular pavement. Climbing up slopes was not a problem for my
prosthetic foot as near as I could assess due to the difficulty I was
having with the sound foot due to the tight heel cord and drop foot on
that side.
Now the less important qualities, technically speaking? The ability and
reliability of the Total Concept's claim to fame: the ability to adjust
heel heights and still walk normally. LOL! Now you know I HAD to test
this to the maximum!? =) Wonderful!!! I can now switch to flat shoes
(that's right folks, you can wear those slippers around the house again)
and then to 3 inch heels and have no problem walking or getting
responsiveness from the foot. (other than the muscles in my ankle which
haven't been used for this in too many years and will need to be
rebuilt) As I said, this feature has also been extremely helpful in
adjusting the alignment on a daily basis as the heel cord tightness on
the sound side seems to effect the response of my prosthetic foot in
feeling balanced and even height-wise on both sides with the difference
in the roll over of the foot varying on each side. I can adjust the heel
slightly to vary or compensate for this.
Cosmetically, the foot was a bit of a challenge. The foot shell
is obviously a Kingsley, which is rarely seen, and which in women's
shoes works extremely well with a narrow ball and toes formation. While
it doesn't match my sound foot nearly as well as the Seattle lite foot,
it does work far better in shoes! Cosmesis was done by sculpting a
stiffer foam over the leg, except for the ankle area, which moves. Here
we used a soft foam and carefully blended the edges while having the
foot set to the most used heel height, which is 3/4 of inch. Then a
stocking and the new stretchier spray-on skin was used. Finally the
paint was matched and airbrushed as usual, while toes were hand painted
and we applied a beauty mark to center the button for heel adjustments
due to reduced feeling in my fingertips from neuropathy.
When adjusting the heel there is a slight wrinkling in the cosmesis, but
nothing that obvious unless searching for it. The paint is holding up to
the adjustments as well, except for the button area, where the skin is
lightening up already. I haven't yet tried it, but think a little of
that difficult to remove type color stay makeup can be applied to
cover and actually stain the wear spot if it gets obvious enough. For
the first time in about 6 years I've been able to wear sneakers
comfortably without umpteen shims in both shoes, and walk on a pair of
heels to dress, and all only takes a minute to adjust and maybe one or
two more after taking steps to feel out the response. My continually
fluctuating alignments are tolerably compensated for by adjusting the
heel as well. The cosmesis was even put to test when visiting a new
doctor unfamiliar with my amputation. Routinely, she attempted to check
pulses in BOTH legs. LOL! The true sign of a good leg guy! :o)
I think this is an outstanding foot, in particular for women and quite
frankly the only improvement I could foresee in the foot would be
devising a way to develop a cosmetic split toe to allow thong type
sandals without compromising the safety of the foot. Great job Century
XXII, and I will be living testimony to resolve the debate about the
ability to cover the foot well! Prosthetists: I think this is an
excellent option for your difficult to align clients/patients, in
particular those with foot problems on the sound side which make
matching gaits and balancing planes difficult.
Thanks again to all who responded in the past with their attempts to
assist. :o) While the fluctuation is RL size is still an ongoing battle
with the diabetes, this makes other aspects of the prosthesis much
easier to compensate and cope with! Ladies who have been asking, there
is the final evaluation to date on this foot. Give it a try! While
everyone's needs and responses are different, I don't think too many, if
any, will be disappointed with this foot!
Sincerely,
Stacey Asby
RBK 1/29/96 due to Charcot Joint Disease
(Yet another complication of diabetes)
Amputee Foundation of Greater Atlanta-North
------------------------------------------------------------------------
********************
OANDP-L is a forum for the discussion of topics related to Orthotics and
Prosthetics.
Public commercial postings are forbidden. Responses to inquiries of a
commercial nature should not be sent to the entire oandp-l list. Responses
should be collected and reposted by the person asking the question.
Send a message to the list by sending to: <Email Address Redacted> To unsubscribe,
send a message to: <Email Address Redacted> with the words UNSUB OANDP-L in the body of the
message. All postings related to US-politics must use a subject line
starting with US-Politics:
Any questions should be directed to Paul E. Prusakowski, CPO at
<Email Address Redacted>
Citation
“Reply to Amputee Seeks Help,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/212429.
