Responses: Stubbie Prostheses
Paul Rieth
Description
Collection
Title:
Responses: Stubbie Prostheses
Creator:
Paul Rieth
Date:
10/21/2003
Text:
Many thanks to all who responded. The replies were very helpful. Below is the initial inquiry followed by the responses:
Initial Inquiry:
I am interested in hearing from practitioners who have had experience in fitting stubbie prostheses, or patients who wear them. I currently have a patient who is a good candidate for them, physically and psychologically. Both residual limbs are short. My question deals with ADL's vs. energy expenditure: Has anyone found any functional benefit in increasing the height of stubbies, i.e. with modular componentry and Sach feet, versus simply fabricating wide, mild rocker bottom crepe soles directly onto the sockets? My thinking is if the stubbies are lengthened, say 6, this would further assist the patient with transfers, toileting, reaching objects on tables, etc... On the other hand, by doing this, does it create any considerable negative consequences, i.e. increased energy expenditure, decreased balance, increased difficulty going from sitting to standing?
Responses:
I don't have much experience with stubbies, but last year I did see a
younger lady in Chicago walking with stubbies with Sach feet turned
backwards and they were attached to pylons. So she was up a good bit off
the ground. Enough to push a small cart.
―-------------------------------------------------------------------------------
We tried lengthening the stubbies and found that the patients tend to fall like a tree if they lose their balance. The shorter they are, the less traumatic the fall is to the patient. They are really just for training and used as a prepatory prosthesis until it is determined if they are doing well enough for permanent prosthesis.
―-------------------------------------------------------------------------------
If you install locking knee units, it also allows the feet to fold down,
thereby allowing the patient to sit closer to tables, steering wheel, etc.
―-------------------------------------------------------------------------------
There are as many variations of stubbies as there are amputees.
I've fitted several types: for very short limbs add pylon height to see which is the best functional level for your patient. The socket style is extremely critical. I mean prevention of pinching in the peroneal area. Though I only ever fit Ischial Containment sockets, quads may work as well....................Liners with pins and-or suction are an option as is the use of a custom silesian or TES belt. I know of 2 amputees who have worn stubbies for 20 or so years very functionally. One uses (Seattle lite) feet with torque absorbers and the other custom pads with soling rubber.
―-----------------------------------------------------------------------------------
Think rocker bottoms for feet. Much less energy used. Place sockets
forward of center line.
―----------------------------------------------------------------------------------
Seems to me the goal would be to lengthen to a point to ad a free swing knee
and a manual lock knee. the free knee should not have any sort of stance
control. I would start with a polycentric knee.
―----------------------------------------------------------------------------------
In my experience with stubbies it is generally advisable to have enough
height to be able to function at counter top height and also to have enough height
to be able to get in and out of a chair, so the ischial height should be at
least 18. Although there are energy studies that look at stubbies vs full
length prostheses, I don't know of any that have compared stubbies of differing heights.
―------------------------------------------------------------------------------------
As far as Sach feet vs rockers either can work. The Sach feet can be either
rearward facing or normally positioned. If there is enough distance between
the sockets and feet to shift them sufficiently posterior than forward facing
feet may be preferred for definitive use. In order to minimize lumbar
lordosis, there needs to be sufficient socket flexion AND sufficient posterior lever
arm. Rocker feet may also be used. One suggestion I have regarding the
rockers is to make the radius of the sole on an arc that is centered at the hip.
If you do use endoskeletal construction you may try torque absorbers, there is a lot of twisting involved in ambulation with stubbies.
―---------------------------------------------------------------------------------------------
What I have done in the past is fabricate endoskeletal stubbies that have the
option of lengthening and even the addition of prosthetic knees if that
becomes a future option. I've had patients that wore the stubbies around the house,
once seated in their wheelchair to go outside used a 4mm wrench to disconnect
the feet, then attached the sockets to cosmetically finished prostheses from
the knee distal. O f course energy consumption is greater the longer the
prostheses especially with short residiums. An option might be to use a child's
step stool to climb to toilet, bed ,etc.
―----------------------------------------------------------------------------------------
You might want to give Wendy Beatty from Becker a call. She recently
fit a pair of Freedom Innovations FS-2000 feet as a pair of stubbies,
and had excellent results.
END RESPONSES-------------------------------------------------------------------
Initial Inquiry:
I am interested in hearing from practitioners who have had experience in fitting stubbie prostheses, or patients who wear them. I currently have a patient who is a good candidate for them, physically and psychologically. Both residual limbs are short. My question deals with ADL's vs. energy expenditure: Has anyone found any functional benefit in increasing the height of stubbies, i.e. with modular componentry and Sach feet, versus simply fabricating wide, mild rocker bottom crepe soles directly onto the sockets? My thinking is if the stubbies are lengthened, say 6, this would further assist the patient with transfers, toileting, reaching objects on tables, etc... On the other hand, by doing this, does it create any considerable negative consequences, i.e. increased energy expenditure, decreased balance, increased difficulty going from sitting to standing?
Responses:
I don't have much experience with stubbies, but last year I did see a
younger lady in Chicago walking with stubbies with Sach feet turned
backwards and they were attached to pylons. So she was up a good bit off
the ground. Enough to push a small cart.
―-------------------------------------------------------------------------------
We tried lengthening the stubbies and found that the patients tend to fall like a tree if they lose their balance. The shorter they are, the less traumatic the fall is to the patient. They are really just for training and used as a prepatory prosthesis until it is determined if they are doing well enough for permanent prosthesis.
―-------------------------------------------------------------------------------
If you install locking knee units, it also allows the feet to fold down,
thereby allowing the patient to sit closer to tables, steering wheel, etc.
―-------------------------------------------------------------------------------
There are as many variations of stubbies as there are amputees.
I've fitted several types: for very short limbs add pylon height to see which is the best functional level for your patient. The socket style is extremely critical. I mean prevention of pinching in the peroneal area. Though I only ever fit Ischial Containment sockets, quads may work as well....................Liners with pins and-or suction are an option as is the use of a custom silesian or TES belt. I know of 2 amputees who have worn stubbies for 20 or so years very functionally. One uses (Seattle lite) feet with torque absorbers and the other custom pads with soling rubber.
―-----------------------------------------------------------------------------------
Think rocker bottoms for feet. Much less energy used. Place sockets
forward of center line.
―----------------------------------------------------------------------------------
Seems to me the goal would be to lengthen to a point to ad a free swing knee
and a manual lock knee. the free knee should not have any sort of stance
control. I would start with a polycentric knee.
―----------------------------------------------------------------------------------
In my experience with stubbies it is generally advisable to have enough
height to be able to function at counter top height and also to have enough height
to be able to get in and out of a chair, so the ischial height should be at
least 18. Although there are energy studies that look at stubbies vs full
length prostheses, I don't know of any that have compared stubbies of differing heights.
―------------------------------------------------------------------------------------
As far as Sach feet vs rockers either can work. The Sach feet can be either
rearward facing or normally positioned. If there is enough distance between
the sockets and feet to shift them sufficiently posterior than forward facing
feet may be preferred for definitive use. In order to minimize lumbar
lordosis, there needs to be sufficient socket flexion AND sufficient posterior lever
arm. Rocker feet may also be used. One suggestion I have regarding the
rockers is to make the radius of the sole on an arc that is centered at the hip.
If you do use endoskeletal construction you may try torque absorbers, there is a lot of twisting involved in ambulation with stubbies.
―---------------------------------------------------------------------------------------------
What I have done in the past is fabricate endoskeletal stubbies that have the
option of lengthening and even the addition of prosthetic knees if that
becomes a future option. I've had patients that wore the stubbies around the house,
once seated in their wheelchair to go outside used a 4mm wrench to disconnect
the feet, then attached the sockets to cosmetically finished prostheses from
the knee distal. O f course energy consumption is greater the longer the
prostheses especially with short residiums. An option might be to use a child's
step stool to climb to toilet, bed ,etc.
―----------------------------------------------------------------------------------------
You might want to give Wendy Beatty from Becker a call. She recently
fit a pair of Freedom Innovations FS-2000 feet as a pair of stubbies,
and had excellent results.
END RESPONSES-------------------------------------------------------------------
Citation
Paul Rieth, “Responses: Stubbie Prostheses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/221966.
