Posts to Ant. Distal Tibia/Silicone Liner Abrasion

Posts to Ant. Distal Tibia/Silicone Liner Abrasion

Arthur Sirdofsky Cpo

The following are responses to my original questions regarding the abrasion
of silicone liners
over prominent distal tibias:

rt,
  
 Use a silicone distal end cap before you don your silicone liner. I believe
Ossur has them, or try a company you are familiar with. Additionally a
flexible inner socket helps (I use proflex with silicone).
  
 Good Luck, Jake
  
  
 Jake R. Wood C.P., F.A.A.O.P.
Orthotics & Prosthetics Associates Inc.
10101 Innovation Dr., Suite 500
Milwaukee, WI 53226

Art,

I have fit several of the Freedom Innovations Evolution custom liners for
just this reason. What they will do is, theey can beef-up the silicone up
to15mm thick over a prominant distal tibia. I also have them beef it up over
patella tendon. This has been a real patient pleaser so far..... I had them
make one for me to start out. I wear a 9mm Alpha now , but I have all kinds
of boney prominances on residual limb from bone grafts 25 years ago. In my
mind this type of liner is one of my last resorts before having a revision
surgery done. So far I am very impressed.

Obviosly it seems that the prominant distal tibia is effected more when
locked in at far distal end with pin vs. a suction sleeve suspension. Has
this been your experience?

Let me know how it goes if you go this route.

Jeff A. Zeller, CP
Spectrum PandO
Redding, CA


> Does anyone have any suggestions for those patients with prominent
> anterior
> distal tibias, who
> are active and keep macerating the silicone gel in this area, causing
> ca

 have come across the problem often. I have in the past added a distal
silicone cup to be used inside the liner for additional cushioning. I have also
modified the socket more like a PTB with adequate pressure in the interosseous and
tibial flares to try to control excessive diatl motion. Make sure the liner
is not gapping anteriorly. Are you using a custom liner or prefab?
  
 Marshall
in the past we've done a flexible inner socket and cut a window out for that
area in the acrylic socket.
susan

Failure only occurs when you stop trying

 Arthur,
Patients with prominent distal tibias will usually show excessive wear in
the gel but I've successfully used distal roll on end caps as well as point
specific silicone to reduce the wear area considerably. Its important that
the casting is done without leaving too much of a relief at the distal tibia
because that can cause the pocket wear your getting. TSB sockets seem to
show the most wear at the prominences when you over correct.1/8 the
buildup is usually enough to preserve the liner. When I have someone who's
real tough I usually switch to a urethane liner (TEC) custom it allows me to
add material where I need it. The same can now be said for the Alpha custom
liners. If you need more info call me.
Carey Glass CPO FAAOP


we use alpha liners, and ... a flex & frame laminated socket keeping constant
pressure on the anterior distal tibia with the flexible frame, to prevent
movement, and the laminated socket is cut out at that point to allow the slight
motion to prevent breakdown during improper extention of the knee or heavy duty
use.  movement within the socket by the liner is typically what I have found
to break down the ant.dist. liner.....
 tonykorjagin, cp,lp,,,,,houston

 I assume you have tried the OWW Alpha cups and other similar products?  You
can have the client use mineral oil on the distal tibial area that is
calloused and use in conjunction with a liner with mineral oil in it (Alpha
spirit style) and this should alleviate some of the breakdown of gel.

Try calling Ray Francis, C.P. at OWW and getting his input - he's been very
helpful in solving some of my similar issues with clients.  Sometimes using
silicone buildups along the sides of the tibia can effectively push the
prominence back slightly thus reducing the rubbing.  Good luc

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