transtibial amputee
Skewes, Ed
Description
Collection
Title:
transtibial amputee
Creator:
Skewes, Ed
Date:
11/16/2005
Text:
From: Skewes, Ed
Sent: Wednesday, November 16, 2005 10:18 AM
To: <Email Address Redacted>
Subject: transtibial amputee
Good Morning to all,
First, I would like to thank Paul for this incredible ability to interact with so many practitioners.
Next, I thank those that responded and have copied the initial responses below.
Have a great week!
Ed
Ps
The patient has been to the dermatologist to rule out ring worm and fungal infection. We were using a plastazote end pad prior to using the lambs wool. The lambs wool is used once, thrown away and changed daily. We suspect that perspiration and friction are major factors in this scenario.
We have many patients that use a variety of liners, alpha, ossur, tech, etc. Have yet to use one this patient.
Photos of residual limb as not allowed on the list serve.
Will let you know what happens.
Initial post-
Good afternoon,
> Appreciate your comments on a very active 9 y.o. female, Dx streeters dysplasia
> Unilateral transtibial amputee, very tapered and prominent tibia (but rounded) distal end of the residual limb
> Knee circumference of 29.2 cm (11 ½ inches) MTP to distal end 11 cm (4 3/8 inches)
> Using conventional PTBSC prosthesis with Bock lite liner (distal liner is perforated), Royal knit Soft Socks and 1K10 foot
> Distal end pads vary from custom made to lambs wool. (currently changing out lambs wool daily)
> Patient periodically has rash on the distal aspect of the residual limb at the level of the distal end pad.
> Sometimes the rash appears in 1 cm circular patterns (not ring worm) and other times it is a reddish circumferential ring around the entire distal end.
> Parents using lotion on residual limb at night, but sometimes skin gets small cracks (because it dries out overnight - making it uncomfortable to don in the morning)
> Have ordered silicone distal end pads to replace lambs wool, and Otto bock derma skin care and socket cleaning products, etc.
> Any other suggestions?
> Think a custom liner would solve the skin problems or aggravate it further?
> Also considering Rx for drysol to reduce perspiration which is sometimes excessive.
> Thank you,
> Ed Skewes
Responses -
You might want to try calling Ohio Willow Wood and checking into a design liner. It's pretty new with the tracer cad T-ring. The local rep is Wayne Fitchel? It seems to be able to accomodate various shapes. I can't remember if it has pediatric applications at this time, but I'm pretty sure it does. If so, it could be really neat for the guys and girls to see the demo process if they can set it up for you. When I was at the course, they were using the design liners for symes amputees quite successfully without expandable wall sockets or pelite liners. The concept was interesting.
This sounds like socket design issue. Pictures would tell help confirm. I have fit many children with traumatic as well as congenital anomalies that developed into the tapered shape you describe. If the Ertl surgery were performed, the tapering [especially at this age] would change to cylindrical, increase in size, and be easier to design a socket for.
There is a Prosthetist in Michigan, who I fit as a youth, had several tibial/fibular resections due to overgrowth, graduated high school, worked for me as a technician, then had Ertl Reconstruction amputation surgery. The result was increased surface area of his residual-limb, with end-bearing capability to boot! He pursued a career as a Clinical Prosthetist.
To answer you question now - a custom liner from Freedom or Otto Bock [their custom profile - same as for a vacuum design] I believe will be extremely beneficial. The socket fit for this child is crucial - maximizing TOTAL-SURFACE-BEARING Concept = applying loads as tissues can tolerate, and they will increase in tolerance when you begin to apply it gradually over the entire surface of her RL.
Consider a Dermatology appointment as the irritations could be fungal in nature.....The MD will know what is best...Hopefully
Ed-Suggestion: keep everything the same but one; Instead of using a cream or lotion have her bathe and then apply vaseline or other nonmedicated, nonperfumed, noncolored moisturizing agent on the distal aspect. Try for 3 to 4 days and examine. I have seen just a few situations of allergic reaction to skin softeners in the environment of a prosthesis.
If this does not help then I would look at the negative pressure during swing as another possible factor.
Question-what is a perforated liner, I am not familiar with system.
The girl with the distal end rash problem might be getting it from an excess of perspiration on the distal end relative to the whole residual limb. The perforated distal end might be allowing her to perspire there because there is some where for the sweat to go - into the holes. The proximal portion, being solid, might be retarding sweating in this area as well as keeping the pooling sweat in the distal portion from wicking proximally and evaporating. See if the reddish circumferential ring around her residual limb corresponds with the level of the perforated end of her liner. If so, try making her a liner with perforations over its entire surface. They have been working well for the kids in the Springfield Shriner's Hospital who have had perspiration problems. Contact me or Steve Thomson if you have questions about fabricating the liners.
Not really a prosthetic suggestion, but my one daughter has terribly dry skin. It becomes intolerable with the dry, cold winters here in Chicago. The best solution we have found is schmearing a large amount of Vaseline on the hands before bed and then donning cotton gloves or socks. We apply such a large amount of the jelly to keep the cotton gloves from wiping it off in the donning process. If we do this consistently her hands are crack and pain free. If we slack off a night or two it returns. The condition is very weather related.
Consider a fungal infection. It sure sounds a lot like one. Gel liners seem like a good idea to me after the possible fungal infection clears up. Over the counter fungal treatments work, however shouldn't the family have seen their doctor for this already? Or make an appointment?
I don't see why people use lambs wool anymore. The potential for harboring infection is significant.
CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients. If you are not the intended recipient, (or authorized to receive for the recipient) you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please destroy all copies of this communication and any attachments and contact the sender by reply e-mail or telephone (813) 281-0300.
Sent: Wednesday, November 16, 2005 10:18 AM
To: <Email Address Redacted>
Subject: transtibial amputee
Good Morning to all,
First, I would like to thank Paul for this incredible ability to interact with so many practitioners.
Next, I thank those that responded and have copied the initial responses below.
Have a great week!
Ed
Ps
The patient has been to the dermatologist to rule out ring worm and fungal infection. We were using a plastazote end pad prior to using the lambs wool. The lambs wool is used once, thrown away and changed daily. We suspect that perspiration and friction are major factors in this scenario.
We have many patients that use a variety of liners, alpha, ossur, tech, etc. Have yet to use one this patient.
Photos of residual limb as not allowed on the list serve.
Will let you know what happens.
Initial post-
Good afternoon,
> Appreciate your comments on a very active 9 y.o. female, Dx streeters dysplasia
> Unilateral transtibial amputee, very tapered and prominent tibia (but rounded) distal end of the residual limb
> Knee circumference of 29.2 cm (11 ½ inches) MTP to distal end 11 cm (4 3/8 inches)
> Using conventional PTBSC prosthesis with Bock lite liner (distal liner is perforated), Royal knit Soft Socks and 1K10 foot
> Distal end pads vary from custom made to lambs wool. (currently changing out lambs wool daily)
> Patient periodically has rash on the distal aspect of the residual limb at the level of the distal end pad.
> Sometimes the rash appears in 1 cm circular patterns (not ring worm) and other times it is a reddish circumferential ring around the entire distal end.
> Parents using lotion on residual limb at night, but sometimes skin gets small cracks (because it dries out overnight - making it uncomfortable to don in the morning)
> Have ordered silicone distal end pads to replace lambs wool, and Otto bock derma skin care and socket cleaning products, etc.
> Any other suggestions?
> Think a custom liner would solve the skin problems or aggravate it further?
> Also considering Rx for drysol to reduce perspiration which is sometimes excessive.
> Thank you,
> Ed Skewes
Responses -
You might want to try calling Ohio Willow Wood and checking into a design liner. It's pretty new with the tracer cad T-ring. The local rep is Wayne Fitchel? It seems to be able to accomodate various shapes. I can't remember if it has pediatric applications at this time, but I'm pretty sure it does. If so, it could be really neat for the guys and girls to see the demo process if they can set it up for you. When I was at the course, they were using the design liners for symes amputees quite successfully without expandable wall sockets or pelite liners. The concept was interesting.
This sounds like socket design issue. Pictures would tell help confirm. I have fit many children with traumatic as well as congenital anomalies that developed into the tapered shape you describe. If the Ertl surgery were performed, the tapering [especially at this age] would change to cylindrical, increase in size, and be easier to design a socket for.
There is a Prosthetist in Michigan, who I fit as a youth, had several tibial/fibular resections due to overgrowth, graduated high school, worked for me as a technician, then had Ertl Reconstruction amputation surgery. The result was increased surface area of his residual-limb, with end-bearing capability to boot! He pursued a career as a Clinical Prosthetist.
To answer you question now - a custom liner from Freedom or Otto Bock [their custom profile - same as for a vacuum design] I believe will be extremely beneficial. The socket fit for this child is crucial - maximizing TOTAL-SURFACE-BEARING Concept = applying loads as tissues can tolerate, and they will increase in tolerance when you begin to apply it gradually over the entire surface of her RL.
Consider a Dermatology appointment as the irritations could be fungal in nature.....The MD will know what is best...Hopefully
Ed-Suggestion: keep everything the same but one; Instead of using a cream or lotion have her bathe and then apply vaseline or other nonmedicated, nonperfumed, noncolored moisturizing agent on the distal aspect. Try for 3 to 4 days and examine. I have seen just a few situations of allergic reaction to skin softeners in the environment of a prosthesis.
If this does not help then I would look at the negative pressure during swing as another possible factor.
Question-what is a perforated liner, I am not familiar with system.
The girl with the distal end rash problem might be getting it from an excess of perspiration on the distal end relative to the whole residual limb. The perforated distal end might be allowing her to perspire there because there is some where for the sweat to go - into the holes. The proximal portion, being solid, might be retarding sweating in this area as well as keeping the pooling sweat in the distal portion from wicking proximally and evaporating. See if the reddish circumferential ring around her residual limb corresponds with the level of the perforated end of her liner. If so, try making her a liner with perforations over its entire surface. They have been working well for the kids in the Springfield Shriner's Hospital who have had perspiration problems. Contact me or Steve Thomson if you have questions about fabricating the liners.
Not really a prosthetic suggestion, but my one daughter has terribly dry skin. It becomes intolerable with the dry, cold winters here in Chicago. The best solution we have found is schmearing a large amount of Vaseline on the hands before bed and then donning cotton gloves or socks. We apply such a large amount of the jelly to keep the cotton gloves from wiping it off in the donning process. If we do this consistently her hands are crack and pain free. If we slack off a night or two it returns. The condition is very weather related.
Consider a fungal infection. It sure sounds a lot like one. Gel liners seem like a good idea to me after the possible fungal infection clears up. Over the counter fungal treatments work, however shouldn't the family have seen their doctor for this already? Or make an appointment?
I don't see why people use lambs wool anymore. The potential for harboring infection is significant.
CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients. If you are not the intended recipient, (or authorized to receive for the recipient) you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please destroy all copies of this communication and any attachments and contact the sender by reply e-mail or telephone (813) 281-0300.
Citation
Skewes, Ed, “transtibial amputee,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/225772.
