Responses To Shower/Swim Leg Over 250#

Responses To Shower/Swim Leg Over 250#

Joel Kempfer C.P.

Dear List,
 
Thanks to all who responded so promptly. I've received a number of options
which may work. Please see responses following my original post...
 
I made a call to Endolite regarding the Aqualeg and there is a 220# weight
restriction, and although some of the responses are practical, I'm not sure
I would take the risk liability-wise.
 
I have a patient who desires a prosthesis to wear in and around the health
club pool or beach. It must be completely watertight as he wants to
wade/swim
and yet be able to ambulate to and from his vehicle. He has a long
transtibial amputation and (the catch is); weighs just over 250#.

I am considering a hard carbon/acrylic socket with latex sleeve suspension
and direct-laminated Flex Foot Mod III. I would gladly entertain any other
creative solutions. This patient is also aware that insurance coverage is
not
available for this device.

I appreciate your attention to this query.

Joel Kempfer CP FAAOP
Kempfer P&O
Greenfield, WI
 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The problem I've found is trying to obtain an strong,easily adjustable
ankle in that weight range to allow plantar flexion for swimming and
dorsiflexion for walking. Active ankle may be adequate or possibly a Runway
foot from Freedom. There are a number of waterproof feet and endo
manufacturers available in that weight range from Otto Bock,OWW, Trulife,
and Ossur. I believe Ossur has endo systems up to 356 pounds.
 
We did a lot of these at Walter Reed We did an exo system with suction
suspension the Active Ankle and a Kingsley flatty foot. You drill holes in the
hollow exo shin section prox and distal to allow water to flow in and drain out
 as a buoyancy control. The active ankle can be locked in position for
ambulation then positioned in max plantar flexion for swimming. Added plus, you can
use the prosthesis for skiing or snow boarding in an un-locked position and
use the ski boots to control dorsi and plantar flexion. We had good success
with this system although there may be others.
 
freedom-innovations has swim ankel and afoot for 250 #
 
While the Mod III is a fantastic foot, you mentioned beach alongside
pool. How will you protect the carbon from the abrasive sand? I'd hate for the
patient to spend big time, and then passively grind his foot to pulp after
one beach trip. As such, I like the Seattle Lightfoot as a water foot.
Impervious to sand, and you can order them with keels accomodating your pt's
weight. Split toe accomodates sandals or (preferably) water shoes. Cheaper for
the patient, for sure. I drill drainage holes in the Seattle foot (the SACH
foot adapter is recessed some) to keep the hardware free from prolonged
immersion in (salt) water. With regard to the socket: Polypropylene would be fine
(maybe even preferable)...the key with the socket is the seal you achieve with
the sleeve. Undersize, if anything.


You can try a waterproof covering, if your client isn't picky about
cosmesis. There is one on the market called the stay dry pro pump (used to be
known as Xerosox). It is a rubber cover (comes in blue or beige) that goes over
the prosthesis and has a small hand pump that evacuates the air to create a
seal.
The advantage to this is that the individual does not have to switch
prostheses to go in the water, they don't need a special water-leg. They can
simply use the prosthesis they feel comfortable in everyday (hopefully) both in
and out of the water. I've used this with 4 individuals so far and only 1 has
rejected it (due to cosmesis). It is not, however, the best choice for someone
with compromised circulation. I am in no way affiliated with the company, I'm
 simply forwarding the link for you to check it out for yourself:
_ <URL Redacted> ( <URL Redacted>)
 
I have been very happy with the couple of Aqua Limbs from Endolite. Not sure
of the weight limit but the system seem very strong. My patients are very
pleased with the results. Good Luck.
 
Endolight makes a great water leg for this purpose and it is cheap. I am
not sure of the weight limit. Give them a call.
 
i have some ideas/experience for your swim leg. you could direct laminate a
t and then bolt on the mod three. making your life a lot easier. I have
done that and the bolts and embedded nuts in the t have held up fine. you could
just glue a sole ont he foot. i did an ak peg leg version of that for a
long time and it served me well. I used a cheetah which makes for an easier
roll over for an ak, if you can circumduct. currently i have a laminated male
pyramid on my water socket. i use a carbon tube and a c sprint foot with sole
glued on it. i have dripped wax over the distal pyramid screws. i have not
on the top because i change this set up out to just a knee pad like devie when
i knee board. if i go to the ocean i just spray everything down with wd40
after the day is over. at the end of the summer i just change all the screws
out before they set up for too long. throw all the old ones away and put new
ones in. it's not expensive and i get to do what i want to. the salt water
is really the only quick acting enemy. you'd be fine to do a lam t with only
two ss bolts to be exposed.
 
I would make him an exo socket and leg and laminate the foot in and later
cut out the heel. this allows him ti ambulate with a soft heel. What I am trying
 to say is laminate in a Sach foot and remove the lamination around the heel.
The patient can then wear a water shoe,
 
Regarding the water leg why don't you just do a socket replacement on one of
his old legs. Most carbon and titanium components are waterproof. I have
jumped in the water more than once with my prosthesis on walked out of the water
and kept on going. Of course this was in the old days before I wore a C-leg.
 
I am also a BK amputee, and a CP. I made myself a water leg a few years
ago, and it works great, it has been all over the world with me and on many
beaches, pools, etc. My leg is basically just a carbon socket, using a Comfort
liner, suction (no pin) with a suspension sleever to keep it on me. The foot is
a VariFlex foot, which I have glued some crepe sole on the bottom of the
carbon foot (no foot shell at all) and used the crepe to make the foot level
(3/8 heel build up). And then on the bottom of the crepe I attached a piece of
Vibram shoe soling, and then trimmed it all down to the size of a flip-flop
that I wear on my other foot. It works great, and I even use it sometimes
around the yard and other places when I wear flip flops (I havent figured out
how to get a flipflop to stay on a prosthetic foot, and keep it on
securely....so I just glued a piece of good vibram shoe sole on the carbon and got rid
of the foot shell). That has worked great, and has lasted me for about the
past 5 years with no problems.

I also offer to make a 2nd socket for my patients, after I get the new leg
finished, and I know that it fits them perfectly, I keep the check sockets
around for a while, and if they want the 2nd socket, I charge them about
$400 for the materials, components, etc. They have to provide some old foot
to use on it though. If they don't have an old foot that is any good, then
I offer them the opportunity to purchase a foot, like a seattle carbon foot,
or a seattle sach foot, or whatever they want to buy. The seattle sach foot
costs something like $80 I think, which also makes a good foot for a beach or
whatever. I have glued a piece of vibram shoe sole on one of these sach
feet before for a patient that likes to go barefoot around the house, beach,
pools, or wherever. I used super glue to attach the shoe sole to the foot. The
Seattle Sach foot looks pretty good as well, split toe, and all, and the
Carbon foot is also a good foot, but it costs a bit more, and I have had a few
patients that will pay for that as well.

I figure that I have made money by making the real leg for them, that was
the hard part, getting the check socket just perfect, etc. To make another
socket is easy, it just takes time and some materials. As an amputee, I
totally understand the NEED to have a backup, spare leg. I could not afford to
pay my prosthetist the $12,000 that he wanted to make me a spare leg to go to a
pool or anything. That was even after he charged me $14000 to make me a bk
prosthesis with a suction socket, low profile Springlite foot, etc. My
insurance paid for SOME of that cost, but I ended up choking out about $7,000 for
the one leg, and to spend another $12000 for a spare just was not going to
happen.
 
 
I am in the middle of making the exact same leg for the same person, but
50lbs heavier and 19 yrs old. We have chosen a carbon exoskeletal design as well
but not watertight as a buoyant leg will float and make him terribly off
balance in the pool. Instead we cut a 1/2 hole in the exoshell at the medial
ankle, just above the ankle block, and proximally medial to the end of the
socket. Consequently the calf section can fill up and drain quickly and
completely. We use either foam and then dremel it out or preferably the lost wax method
to empty the calf section.
 
In my experience a carbon foot is a bad idea as they tend to delaminate
after a short period of time when they are in regular contact with water. Water
may also void your warranty. Instead I have used a zero heel height Kingsley
foot, the strider?, made to the patients specs. I have also used Seattle
lightfoot II and waterproof SAFE feet (red keel). In this way, walking barefoot of
in sandals is not a problem. A foam ankle block from seattle limb systems
will so the trick to join the foot to the foot to the exoshell.
 
Silicone or Ziegleharz will work wonders to seal all of the potential areas
of water penetration.