Foot recommendations for bilateral TT amputee - summary

Foot recommendations for bilateral TT amputee - summary

Brad van Lenthe

3/23/2010

Original Post:
Hi all, I am wondering what feet people like using for their older
clients with bilateral TransTibial amputations. The client in
question is a motivated 60 year old who was wearing a SureFlex before
loosing the second leg (both due to PVD). He was doing well with the
Sureflex, but I'm not sure it would be the best script for him now
that he needs two. The majority of his walking will be flat, level
ground with only the very occasional foray into lawns and hills and
such. He walks reasonably well now with two SACH feet(temporary until
we decide on prescription), but would like a little more than what
these feet offer.

Thanks for any insights,
Brad van Lenthe C.P.(c)

I received 11 replies summarized as:
Highlander, Ossur's Assure, Sureflex, Variflex (x2), LP Ceterus, 1D35
from OttoBock, Seattle Carbon Lite Foot, and Catalyst, College Park's
TrueStep and Soleus, one vote for Trias from OttoBock and one vote
against it.

I also received this from Jan Stokosa:
For what it's worth, he would best be served to test various foot/ankle
systems to determine optimal function for his personal daily activities.
Prescription is an outdated method of designing a prosthesis. With
over
200 to choose, how can you, or how can anyone intelligently think that
we
know what would be best for any individual amputee?! You must educate
physicians, and Prosthetists to this. I have written and lectured
extensively on this and many are just beginning to realize the REAL
FUNCTINAL BENEFIT to the amputee. To allow an amputee to do functional
comparative component testing is the only humane way to answer your
question. I and many colleagues provide the amputee the opportunity to
walk
on foot #1, optimize biomechanical alignment. The amputee gets a feel
of the
dynamics. We then, having previously prepared foot #2 with its own
adjustable alignment couplings ,remove foot # 1 with its shin segment
and
adjustable alignment couplings, and attach foot #2. Biomechanical
alignment
is optimized and the amputee gets a feel of foot #2, and has a feeling
which
one is better for him/her. I then remove #2 and re-attach #1, and the
patient is even better able to make a functional comparison. I might
do this
several times. I then will have foot #3 and by process of elimination
the
patient is able to determine which s/he likes and for what reason. The
number of feet is between the patient and Prosthetist. I have done as
many
as 9. Most will choose 3-5. Manufacturers allow 60 days for full credit
return.
I write to the physician and explain the benefits to the patient and
explain
the difficulty we as Prosthetists have in choosing. The patient must
use the
foot for a long time, and it is reasonable, and, responsible, for us to
allow the patient this opportunity.
I do have considerable experience fitting bilateral and trilateral
amputees
of varying levels of amputation (35 years) and still cannot, do not,
feel
comfortable making a decision without this comparative testing.
I sincerely hope this has helped you.

__________________
JAN STOKOSA, CP, FAAOP
STOKOSA PROSTHETIC CLINIC

Thanks for everyone's input

Brad van Lenthe C.P.(c)

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