Digest of Query Answers regarding feet for bilateral transfemoral presentation

Digest of Query Answers regarding feet for bilateral transfemoral presentation

Harry Phillips

1/19/2012

My apologies for the delay in posting this digest-apparently you have to
hit the Send button to make the message go out. My original query is
first followed by the responses. Thanks for the help.

 

To the List,

                I have been working with a woman who is 16 years post
bilateral transfemoral amputation secondary to MVA. She presents with a
left KD and a right transfemoral amputation just above the femoral
condyles. She is highly motivated and has recently (intentionally) lost
an impressive amount weight (approximately 50 lbs to bring her to about
160 lbs) and actually worked out rather significant hip flexion
contractures (a rarity in my experience). At this point she is wearing
her stubbie prostheses all day long. She has done quite well on KISS
Trainers (although she has worn out 2 sets in the last 18 months). She
would like to try real (i.e. anthropomorphic) feet so that she can go
back to wearing shoes. I am interested in input from the list as to the
most appropriate feet for this level of presentation.

 

My inclination is to go with feet that have firm heels (to ease the
transition from the posteriorly oriented Trainers) but beyond that, I am
open to any and all suggestions. In the future, it is likely that this
individual would like to at least explore the possibility of being
taller and, perhaps, incorporate active knees into her prostheses (her
present prostheses have locking knees that allow her to easily get
behind the wheel of a car but which she does not use actively).

 

Thanks in advance for your advice

Harry, Harry, Harry,

Put her on College Park Accents bilaterally. The weight of them is good
and gives her the ability to wear different heel heights, whether she
walks any significant distance in the heels, or not. Additionally, you
can modify the feel/function of them significantly. Give her one weight
activated locking knee, at least, with the possibility of moving into a
DAW SLK (very reasonable weight for computer knee). Keep her low/short
and let her lead you on increasing her height. Have you thought about
looking into skin fit suction? She'll be amazed at the increased
control.

 

Try Freedom Runway, can go flat then to shoe with plyon and then knee.
This will also help with alignment thur the stages without having to
learn new foot type

I like the Axtion feet from Ottobock for bilat AK's maybe a size or two
shorter than normal using hip center to floor distance x .15 to arrive
at foot length. These feet will allow overall height to be lowered if
knee joints are added later. Also consider using manual locking knees
to increase wear time during wheelchair ambulation. They prevent the
feet from running into things and look more natural. Hope this helps.
I have a large patient load of bilat AK's so if you have other
questions, please let me know.

Like others, I will recommend the Eschelon by Endolite as the
dorsiflexion hydraulics will aid in toe clearance and teach her to load
the toe, a helpful habit to promote proper gait.

Good luck!

Harry,

 

At our facility we have a similar client who uses total knees from Ossur
due to their inherent stabilty. I'm not sure of her age, but our client
is late 40's and female. I would think you could you pretty much any
type of active foot with the proper alignment. She would need a fair
amount of physio before I would let her take them home safely. You would
want heels that were firm, but not too firm. Heel bumpers would work on
most carbon fibre feet. We use a lot of Freedom Tech. feet which have a
very good warranty and are well built. Hope this helps.

 

 

 

Thanks again for the advice.

Sincerely,

 

Harry Phillips, CPO

Triangle Orthopaedic Associates, P.A.

Orthotics and Prosthetics Department

120 William Penn Plaza

Durham, NC 27704

(919) 281-1814

Fax: (919) 281-1877

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