Transtibial amputee with large calf muscles that cause pain in terminal stance

Transtibial amputee with large calf muscles that cause pain in terminal stance

Jake Brubaker

6/4/2015

I have a patient who still has his calf muscles fully intact because when
he is walking he still flexes his muscles as if he was controlling his
foot. This causes a pretty big issue for me. If I have the socket the
tightness that I want, he is unable to stand the pressure/pain during
terminal stance. He literally winces in pain, it's not just regular
pressure in the calf.

Patient history
post amputation 6 months, this will be his second prosthesis. He rapidly
shrunk out of his preparatory prosthesis after 3 months and gained 50 lbs
during that time. he is now wearing 30 ply of socks in his preparatory
prosthesis. He has a history of not explaining where things hurt correctly,
like mid tibia when it is distal end pressure, those types of things.

I tried modifying the socket by pulling out the gastroc area this helped
but made his socket loose, we increased the ply of sock and he had the same
issue. I tried changing his liner from 3mm to 6mm and this did not help. I
tried coaching him not to use his calf muscles during ambulation but this
did not work.

I am looking for a solution. Has anyone tried using a flexible inner liner
for this issue or padding in the socket to allow for the expansion the the
calf muscles?

I am making him second check socket for a Friday fitting. I am going to try
adding 1/4 plastazote padding to the calf area and pull it in the check
socket.

Has anyone encountered this issue

Thanks

Jacob Brubaker CPO
Northern Orthopedics