Fit and comfort are everything! As an above the knee (AKA) amputee (March 13, 1998), among my first challenges was constantly struggling with getting a comfortable fit on my prosthetic leg. It has taken me years of trial and error to figure out that I don't have to put up with pain. I use a shuttle lock pin system (not suction).
The proper "fit" of your prosthetic device is critical to your comfort, and acceptance of (wearing) it. This requires a skilled prosthetist and your participation in the way of feedback to him or her! The prosthetist I was fortunate enough to meet is himself an amputee, so he knows firsthand what the real concerns of an amputee are. Finding another skilled amputee to work with is a major benefit if you can find one! Like your family doctor, you must clearly communicate to your prosthetist what your needs and future expectations are. You should also go to amputee product trade shows if you can find them.
I use an ICEROSS brand silicone liner suspension system (not suction) with a pin system which I really like. As a new amputee, until I discovered a few tricks, I was experiencing pretty bad "distal end" pain (pressure on the end of the residual limb) to the point where I really couldn't walk comfortably without a cane.
An amputee friend who saw me walking said to me, "you're sinking down too far in the 'bucket' (socket) Chuck". I already sort of knew that, but putting even an additional ply sock on of any thickness was too much and I couldn't get my leg on at all. For anyone (new amputees) that don't already know it, there should NOT be any pressure directly on the end of the bone where you had your amputation ever! My Iceross silicone liner suspension system uses a locking pin which was causing me a lot of pain simply because it was too long. The socket or "bucket" where your leg goes should support your weight evenly all the way down and all the way around your leg. In fact, a part of your rear "butt" should even sit slightly on the uppermost, back part of the socket lip.
Over the years I have figured out a few tricks for myself and wanted to share it with anyone that can benefit from it.
Trick:
#1. Like I mentioned above, even adding an extra one-ply sock made the
diameter of my limb to big to fit down in the socket and it prevented the locking pin on the bottom of my leg from reaching down to the
shuttle pin locking mechanism. Instead of wearing an additional limb sock, try
wrapping your leg with an "Ace" type bandage over any existing socks that you
wear. I recommend wrapping the leg from about the middle of your residual limb and
working upwards toward your body. Experiment for yourself, but I have found that if I wrap
too low, the curvature of the prosthetic leg near the bottom prevents the leg from seating
properly. Your leg will naturally tend to compress more near the top, where the
majority of the fatty tissue is.
#2. Another thing you can do is to cut the bottom of a limb sock out so that it slides over your existing limb socks. Once again, too many sock ply layers down near the extreme bottom of the socket (where it curves the most) may cause a fit problem. Pull it up at high as possible so that the part you cut off is about 2/3 to 1/2 the way up your leg.
#3. Silicone liners come in different sizes are supposed to fit very snugly, and when clean, use friction against the skin to stay in place. I found that at the end of the day my skin was becoming very irritated and red around the very top edge of the silicone liner. This is a common problem with liners but there is any easy way to solve this problem and ease the pain. Before you put your silicone liner on, take a bit of lotion or "aloe" gel and put it where the irritation normally occurs. While its still wet, go ahead and put the liner on (donning process). This small area where the aloe is can now slip a little and it will cause less skin irritation. Use lotion sparingly however, because otherwise the silicone rubber liner can more easily try to slip off. If you don't want to use lotion, you can use a piece of a cloth sock about 2" tall at the very top under the silicone liner. Just like a blister on a shoe, you can also use a Band-Aid adhesive strip etc.
#4. I often had problems getting my leg to slide into the socket easily, until I discovered that I could use a spray bottle filled with normal isopropyl alcohol to spray on my stump sock as well as down inside the socket first. Doing this allows me to slide my leg on very easily. Note: Some cotton stump socks are impregnated with some anti-slip silicone rubber to prevent your leg from twisting. It makes the leg quite a bit harder to get on, but it does the job of preventing the leg twisting. I actually gave the impregnated socks up because I have never had a problem with unwanted twisting.
#5. For amputees like me that are using silicone liners with a pin attached, after putting your liner on, let your leg hang down and look down paying very close attention to the vertical alignment of the pin. Is it pointing straight down like it should, or is it pointed in the wrong direction or at an angle? Note: I have to intentionally roll my silicone liner on slightly crooked every day to make the pin line up correctly. Also make absolutely sure that the pin is not too long! (See excellent note below from a prosthetist named Kris who emailed me from Iowa) Even after two years, because it was easier to get my first "click", I made the mistake one day of using a pin that was too long. It took me a week of torture and pain to figure out that it was too long. If it is too long it will apply unwanted pressure to the end of your residual limb and that will cause intense pain! Test fit your pin with your leg off, and count to see how many "clicks" the pin makes as you insert it into your socket locking mechanism. Then, when you put your leg on, be certain that you count and hear less than that number of clicks. You do NOT want the pin to "bottom out" in the locking mechanism.
* Valuable comment from Kris (a prosthetist): I have a lot of
experience with shuttle locks. One of the big problems I see you had was the pin
"bottoming out" on the pyramid and so you resorted to using a shorter pin.
Instead of using a shorter pin, this problem can more easily taken care of by using
a pyramid with a hole
through it, where the longer pin actually slides through it as well, giving you the space
you need for the pin. It is much easier to get those first few clicks with a longer
pin! (VERY TRUE!)
#6. Regarding silicone liners in general, I like the ICEROSS brand with the built-in support "matrix" inside. This prevents the liner from stretching as much and prevents on/off pistoning or slippage of your leg inside the liner. Other brands like "Alpha" are available as well but my prosthetist likes the ICEROSS brand because it has a better guarantee and comes in more sizes.
#7. Don't make the mistake of shaving your leg!!! (sorry ladies, but this applies to both men and women). Some people think the silicone liner will stick to their skin better if they shave, but it is a big mistake. If you shave your arm or leg and then slide a silicone liner over it the new hairs can become ingrown in the hair follicle causing severe irritation. Having some hair on the residual limb can actually cause less irritation to the skin by providing a slight barrier between the silicone rubber and your skin.
#8. Keep those liners and your residual limb clean. Clean sticky rubber will adhere to your skin better and prevent slippage. Antibacterial "baby wipes" are very convenient to have near your bedside and work well! I clean both my residual limb (a.k.a. "stump") and silicone liner just before I get into bed every evening. By morning it is dry and ready to go.
#9. Your leg should fit on as tight as possible. The best way to explain this is that it should almost be hard to get on. You should not be able to wiggle your stump around at all inside the socket. If you can, you are losing all of this energy when you try to walk. * Another valuable comment from Kris (prosthetist): Other problems like rotation and tightness of the socket are contour issues. The design of the leg is crucial. Having it "as tight as possible" can actually prevent your muscles from "firing" properly" creating more energy consumption and possible soreness at the medial brim (groin). Right again Kris. I guess I meant comfortable "snug" where you didn't have any wasted motion.
#10. Be sure your leg is all the way on. Your leg should fit down into the socket as far as possible for the best leverage.
If any of this helps anyone at all, please send me some email feedback by clicking here to tell me how it worked. Any additional helpful ideas? Please contribute so we can all benefit. Thanks.
* Special thanks to Kris in Iowa for submitting some good ideas.
Updated December 12, 2003
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