Lower Extremity Prosthetic

How it works

When your physician has given clearance to begin the prosthetic fitting, your prosthetist will take a cast or a scan of the limb; this will provide him/her with a model to make the prosthesis. Prior to this appointment he/she will have assessed your individual needs and goals for life as an amputee. This includes but is not limited to determining how active you are or would like to be, your current weight, occupation or leisure activities, current health status (if there are other health factors that may need to be accommodated), and the condition of the residual limb. This information is extremely important when determining the components and which type of prosthetic device is most suitable for the individual amputee.

Levels of lower extremity amputations

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  • Hemi pelvectomy amputation
  • Hip disarticulation amputation
  • Above knee amputation (Transfemoral)
  • Through the knee amputations
  • Below knee amputations (Transtibial)
  • Ankle disarticulation(Symes)
  • Partial foot amputation

Prosthetic options for lower extremity amputations:

This type of prosthesis can be used for all levels of amputation. It is used primarily to replace the body part that is missing. This promotes a healthy body image, and is also functional in that it can assist the sound side arm in activities such as holding or placing objects.

Socket Design

Depending on your level of amputation, there are several types of socket designs that one could be fit with. Your prosthetist will determine which socket design is best suited for you based on the shape and the condition of the residual limb. Other factors include length, circumference and skin integrity. The most common socket designs for below-knee-amputees are Patellar Tendon Bearing (PTB) which means the pressures inside the socket are placed on pressure tolerable areas (muscle and tendon) and relieved in pressure sensitive areas (boney area). A Total Surface Bearing socket (TSB) means that the pressures are spread more evenly over the entire limb. The use of a silicone or urethane interface flows over the limb, thinning out over pressure tolerant areas and remaining thick over areas that are pressure sensitive.

For above-knee amputees the most common socket design is the Ischial Containment design. The prosthetic socket for a transfemoral amputee needs to support your weight, contain your tissue and your limb comfortably, and provide stability so that you can walk as efficiently as possible.  Achieving a good fit is imperative to becoming a successful user of a prosthesis.  The main pressures inside the prosthetic socket are absorbed by the bony anatomy of your pelvis (ischial tuberosity), which are the bones you sit on and can feel when sitting on a hard surface.

Suspension Techniques

There are many ways to suspend a prosthesis. Some of the more common techniques are as follows: Supracondylar suspension which is suspension above the bony anatomy of the knee. Silicone suspension uses a liner that is rolled onto the limb which has a pin attached into a lock into a mechanism inside the prosthesis. Seal-in suction is also a liner that is rolled onto the limb but this design has a sealing ring, or rings, that seal against the walls of the prosthesis. Vacuum suspension is another technique that uses the TSB socket design ( for below knee-amputees ) and vacuum pump to mechanically hold the prosthesis on the limb with suction. This design provides excellent adhesion and improved wearer comfort.

Prosthetic Knees

Prosthetic knees today offer many different options for amputees of all levels.  Depending on your level of activity and specific circumstances, your prosthetist will choose a knee that will provide you with what is most appropriate.  A Manual Locking Knee is the most stable type of knee available.  A Single-Axis, Constant Friction Knee is simple and lightweight.  A Single-Axis, Constant Friction Knee with Stance Control has a breaking feature that prevents the knee from buckling when weight is put on the leg.  A Single-Axis, Fluid Friction Knee varies its resistance as walking speed varies or when running.  A Polycentric Knee is a very stable knee that allows for very fluid walking.  A Microprocessor Knee is a computerized knee that responds automatically to the walking patterns of the patient and has added stability.

Prosthetic Feet

Prosthetic feet are categorized by levels of activity; this means how well you ambulate (walk). Examples like: if you walk with an assistive device (walker or cane), if you walk in varying speeds, or if you lead an active lifestyle and participate in sports or other recreational activities. The type of foot that is prescribed will vary. Other factors that determine the type of foot that is chosen are your body weight, if you walk on uneven surfaces, the type of job you have and the length of your residual limb.

Prosthetic feet are categorized as: SACH (solid ankle cushioned heel), single-axis (one plane of movement), multi-axial (more than one plane of movement), and dynamic response (materials used in the foot return energy to the patient when walking). Speaking with your prosthetist regarding your goals will help determine which prosthetic foot will be the most appropriate and which foot will help return you to a more active and independent lifestyle, much like you had prior to limb loss.

Mechanical (Body Powered)

This prosthesis uses body movements to operate the terminal device (hand or hook.) The prosthesis is connected to the body through the use of cables and harness. Using movements of the shoulders and the arms, the person can open and close the terminal device.

Myoelectric (Externally powered)

The Myoelectric/Microprocessor/Brain control prosthesis uses signals from muscles of the residual limb to control the opening and closing of the terminal device (hook or hand) or elbow depending on the level of amputation. Electrodes are incorporated into the prosthetic socket and by contracting the muscles of the residual limb, electrical signals are sent to the motors which open and close the terminal device (hook or hand) or lift and lower the forearm at the elbow.

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