Prosthetics
What Now?
How do I know what questions are going through your mind? I know because I was once in the same place you are today: facing the fact that I was losing a limb, and that my life would be changed forever.
Having an amputation is difficult for anyone at any age. Losing a limb may affect your feelings of self-worth 
as well as your physical capabilities.
In addition to these feelings, there are your uncertainties with regards to wearing prosthesis (artificial limb):
- What will I be able to do?
- Will I be able to walk?
- Will I be able to learn to work with an artificial limb?
- What will the prosthesis look like?
- What will I look like in the prosthesis?
- Will people be able to tell I am an amputee?
- When will I be able to get back to my day-to-day activities?
- Will I be able to play sports?
- Will my insurance cover the costs of the prosthesis?
Because I was once in your shoes, I can help answer these questions for you as they pertain to obtaining and learning to use your prosthesis.
What's the Process?
Once your residual limb (the remaining portion of your amputated limb) begins to heal, your physician may request that you wear a "shrinker," a compression sock for your residual limb that helps reduce the edema (swelling of the tissue).
Depending on your condition, you may start wearing a shrinker within one week of your surgery. When your physician feels you're ready for your prosthesis, you will be prescribed either a temporary prosthesis or your permanent prosthesis.
Who Do I See?
After your wound has healed enough for you to be fitted with a prosthetic device, your physician and / or rehabilitation therapist will suggest you see a licensed prosthetist. Most likely they will give you several candidates to choose from.
Just as you need to feel comfortable with your physician, you need to feel that same comfort level with your prosthetist. After all, the goal of a licensed prosthetist is to provide you with a prosthesis that will enable you to return to the activities of your daily living. A high comfort level with your prosthetist is imperative so you can openly discuss your amputation and ask any questions you may have concerning the wear and care of your prosthetic device.
Questions you may wish to ask a potential prosthetist include:
- Are you certified in Prosthetics by the ABC (American Board of Certification) or the BOC (Board of Orthotic Certification)?
- Do you make house calls?
- How long have you been a prosthetist?
- How many prostheses have you made?
- Who will be making my prosthesis?
- Where will it be fabricated?
- Are you a provider on my insurance?
- Do you accept assignment for your fee?
What's in a Leg?
The human leg is a complex mixture of functions. And that's also very much the case with prosthesis, a replacement limb made up of a number of parts.
The first component is either a liner or insert. This component acts as an interface between the hard, weight-bearing socket and the skin. If you and your prosthetist choose a liner, it will be made of silicone gel, a soft, stretchy material rolled onto the residual limb. If an insert is chosen, it will be made of pelite foam and placed on the residual limb over socks.
Once the liner or insert is on, the residual limb then slides into the socket. This socket is specially made to fit and can be made out of a variety of materials. The socket for transfemoral (above-knee) prosthesis has a knee joint connected to it. The better the design, the more fluid and natural the movement of the knee will be. Below that is an aluminum or carbon fiber tube to which a foot module is connected. The design technology of the foot is critical to energy expenditure and comfort when walking. A transtibial (below-knee) prosthesis has the foot connected either directly to the socket or via a tube, depending on the amputee's height and the length of the residual limb.
The Temporary Prosthesis
The temporary prosthesis is designed to accommodate the anatomical changes that occur while your residual limb is healing, such as the reduction in edema and the change in shape of your residual limb. It also provides a stepping-stone approach in learning to use a prosthetic limb for those who may not have the strength to walk with their permanent prostheses right away.
Several factors determine whether or not your physician prescribes a temporary prosthesis, including:
- Age
- Muscle tone
- Mental acuity
A temporary prosthesis differs from the permanent prosthesis in the following ways:
- Weight
- Type of Socket Design
- Type of Suspension
- Type of Knee or Ankle Joint
- Type of Foot
- Less Cosmetically Appealing
In order to ensure an excellent fit, your prosthetist will take measurements along with a cast of your residual limb to act as a model from which your temporary socket will be fabricated. The cast is made by making a plaster impression of your residual limb using plaster bandages; once the plaster has dried sufficiently, it will be gently removed and your prosthetist will begin the fabrication of your temporary prosthesis.
The temporary prosthesis is usually worn for 3 to 6 months. During this time, your suture line fully heals, the majority of the edema subsides and your residual limb begins to take a more conical shape.
The Permanent Prosthesis
Your permanent prosthesis is designed to meet the needs you have defined as part of your daily living requirements. Unlike years ago, today there are a variety of prosthetic feet, legs, knees, hands and arms available, each with a functional feature designed to meet the specific needs of an individual. Consequently, it is extremely important to communicate your daily activity goals to your physician and prosthetist, so they can create a customized prosthesis to help you meet these goals.
The following process will be the same regardless of whether or not you already have a temporary prosthesis: An impression and measurements will be taken of your residual limb, and your permanent socket will be fabricated. The components for your permanent prosthesis will be chosen in part by you, your physician and your prosthetist.
If your residual limb goes through further shape changes, your prosthetist will take a new impression with precise measurements for refabrication of a new socket. The other components will most likely remain the same, although sometimes it is necessary to change them as well.
Prosthetic Follow-Up
To ensure your prosthetic limb continues to serve you well, plan on visiting your prosthetist quarterly for check-ups to look at proper fit, proper sock ply and possible irritation points.
Normally, most insurance plans allow for a new prosthesis every two years. If you experience significant weight gain or loss, however, you may be eligible for a new prosthetic limb at an earlier date. If your prosthetist finds your prosthesis is causing irritation points on your residual limb due to weight gain or loss, most insurers allow for a new prosthesis.
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