Amputation – The loss of a limb is a life-changing event, whether the amputation is due to a traumatic accident, disease, or a congenital deficiency. Whatever the case, amputation can be a major emotional hurdle. Many patients or parents of patients find it helpful to speak with a prosthetist at the time of amputation. It may also be beneficial to speak with someone who uses a prosthesis regularly. At this time, it is extremely important to know there is someone to talk to, answer questions, and explain their own experience.
Healing – Before a permanent prosthesis can be used, the patient must be healed from the amputation. While the limb is healing, it is very important to follow the doctor’s orders concerning dressing the incision line, physical activities, ice, and compression. Sometimes a prosthetic shrinker is used to reduce swelling in the limb before casting. A shrinker is essentially a tight sock worn on the limb. This device can also help reduce sensitivity and phantom sensations in the limb.
Casting –A prosthetist needs a 3-D model of the limb from which the prosthesis will be made. The casting appointment will consist of measuring and molding the limb. This process involves wrapping the limb in plaster or fiberglass casting tape.
Fitting – The fitting process can involve several preliminary fittings before a patient is able to take the permanent prosthesis with them. In these appointments, the prosthetist will show the patient how to put the prosthesis on, take it off, and take care of all the parts. It is common for the patient to stand and walk in the preliminary prosthesis, also known as a “check socket,” to assess the alignment of the parts and the comfort of the socket. The socket is the hollow portion that comes into direct contact with the patient's limb. This part of the prosthesis is custom molded to the patient’s leg or arm. The patient and prosthetist must be patient and thorough during the fitting process to make sure the socket is as comfortable as possible. Changes to the socket are harder to make once a permanent prosthesis has been made.
Initial Use of a Prosthesis – We encourage our patients to seek physical or occupational therapy once they receive a prosthesis. Sessions with a therapist can help reinforce good prosthetic habits, build remaining muscles, and promote acceptance of the device.
Follow-Up – Adjustments down the road are almost guaranteed in prosthetics. As patients become more adept at using their prosthesis, small changes may be necessary. With lower extremity prosthetics, as a patient learns how to walk faster, or even run, the prosthesis may need changes to the socket or alignment to maintain comfort & function. It is also common for a patient’s limb to change shape. With extended prosthetic use, the limb will get smaller and smaller. This is a normal maturation of the limb. Muscles that have been cut in the amputation process will atrophy and any swelling left in the limb from surgery will subside. Because the socket cannot shrink with the patient, socks are used to keep the prosthesis from getting too loose. This is referred to as “sock management.” With the permanent prosthesis, a supply of prosthetic socks are given to the patient. Prosthetic users must pay close attention to how their prosthesis fits. Learning when to add a sock is challenging, but mastering “sock management” can make a world of difference. The number of socks a patient is using can be used as an indicator to the prosthetist as well, signaling that a new socket needs to be made.