To Wear or Not to Wear … A Lower-Limb Prosthesis

To Wear or Not to Wear … A Lower-Limb Prosthesis

– by Paddy Rossbach, RN

Whether you choose to or are able to wear a prosthesis after amputation will depend on many things. Most amputations in seniors are the result of circulation problems from diabetes or peripheral vascular disease (PVD). Poor circulation affects all parts of the body, not just the legs. So, you may also be dealing with other problems. These might include heart or kidney disease, memory loss, loss of feeling in your hands and remaining foot, and poor circulation in your remaining foot.

You may not have been active for some time. You may have been hospitalized for surgeries to save as much of your leg as possible. You may be weak, exhausted, and even depressed. But don’t lose hope! With good care from your entire healthcare team, the support of friends and family, and a “can do” attitude on your part, it is possible to walk again.

Some of you may choose not to wear a prosthesis. You may find it easier or feel safer using a wheelchair, crutches or a walker. Or, due to health problems, you may not have the stamina required for physical therapy and using a prosthesis. This is fine as long as you remain as active as possible (see the exercise articles in this issue).

Most people who wear a prosthesis also occasionally use a wheelchair and/or crutches, canes or walkers. These devices help them maintain their independence when:

• Their prosthesis is being repaired.
• They are awaiting a new prosthesis.
• They are recuperating from skin breakdown.
• They are fatigued from using their prosthesis.
• They are experiencing balance or coordination problems.
• Safety is a concern.

What Do You Need to Walk Again?

First, you need a team made up of a surgeon, nurses, therapists, social workers and a prosthetist (a person who makes and fits artificial limbs). This team will work together to plan the best surgery, rehabilitation, and prosthetic care for you.

The main ingredients for success are:

Surgery that leaves a well-healed, well-shaped, well-padded limb that is the best length for the type of prosthesis you will use

• An appropriate amount of physical therapy that

  – Keeps your joints flexible
  – Strengthens your remaining limb
  – Teaches you how to carry out activities of daily living
  – Trains you in using your prosthesis

• A certified prosthetist

  – Who is experienced in working with older amputees
  – Who can fit you with a lightweight limb
  – Who offers components (feet, knees, etc.) that will help you walk safely and, most importantly, COMFORTABLY!

• A healthful diet to give you the strength to work hard
• Appropriate care of any other health problems you may have
• Pain control.

If any of these ingredients are missing, however, you might not be a good candidate for a prosthesis. A residual limb that is not well-healed, well-shaped, and well-padded may not be able to bear weight into your prosthesis or may cause you pain when you wear it. Without appropriate physical therapy, your limb may be inflexible and/or too weak to wear a prosthesis or you may not know the proper way to walk with it. Unless you have a prosthetist who is well-trained in fitting older patients with appropriate lightweight components, the prosthesis may merely become a burden for you. Since wearing a prosthesis requires more energy from a person, being in good health is essential. Eating a proper diet and taking care of your other health problems will help ensure that you can manage the additional stress that wearing a prosthesis puts on your body and heart. Finally, if the prosthesis is painful, you will not wear it. It will merely sit in your closet.

Tips For Before Your Surgery

If you know you are going to have an amputation and have time

• • Find the right prosthetist – with the help of a family member, if possible – before you have the surgery (see the article You and Your Prosthetist: Making the Relationship Count).
  • Choose a prosthetist you can get to easily, whom you feel comfortable talking to, and who is knowledgeable and explains things in terms you can understand.
  • Check his or her qualifications and ask to speak to some of his or her other patients to see how they are getting along.

Ask him or her to call your surgeon to discuss your care after the surgery.

Tips For After Your Surgery

When you are discharged from the hospital, it is important that

• You know how to take care of the remaining part of your limb.
• You know how to check your incision.
• You know how to keep the swelling down.
• You make arrangements to continue with physical therapy.
• You make follow-up appointments with your surgeon so that once you are healed you will be in good shape to start being fitted for your new prosthesis.

Making a Prosthesis

Making a prosthesis takes time and skill. There are many ways to do it. Following are some general things you should know.

During your first visit with your prosthetist, he or she will probably

• Take a full history of your health including medications and any other treatments you are having, such as dialysis.
• Examine and measure your residual limb so that he or she can make an exact mold of it (The process of measuring the residual limb and making a mold of it may be done mainly by computer or by plaster-casting techniques).
• Discuss with you what activities you hope to do Suggest different feet, knees, and how the prosthesis is going to be held on, etc.
• Discuss your insurance coverage and what out-of-pocket expenses you may be expected to pay.

At the next visit, your prosthetist will probably have a “diagnostic socket” ready for you to try on. This is a clear plastic container close to the exact shape of the outer contour of your residual limb. The prosthetist can see if it fits your residual limb perfectly or needs any changes made to it before he or she makes your permanent socket.

At the next visit

• Your prosthesis will probably be ready. (The socket will be made of a different material than the diagnostic socket, and the parts you have chosen will be attached to it.).
• Your prosthetist will help you put the prosthesis on. You will stand up in parallel bars to line up all of the parts to make it comfortable. This “alignment” will be changed often at the beginning as your body starts standing up straighter, etc. These changes are perfectly normal.
• Your prosthetist will teach you

  – How to put the prosthesis on and take it off
  – How to check if it is on correctly
  – How to add extra socks or take some off if your residual limb shrinks or swells. (He or she should explain that as you use your prosthesis more, the swelling will go out of your limb.

• He or she will either start teaching you to walk using parallel bars or refer you to a physical therapist. (You will walk for short periods at first and check your limb often for pressure.).
• He or she will tell you when to come back for another appointment.

Things to Remember

In the beginning, a lot of changes will occur. Your limb will change shape, so your socket must be changed by your prosthetist.This is very important. If the socket does not fit well, you will not be able to walk properly and could get a blister or sore spot. At first, you will need to visit the prosthetist often. As things settle down, the visits will get less and less.

Examine your limb every time you take off the prosthesis. Use a mirror if necessary and massage the limb to get the circulation going. Wash the limb with a mild soap and pat it dry every day. Don’t use anything that includes alcohol because it will dry the skin, which may then crack and become infected. Also, wash any socks, silicone liners, and the inside of your socket with mild soap and water (or as the manufacturer advises) and rinse them every day. A buildup of sweat and dirt will cause infections..

Although it is more difficult to walk with an above-knee prosthesis, with the right care it is possible for older amputees. Always use a walker or cane if you feel unsure of yourself..

Remember, eat right, stay active, make sure your prosthesis is fitting correctly, visit your prosthetist regularly, and look after the rest of your health needs. Life is definitely different, but it can still be enjoyable and fulfilling.