Sawtooth Orthotics & Prosthetics  

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Boise, Idaho

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Ankle Foot Orthosis (AFO) - Conventional

General Information:

An AFO is a brace that helps to control the ankle, foot and in some cases the knee. Patients who have lost control of the foot, ankle and knee may benefit from an AFO because the brace stabilizes the part of the body permitting it to function in walking. A conventional AFO is usually a double, upright, metal device, with leather covering a metal band at the calf and often a leather strap at ankle. The metal ankle joints may be adjustable with springs to assist with toe pickup. The joints attach to a metal stirrup that is riveted directly to the shoe. The one major advantage of a conventional AFO over the more modern plastic style is that it will fit patients experiencing large swelling changes in leg and foot.

Applying AFO:

Put on a long, over the calf sock. The sock should be longer than the orthosis.
Open all straps to maximum end point.
Slide foot in proper AFO, placing the heel firmly down and back into the heel cup.
Fasten strap inset.
Place lower leg into the shell and fasten the strap.
While seated with knee flexed, open the shoe fully and slide foot in as far as possible.
Slide the heel into the shoe using a shoehorn. This is less traumatic to the skin on the heel and lessens the likelihood of rolling          the back of the shoe.
Lace up or Velcro the shoe snuggly, but not too tight, and attach the strap at the top of the brace.

Wear Schedule:

  • It is important to slowly and progressively increase wearing time to prevent skin breakdown.
  • When you receive the brace, begin by wearing it for only one hour. After one hour, remove the AFO and sock and check your skin for redness. Some redness may be seen on the skin and should go away within 30 minutes after removing the AFO. Watch to see how long the redness lasts. If redness remains after 30 minutes or if you notice any blistering or bruising, please call to schedule an early return appointment.
  • If the skin is fine and redness goes away in 30 minutes wait at lease one hour before putting the AFO back on. Alternate wearing on and off for the rest of the day making sure to check the skin condition after removal each time.
  • For the second day alternate two hours on and one hour off. Check skin condition each time it is removed.
  • Increase wearing time one hour each day always checking skin condition on removal.
  • Unless specifically instructed, remove orthosis for sleep.

Cleaning & Maintenance:

  • Leather conditioner on the brace leather every three months is recommended.
  • Clean Velcro frequently on straps by removing lint and hair.
  • Very lightly oil moving parts on the AFO every month. Wipe off any excess oil so it won’t stain clothing.

Call us if...

• Redness lasts for 30 minutes or more upon removal
• Skin is blistered
• Skin is scratched
• Skin is bruised

 

Ankle Foot Orthosis (AFO) - Plastic

General Information:

An AFO is a device that supports the ankle and foot and extends from below the knee down to and including the foot. AFO’s are custom molded in a variety of different ways to facilitate the patient’s needs. A plastic or Carbon AFO is worn inside a properly fit shoe. An AFO may be required by a physician for any number of conditions affecting the stability of the foot and ankle. Input and information from the physician, physical therapist, family members and the orthotist regarding the biomechanical needs and anticipated goals for the patient will help determine the properly designed device for the patient.

Applying AFO:

Put on a long, over the calf sock. The sock should be longer than the orthosis.
Open all straps to maximum end point.
Slide foot into position, placing the heel firmly down and back into the heel cup.
Fasten strap inset.
Place lower leg into the shell and fasten the strap.
While seated with knee flexed, open the shoe fully and slide foot in as far as possible.
Slide the heel into the shoe using a shoehorn. This is less traumatic to the skin on the heel and lessens the likelihood of rolling          the back of the shoe.
Lace up the shoe snuggly, but not too tight, and attach the strap at the top of the brace.

Wear Schedule:

  • It is important to slowly and progressively increase wearing time to prevent skin breakdown.
  • When you receive the brace, begin by wearing it for only one hour. After one hour remove the AFO and sock and check your skin for redness. Some redness may be seen on the skin and should go away within 30 minutes after removing the AFO. Watch to see how long the redness lasts. If redness remains after 30 minutes or if you notice any blistering or bruising, please call to schedule an early return appointment.
  • If the skin is fine and redness goes away in 30 minutes wait at lease one hour before putting the AFO back on. Alternate wearing on and off for the rest of the day making sure to check the skin condition after removal each time.
  • For the second day alternate two hours on and one hour off. Check skin condition each time it is removed.
  • Increase wearing time one hour each day always checking skin condition on removal.
  • Unless specifically instructed, remove orthosis for sleep.

Cleaning & Maintenance:

The best way to clean an AFO is to wipe the inside with rubbing alcohol. The AFO can also be cleaned by wiping it out with a damp towel and anti-bacterial soap. Regular appointments should be kept for maintenance and upkeep of the orthosis.

Call us if...

• Redness lasts for 30 minutes or more upon removal
• Skin is blistered
• Skin is scratched
• Skin is bruised

Custom LSO (Spinal Brace) and TLSO

A spinal brace is custom made to fit the patient’s torso.

Applying a Spinal Brace:

When first learning to apply the brace, having an assistant’s help is recommended.

♦ Method 1:

  • Wear a tight fitting T-shirt. Your orthotist may have provided a special T-Shirt to wear.
  • Lie on your back and roll to your side, and slide the brace around your back. Line up the waist pads on the brace with your waist. Then roll onto your back. You may need to reposition the LSO brace again as it may have moved when you rolled back. If so, make sure the waist pads are again in the correct area.
  • Once the brace is centered on the body, secure the Velcro straps, starting with the middle strap first. The Orthotist may have already marked the Velcro straps. Make sure the straps are secured to these marks. If your abdomen is swollen, these marks may need to be adjusted as their volume changes.
  • You are now ready to roll to your side and stand up as the therapist has instructed.

♦ Method 2:

  • A physician must indicate that the patient’s back is stable enough to stand for method #2.
  • Standing up, apply the LSO around your back. Line up the waist pads in the brace to match your waist. Then stand against a wall or door to hold the back section while they secure the Velcro straps.
  • Secure the straps to the marks indicated. During this process it is important to keep as straight as possible to insure the spine is aligned correctly. Standing in front of a mirror is helpful.

Care & Maintenance:

Wash the brace as needed with soap and water. Dry with a towel, do not use a hair dryer.

Care of Skin:

Wearing a tight fitting spinal brace will result in redness to skin. Redness should only last 30 minutes after the brace is removed. If redness persists longer than 30 minutes, contact an Orthotist for assistance. Make sure that the brace is applied correctly, and that t-shirt worn underneath has no wrinkles.

Wear Schedule:

Depending on the extent of the patient’s injury or surgery, they may be advised by a physician to wear the brace 23 hours per day, removing it only for bathing. Otherwise, the patient may be advised only to wear it during non-sleep hours. Unless specifically instructed, remove orthosis for sleep.

Troubleshooting problems with the LSO Brace:

A common problem is that the brace will migrate up the patient’s body when they are lying in bed. Two things cause this:
The body has changed in shape, (lost volume due to medications, post injury swelling, or even excessive weight loss). Solution:         Tighten the straps, or contact an Orthotist to make adjustments. Additional padding may need to be applied to the inside of the          brace.
The straps are not tightened to the proper marks, or they are placing the brace in the wrong location on your body. Solution:         Apply the brace lying down and tighten to the marks on the straps. If the straps can tighten past the marks, go ahead as long as          it is comfortable. Make sure the brace is placed correctly on the patient’s waist before tightening and locking it into place.

Knee Orthosis (KO)

A Knee Orthosis is a device that extends from approximately mid calf to mid thigh level. There are different types of KOs.

Application:

Since there are many different reasons to use a KO, there are many different designs. Each design has special features and its own specific way to be worn properly. The orthotist providing the device will instruct the patient on the proper way to wear the KO, making best use of the design features of the device. It is also important to refer to the instruction pamphlet that is supplied with the device. Unless specifically instructed, remove orthosis for sleep.

Care & Maintenance:

Spray the inside with rubbing alcohol and wipe it dry in order to remove body oils and residue the brace has accumulated. Wipe it out with a damp towel and anti-bacterial soap, or anti-bacterial moist towelettes. Be sure to remove any excess soap, as this can cause irritation to the skin.

Many KO’s are designed for use in or out of water. Check with the manufacturer’s instructions to see if water is harmful to the device. Keep the KO away from excessive heat to prevent damage to the plastic.

Tips & Problem Solving:

  • KO’s can be worn directly against the skin for better suspension, or over a cotton or neoprene sleeve for greater comfort.
  • Usually, the back straps just below the knee provide the most suspension on the calf. Be sure these straps are kept tight. If there are any problems, questions, or concerns, contact the orthotist.

Foot Orthosis (FO)

A custom foot orthosis, or foot orthotic, is ordered for a misshapen foot as well as to help relieve areas of pressure on the foot. It is designed to support the foot and encourage a normal gait.

Foot orthosis will replace the insole of the shoe and generally are left in the shoe at all times. If the shape and style of the shoes are comparable, the orthoses can be transferred from one shoe to another.

Wear Schedule:

It is important to allow a break-in period of up to two weeks for foot orthoses. During this time, a patient may experience muscle aches or fatigue. This is normal. Do not exceed one to two hours of wear the first time wearing your new orthoses, including sitting and standing. Increase your usage slowly, adding one to two hours each day. Report problems to your orthotist.

Care & Maintenance:

Cleaning of the foot orthosis depends on the materials used. Plastics and foams can be wiped clean with alcohol or baby wipes. Leathers can be wiped with a cloth or damp cloth if heavily soiled. Suede can be brushed with a stiff nylon brush. Make sure the foot orthosis is dry before putting it back in the shoe. Harsh chemicals or cleaning solutions may cause a skin reaction and/or damage the orthosis. Keep foot orthoses away from excessive heat to prevent damage to them.

CROW Walker (Charcot Restraint Orthotic Walker)

A CROW walker is prescribed for patients who have foot ulcers or insensate feet. The orthosis has two pieces, like a clamshell, and covers the entire foot and calf of the leg, resembling a ski boot. Although this can be somewhat bulky, the CROW gives tremendous support by preventing foot and ankle movement. It is fully padded on the inside with a removable insert that can be changed or adjusted. A shoe is not worn with the CROW walker.

How to apply the CROW walker:

Put on a long, thin, seamless cotton sock or cotton stockinette.
Slide the CROW walker into position in front of you placing your heel squarely in the bottom of the footplate. Make sure the heel          is all the way back and in contact with the bottom of the footplate.
Apply the font section of the orthosis, making sure that the sides overlap the bottom section.
Apply the instep strap on the front of the ankle; then fasten all remaining straps.
Check the skin for redness that does not go away after 15 minutes. Slight redness is common over the instep and under the ball          of the foot.
Be sure to wear proper footwear on the opposite foot at all times.
On the first day, only wear the brace for one hour at a time. After one hour, remove the brace and check your skin for redness.          Some small, light red marks may be noticed on the skin and should go away in 20 to 30 minutes. If the red marks don’t go away        after 20 to 30 minutes or if you notice any scratching, bruising or blistering, do not put the brace back on. Call immediately to          schedule an appointment with your orthotist.
If the skin is okay, wait one hour before putting the brace back on for one hour at a time for the rest of the first day. Be sure to          check the skin after each hour.
On the second day, wear the brace for two hours, remove it and check the skin. If the skin is okay, put the brace back on for two       hours at a time for the rest of the day, checking the skin after every two hours. If your skin continues to be okay, gradually          increase the wearing time by an hour each day and checking the skin after each wearing time.
Unless specifically instructed, remove orthosis for sleep.

Care & Maintenance:

To remove body oils and residue from the inside of your CROW walker, spray rubbing alcohol on the interior and wipe dry. You can also use a damp towel and anti-bacterial soap or anti-bacterial moist towelettes. To prevent damage to your orthosis, do not immerse it in water and do not expose it to excessive heat.

Extra Depth Footwear

For patients with diabetes, extra depth footwear is very important, particularly if there is loss of sensation (peripheral neuropathy). Correct fit in the correct type of shoes is crucial to preventing or reducing calluses and diabetic ulcers, as well as preventing amputations.

People who suffer from peripheral neuropathy often wear shoes that are too narrow, or too short, because there is a loss of protective sensation in their feet. A diabetic should always have footwear fit by a certified pedorthist who is trained to fit the footwear properly.

Extra depth footwear, as approved by Medicare, is designed to relieve areas that cause excessive pressure, such as hammertoes, bunions, and extreme foot shapes. They are able to accommodate, stabilize and support deformities. Extra depth shoes will have seamless and deeper toe boxes. They will also have different lasts or shapes to fit different types of feet. Because of their adjustability, they are available in many sizes and widths in order to achieve a proper fit. If necessary, custom fabricated shoes can be ordered that are made from a cast of the foot.

Wear Tips:

To avoid irritation to the foot, extra depth footwear should be worn with seamless socks that do not have an elastic band at the top. White socks are preferred so that any discharge, indicating a sore, will be seen on the socks.

Diabetic Foot Care

Diabetes can be a very complicated and progressive disease. It often causes nerve damage leaving the foot insensitive to pain. The diabetic foot is in danger of irritations and infection that may not be noticed because of the lack of feeling. Complications from diabetes may also decrease blood flow to the foot making it more difficult for a sore to heal. High blood pressure can also decrease the body's ability to fight infection. It is important that you follow instructions to prevent serious consequences such as ulcerations and possible amputation.

Listed below are guidelines on how to care for diabetic feet:

  • Inspect your feet daily. Look for cuts or sores, changes in skin color, bleeding, tenderness, swelling, and areas of high temperature. If necessary, use a hand mirror to check the bottoms of your feet. If you have poor eyesight, ask a family member or friend to inspect your feet. Any major changes should be reported to your doctor. Have a thorough foot exam by a professional every 3 to 6 months.
  • Bathe your feet daily in warm water using a mild soap and rinse thoroughly. Pat your feet dry with a soft towel making sure to dry between the toes at least twice. Do not soak your feet. Dust your feet lightly with cornstarch to keep the skin between the toes dry.
  • Never use a lotion or cream between your toes. It's okay to use lotion or creams on the tops and bottoms of your feet.
  • Do not wear socks that are too tight. Do not wear nylons. Avoid socks with seams. Discard socks with holes. Always wear clean socks. Non elastic cotton is recommended. Smooth out wrinkles in socks after application.
  • Wear shoes that fit properly. Shoes should be well cushioned and roomy. Don't wear shoes with high heels or pointed toes. Avoid plastic or vinyl shoes. Avoid sandals with thongs between the toes or shoes with open toes or open heels. If necessary, your doctor may prescribe extra-depth or custom-molded shoes.
  • Use of a shoe horn is recommended to prevent the sturdy heel counter from breaking down. Keep shoes laced tightly enough to prevent the foot from sliding forward, but avoid lacing so tightly that pressure marks appear.
  • Shake your shoes before putting on to remove any pebbles or debris. Vacuum out shoes every week.
  • Avoid wearing shoes without socks.
  • Do not attempt to trim your toenails, corns or calluses or use commercial corn remedies unless given the ok by your doctor.
  • Do not walk barefoot, not even indoors. Use slippers in the house.
  • Avoid extremes of heat and cold. Never use hot water bottles or heating pads.
  • Check your feet often in extreme weather especially cold to prevent frostbite.
  • Avoid wearing anything tight around the legs or ankles.
  • Do not use adhesive tape on the feet.
  • Do not cross legs or ankles while sitting.
  • Keep your feet elevated when sitting.
  • Be more active.
  • Keep your weight in check.
  • Avoid smoking.
  • Avoid alcohol.
  • Keep your blood glucose level under control!

Cranial Molding Helmet

General Information:

A cranial molding helmet is used to treat plagiocephaly or brachiocephaly. Plagiocephaly is the uneven flattening of one side of the back of the head, combined with an uneven bulging of the forehead on the opposite side of the head. For example, if the back right of the head is flat, the front left forehead will bulge. Brachiocephaly is the even flattening of the back of the head.

The cranial helmet is used to remold the head into a symmetrical shape as the baby grows. It allows the flattened areas to round out and prevents the bulging areas from bulging more. The helmet does not put pressure on the baby’s head, but rather guides the growth to specific areas to improve the head shape.

It is very important to start treatment early since the growth of the head slows down after the age of 12 months. Usually the earliest an infant can start wearing a helmet is at 5 months. Infants younger than that typically do not have the appropriate strength in the neck and head muscles to control the movements of the head. It is also important for the baby to be screened for other conditions that may have caused the uneven head growth.

Application & Removal:

The infant starts by wearing the helmet for small increments of time throughout the day. Each day, the amount of time in the helmet increases until the patient is in it for 23 hours per day. Increased time wearing the helmet allows the device to capture as much growth as possible. It also allows for the child to be bathed and clothed. Since the helmets are custom made, they are easy to put on the baby. The device should not rub on the ears or slip down over the eyes. When the helmet is removed, there should be no prolonged redness on the baby’s head (longer than 20 minutes). If these problems arise, contact your orthotist.

Care & Maintenance:

The cranial helmet is made of plastic and foam. Allergies to these materials are rare but may occasionally occur. Since the helmet is worn for 23 hours per day, it is important to clean the helmet when the helmet is off. The most common cleaning method is to scrub the inside of the helmet with a soft toothbrush and the same shampoo or soap that is used on the baby’s head. In the course of one to two weeks, areas inside the helmet may become pale yellow in color. This is the dead skin that rubs off of the head and onto the foam. The yellowing serves as an indicator to the orthotist as to where adjustments need to be made, in order for the most correction to occur.

Regular appointments with the orthotist (usually every two weeks) are necessary to adjust the fit of the helmet. Adjustments are usually made by removing small amounts of the foam in the helmet that correspond to areas of increased contact on the head. The decision to stop using the helmet is usually made jointly between the parents, physician and orthotist. The infant is then weaned out of the helmet in a similar manner to which he or she started wearing the helmet. Very seldom will the shape of the head regress after the helmet use has been discontinued.

A helpful website regarding cranial remolding helmets is www.orthomerica.com.

STARband® Cranial remolding Orthosis - (Cranial Information Guide Here)

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any body part from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any body part from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any body part from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any body part from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any body part from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

Orthosis for Hip, Neck, Shoulder, Elbow, Wrist, Finger

General Information:

Sawtooth Orthotics can fabricate an orthotic for any part of the body from head to toe. We have constucted numerous amounts of castings for the arm, including: Shoulders, elbows, wrists, hands, fingers. We also specialize in fabrications as complex as the hip and neck. Each fabrication is customized to fit each individual person. Let us know what we can do to help fabricate an orthotic for you.

 

Above Knee Prosthesis

Above knee prostheses are available in several designs, usually depending on the patient’s age, activity level, residual limb size and shape, as well as their diagnosis and prognosis. The above knee amputee will support their body weight on the ischial tuberosity (seat bone), with the soft tissue of the residual limb bearing only a minimal amount of weight. The above knee amputee will always feel some pressure on the ischial tuberosity because they are essentially sitting on the socket. The above knee prosthesis is held onto the patient’s residual limb using one of the following suspension methods.

Suction Suspension
Silicone Suction Suspension (3S)
Silesian Belt/TES Belt

 

Above Knee Prosthesis - Suction Suspension

Suction suspension refers to the negative pressure or suction that is created between the residual limb and the smaller prosthetic socket when a person pulls his or her remnant limb into the prosthesis with a sock or a donning sleeve through a hole in the bottom of the socket. Once a person is down in the socket, a valve is then inserted into the hole and vacuum is achieved. Suction suspension helps the prosthesis feel lighter to the wearer because it is a positive suspension and little movement occurs between the residual and the socket. Persons using suction suspension must have stable volumes of their residual limb. If the person swells or gains weight he will no longer be able to get into the prosthesis. If the person loses weight, suction will be lost and the prosthesis can fall off. A person using suction suspension must also have sufficient arm and hand strength and the steadiness to pull their remnant limb into the prosthesis.

Application of a Suction Socket:

The three traditional ways to apply or don a suction socket are a pull sock, ace bandage, or a donning sleeve.

Pull sock: Use a cotton or nylon tubular pull sock that is two to three times the length of the residual limb. Pull the sock over the remnant limb all the way up to the groin area. Push the long excess remainder of the sock through the valve opening at the bottom of the prosthetic socket. Begin pulling the end of the sock through the valve hole while pushing the remnant leg into the prosthetic socket. The wearer must alternate between lifting up and pushing down while gently pulling the sock through the valve hole. Progressively, the pull sock will have pulled all the way out of the valve hole and the remnant limb will be all the way into the socket. There should be no air pocket between the remnant and the bottom of the socket. While keeping the weight on the prosthesis, the valve is then inserted into the valve housing creating an airtight suction seal.
Ace Bandage: Use a 4”x 5’ ace bandage. Begin wrapping the bandage from the top of the remnant limb using modest force and overlapping roughly half of the previous wrap. After wrapping the whole remnant limb, a length of ace bandage will be remaining at the bottom of the remnant limb. Push what’s left of the bandage through the valve hole at the bottom of the prosthetic socket. Begin pulling the end of the bandage through the valve hole while pushing the remnant limb into the socket. The wearer must alternate between lifting up and pushing down while gently pulling the bandage through the valve hole. Progressively, the bandage will have pulled all the way through the valve hole and the remnant limb will be all the way into the socket. While keeping weight on the prosthesis, the valve is then inserted into the valve housing creating an airtight suction seal.
Donning Sleeve: This is a cone fashioned sleeve made out of a slick material that is like parachute fabric. Introduce the remnant limb into the sleeve up to the groin area. Begin pulling the tail of the sleeve out through the valve hole in the bottom of the socket while pushing the remnant limb into the socket. Start pulling the end of the tail through the valve hole. The wearer must alternate between lifting up and pushing down while gently pulling the sleeve through the valve hole. Progressively, the sleeve will pull totally through the valve hole and the remnant limb will be all the way into the socket. While keeping weight on the prosthesis, the valve is then inserted into the valve housing creating an airtight seal.

Prosthesis Removal:

To remove the prosthesis, the wearer should either depress the button on the suction valve or unscrew the valve fully to remove it, this then releases the vacuum. Now the prosthesis can be pushed and gently worked off of the remnant limb.

Care & Maintenance:

The prosthetic socket ought to be washed daily with mild soap (no perfumes, lotions, or deodorants) and water. Depending on the skin sensitivity of the wearer, alcohol or moist towlettes may also be used. The valve may also need intermittent cleaning. Ask a prosthetist how to take apart and clean the suction valve or see a prosthetist for periodic valve cleaning.

Tips and Problem Solving:

If the prosthesis looses its suction:

  • There may be a leak in the valve. See a prosthetist for an assessment.
  • A weight loss may have resulted a decrease in remnant limb volume. The prosthetist should be seen for possible filling of the socket.

If the bottom of the residual limb is purplish in color or swollen:

  • Weight increase or volume fluctuation may be preventing the remnant limb from going all of the way into the socket. See a prosthetist for a socket assessment.

Above Knee Prosthesis - Silicone Suction Suspension

A silicone suction suspension user rolls a silicone suspension liner onto the remnant limb creating a seal between the liner and the person’s skin. The suspension liner has a pin with a pull string or a rubber seal on the end that locks into the bottom of the socket. A prosthetic sock is worn on the silicone insert in order to allow for volume fluctuation.

Application and Removal:

  • To apply the silicone suction liner prosthesis, the liner insert must first be turned inside out and gently rolled onto the remnant limb. Do not us any lotions or creams on the remnant limb before rolling on the silicone insert. When rolling on the liner be certain there is not an air pocket between distal liner and the remnant limb. As the liner is rolled up on the remnant limb be sure the top of the liner is not stretched up on the thigh. Over pulling the top of the liner can cause blisters and skin irritation. Socks are then worn over the liner for an appropriate fit of the prosthesis and to adjust the fit of the prosthesis for size changes of the remnant limb. At the bottom of the silicone liner there is either a pin with a string or a rubber seal.
  • The string is put down in the socket and pushed into the center of the lock located in the bottom of the socket. As the string is pushed into the lock it will come out the front of the prosthesis and will be pulled down towards the foot which will pull the remnant limb into the prosthesis. A clicking will be heard as the string is pulled down which indicates the prosthesis is locked on. To remove the prosthesis press in and hold the release button which is generally located near the bottom of the socket on the outside of the prosthesis. With the release button pushed in you can generally push the prosthesis off your remnant limb.
  • The Seal-end liner is rolled on the remnant limb the same as the pin type liner. Before the remnant limb and liner are inserted into the socket a 50 /50 mixture of water and rubbing alcohol are lightly sprayed in the socket from a spray bottle. The person then pushes the remnant limb and liner into the socket and the trapped air is pushed out a valve at the end of the socket. The rubber seal then creates a suction seal between the silicone liner and the socket which holds the prosthesis in place. Special Seal-end socks can be used to compensate for shrinkage of the remnant limb. This sock is placed under the rubber seal of the silicone liner and them fits on the upper part of the remnant limb and the liner. If the sock is pulled over the rubber seal no suction suspension will be created. To remove the prosthesis with a Seal-end liner, air must enter the bottom of the socket by removing the suction valve or pushing and holding it in as the prostheses is pushed off. The gel insert is removed by unrolling the insert off of the limb.

Care & Maintenance:

  • The gel insert must have the inside washed by hand every day with mild soap such as Soft Soap and water.
  • DO NOT USE AN ABRASIVE DEVICE WHEN CLEANING THE LINER, scrubbing with your hand works best.
  • Avoid soaps with perfumes or deodorants and rinse well several times to remove all soap.
  • Dry by blotting with a lint free towel such as a dish towel and store the insert right side out away from direct heat.
  • Clean prosthetic socks should be used every day.
  • The socket can be wiped out with mild soap and water or with rubbing alcohol weekly, or as needed.

Tips and Problem Solving:

If the pin locking device is sticking:

  • Spray the lock with WD-40 or spray silicone.

Below Knee Prosthesis

There are several designs for below knee prostheses. The style of prosthesis that a patient is fit with will depend on their activity level, residual limb length and shape, as well as their diagnosis and prognosis. The three major types of socket designs are:

Patella Tendon Bearing (PTB)
Silicone Suction Suspension (3S)
Suction Socket

 

Below Knee Prosthesis - Patella Tendon Bearing (PTB)

The patella tendon bearing socket places weight distribution over areas of the residual limb that are tolerant to pressure. This allows the user to put weight on the patella tendon, which is right below the kneecap. The patient is then able to minimize pressure over the residual limb and other boney areas, which are most sensitive. Most below the knee amputees are able to wear a patella bearing prosthesis. The PTB prosthesis is held onto the patient’s residual limb using one of the following common suspension systems:

  • Removable Supracondylar (RSC)
  • Supracondylar Suprapatellar (SCSP)
  • Suspension Sleeve
  • Patella Tendon Bearing RSC, or Removable Supracondylar Suspension

*RSC or Removable Supracondylar Suspension:
RSC holds the prosthesis on the residual limb by attaching above the bone on the inside of the knee. The user removes the supracondylar wedge to put the prosthesis on then puts it back in once the remnant limb is in the prosthesis. The wedge locks in over the bone of the knee.

Application and Removal:

  • To apply the prosthesis, the patient will first remove the wedge from the prosthesis and insert the residual limb into the socket.
  • The residual limb is then pushed tightly into the socket.
  • The removable wedge is then inserted back into the socket to lock in the residual limb.

Care & Maintenance:

In order to clean the prosthetic socks, the user should follow the directions of the manufacturer. The prosthetic socket may be wiped out with warm, soapy water, or alcohol if needed. Clean socks should be worn every day.

Tips & Problem Solving:

Usually, the most complicated idea for an amputee to master is how to determine the right sock ply to wear in the prosthesis. Wearing the correct amount of socks is important for comfort, as well as proper fit and function of the prosthesis. A good fitting socket can create fit problems if worn with the wrong sock. If a patient is unsure, a prosthetist and physical therapist will provide the patient with information that can help determine the proper sock ply to wear with the prosthesis.

*SCSP or Supracondylar Suprapatellar:
SCSP keeps the prosthesis on the limb by holding on above the inside bone of the knee. A variant of the SC design is SCSP or Supracondylar Suprapatellar. This socket design extends the socket above the kneecap. This particular system is commonly used in individuals with short residual limbs because high trim of the socket improves the control the patient has of the prosthesis.

Care & Maintenance:

In order to clean the prosthetic socks, the user should follow the directions of the manufacturer. The prosthetic socket may be wiped out with warm, soapy water, or alcohol if needed. Clean socks should be worn every day.

Tips & Problem Solving:

Usually, the most complicated idea for an amputee to master is how to determine the right sock ply to wear in the prosthesis. Wearing the correct amount of socks is important for comfort, as well as proper fit and function of the prosthesis. A good fitting socket can create fit problems if worn with the wrong sock. If a patient is unsure, a prosthetist and physical therapist will provide the patient with information that can help determine the proper sock ply to wear with the prosthesis.

*Patella Tendon Bearing Suspension Sleeve:
The sleeve is attached to the prosthesis and held in place by tension and friction of the material. The sleeve is generally rolled up on the thigh and holds the prosthesis on with suction and friction on the patient’s skin. Suspension sleeves are made of silicone, or similar gels, neoprene and elastic fabrics.

Application and Removal:

If an insert is used, the prosthesis is applied as follows:

  • First, a prosthetic sock is pulled on over the insert. The prosthetic sock should be pulled up firmly without any wrinkles. The residual limb is then pushed into the prosthetic socket.
  • Some socket designs are worn only with socks and no soft liner, this is often referred to as a hard socket. A suspension sleeve may be used with a hard socket where no soft insert is present. In the case of hard sockets the patient is only wearing socks, which can be wool, cotton, acrylic or a blend of the three. Some socks have a silicone gel for improved skin protection and more comfort. With a sock fit and hard socket, the patient first applies the socks, and then pushes into the prosthesis. Once the prosthesis is on, the suspension sleeve must be rolled or pulled up onto the thigh, depending on the manufactures recommendation. In either application, the sleeve must be up on the thigh and wrinkle free. There must be at least 2-3 inches of the sleeve contacting the bare skin of the thigh for good suspension of the prosthesis. In order to achieve good suspension of the sleeve, the sleeve must extend above the socks used with the prosthesis. If the sleeve is applied when sitting, the patient may need to pull the sleeve up when they stand if wrinkles are present. To remove the prosthesis held on with a suspension sleeve, the sleeve is pulled or rolled down to allow the patient to withdraw the residual limb from the socket.

Care & Maintenance:

In order to clean the prosthetic socks, the user should follow the directions of the manufacturer. An insert, if used in the prosthesis, should be cleaned according to the manufactures recommendation or the prosthetist’s suggestion if the insert is a custom made device. The socket should be cleaned with warm, soapy water or alcohol as needed. Also, follow the manufacturers recommendation on cleaning the suspension sleeves.

Tips & Problem Solving:

Usually, the most complicated idea for an amputee to master is how to determine the right sock ply to wear in the prosthesis. Wearing the correct amount of socks is important for comfort, as well as proper fit and function of the prosthesis. A good fitting socket can create fit problems if worn with the wrong sock. If a patient is unsure, a prosthetist and physical therapist will provide the patient with information that can help determine the proper sock ply to wear with the prosthesis.

A patient’s activity will largely determine the length of time a suspension sleeve will last before being worn out. The average life of a suspension sleeve is two to six months. Over time, the sleeves may become stretched out and develop holes, which both reduce the ability of the sleeve to suspend the prosthesis. If the sleeve is not suspending the prosthesis well, the patient should contact their prosthetist for a replacement suspension sleeve.

Below Knee Prosthesis- Silicone Suction Suspension (3S)

Silicone suction suspension employs a roll on silicone liner that creates suction on the patient’s residual limb, and then uses a pin coming out of the bottom of the liner to lock into the prosthetic socket. It can be used with a patella tendon bearing (PTB), total surface bearing, or hydrostatic socket designs. Total surface bearing sockets which load all parts of the patient’s residual limb are often used with the 3S system. Prosthetic socks must still be worn over the silicone insert to compensate for swelling and general fluid changes in the residual limb.

Application:

  • The liner is turned inside out. The liner should be clean and free of any dirt or debris that could irritate the residual limb.
  • With the liner inside out, press firmly up against the residual limb making sure there is no air pocket on the end of the liner as it is rolled up. With gentle pressure the liner is rolled up onto the residual limb.
  • Roll the liner up the limb. Do not over pull the liner when rolling it. Take care not to damage the liner with rings or jewelry.
  • When the liner is rolled up on the residual limb, attempt to get the pin straight off of the end. Take care not to puncture the liner with the pin.
  • If the liner does not have a fabric cover, a lubricant may be needed on the outer surface in order to get the liner to roll up the limb. Baby powder or a mixture of water and rubbing alcohol used in a spray bottle may be needed to lubricate the outside of the liner. Apply the lubricant onto the outer surface of the liner, turn the liner inside out, apply the lubricant and roll onto the limb. Check with a prosthetist to decide the best lubricant to use with the liner.
  • Apply the correct thickness of prosthetic socks for an appropriate fit. Be careful to insure the pin is out through the prosthetic socks for proper connection to the lock. A sock over the pin can result in the pin getting stuck in the lock. If this occurs consult a prosthetist.
  • Once the liner is on the residual limb, insert it into the socket. The pin will insert into the lock and click in as the residual limb goes into the socket. It should not be too easy to get the prosthesis to click on. If the application is too easy a thicker prosthetic sock may be required for a correct fit.

Removal:

  • Depress the release button on the side of the prosthesis at the bottom of the socket and hold it down while removing the remnant limb out of the prosthesis.
  • The liner can be rolled down once the prosthetic sock is removed. If the liner does not have a cloth cover, a lubricant may be required to remove the liner.

Care & Maintenance:

  • The gel insert inside must be washed by hand every day with mild soap such as Soft Soap and water.
  • DO NOT USE AN ABRASIVE DEVICE WHEN CLEANING THE LINER, scrubbing with your hand works best.
  • Avoid soaps with perfumes or deodorants and rinse well several times to remove all soap.
  • Dry by blotting with a lint free towel such as a dishtowel, and store the insert right side out, away from direct heat.
  • Clean prosthetic socks should be used every day.
  • The socket can be wiped out with mild soap and water or with rubbing alcohol as needed.

Tips & Problem Solving:

If the pin-locking device is sticking, spray the lock with WD-40 or spray silicone.

Below Knee Prosthesis- Suction Socket

A suction socket employs a roll on silicone liner that is rolled onto the patient’s residual limb, and then uses a suspension sleeve or a Seal-end liner and a valve in the end of the socket. The suction socket can be used with a patella tendon bearing (PTB), total surface bearing, or hydrostatic socket designs. Total surface bearing sockets, which load all parts of the patient’s residual limb are often used with below the knee suction socket system. This system creates a positive suspension, and very little movement is allowed between the prosthesis and the residual limb. Prosthetic socks must still be worn over the silicone insert to compensate for swelling and general fluid changes in the residual limb.

Application:

  • The liner is turned inside out. The liner should be clean and free of any dirt or debris that could irritate the residual limb.
  • With the liner inside out, press firmly up against the residual limb making sure there is no air pocket on the end of the liner as it is rolled up. With gentle pressure the liner is rolled up onto the residual limb.
  • Roll the liner up the limb. Do not over pull the liner when rolling it. Take care not to damage the liner with rings or jewelry.
  • The suction socket can be used with 2 styles of liners: the roll on cushion liner and the seal-end liner. The cushion liner requires a suspension sleeve to create the seal on the socket for suspension. A seal-end liner creates its own suction with the rubber seal built into the bottom of the liner. Both systems create a more positive suspension for the patient.
  • If a seal-end liner is used on the residual limb a 50/50 mixture of rubbing alcohol and water is sprayed in the socket to allow the Seal-end liner to slide into place in the socket. A valve in the distal socket allows the air to escape as the residual limb is pushed in the socket. If a cushion liner is used, an airtight suspension sleeve is needed to create the suction seal and the distal valve allows air to be expelled as the patient pushes down in the socket.
  • Apply the correct thickness of prosthetic socks for an appropriate fit. The cushion liner uses a standard prosthetic sock and the Seal-end liner requires a special sock that goes under the rubber seal and up over the liner. If there is difficulty determining the proper sock ply consult a prosthetist.
  • Once the prosthesis is on the residual limb and a cushion liner is used, a suspension sleeve must be rolled or pulled up onto the thigh, depending on the manufactures recommendation. In either application, the sleeve must be up on the thigh and wrinkle free. There must be at least 2-3 inches of the sleeve contacting the bare skin of the thigh for good suspension of the prosthesis. In order to achieve good suspension of the sleeve, the sleeve must extend above the socks used with the prosthesis. If the sleeve is applied when sitting, the patient may need to pull the sleeve up when they stand if wrinkles are present.

Removal:

  • To remove the prosthesis with a Seal-end liner, air must enter the bottom of the socket by removing the suction valve, or pushing and holding it in as the prostheses is pushed off. If a cushion liner is used with a suspension sleeve, simply roll down the suspension sleeve and the prosthesis will push off. The gel insert is removed by unrolling the insert off of the residual limb.

Care & Maintenance:

The gel insert inside must be washed by hand every day with mild soap such as Soft Soap and water. DO NOT USE AN ABRASIVE DEVICE WHEN CLEANING THE LINER, scrubbing with your hand works best. Avoid soaps with perfumes or deodorants and rinse well several times to remove all soap. Dry by blotting with a lint free towel such as a dishtowel, and store the insert right side out, away from direct heat. Clean prosthetic socks should be used every day. The socket can be wiped out with mild soap and water or with rubbing alcohol as needed. If suspension sleeves are used, clean according to the manufacturers directions.

Tips & Problem Solving:

Usually, the most complicated idea for an amputee to master is how to determine the right sock ply to wear in the prosthesis. Wearing the correct amount of socks is important for comfort, as well as proper fit and function of the prosthesis. A good fitting socket can create fit problems if worn with the wrong sock. If a patient is unsure, a prosthetist and physical therapist will provide the patient with information that can help determine the proper sock ply to wear with the prosthesis.

A patient’s activity will largely determine the length of time a suspension sleeve will last before being worn out. The average life of a suspension sleeve is two to six months. Over time, the sleeves may become stretched out and develop holes, which both reduce the ability of the sleeve to suspend the prosthesis. If the sleeve is not suspending the prosthesis well, the patient should contact their prosthetist for a replacement suspension sleeve.

Tibial Fracture Brace

The Tibial Fracture Brace is a protective device worn on the lower leg to aid in the healing and alignment of an injured bone. The brace has a similar function to a cast, however is removable, and usually allows ankle motion.

Application:

  • Put on a clean stocking, or a long sock, smooth out any wrinkles.
  • Apply the front panel over the shin, above the ankle bone.
  • Apply the back section. (The two sections should overlap, with the back section fitting inside of the front section. If possible, have someone assist in putting the brace on to assure the best fit.)
  • Take the middle Velcro strap and thread it through the center plastic loop. Hold the front and back sections together tightly, and pull the strap through the next plastic loop on the side. Continue pulling the strap across the front until it fastens to itself.
  • Repeat with the remaining straps. Equal pressure should be maintained on all straps. Straps may need adjustment to achieve a snug fit.
  • Apply shoe, ensuring the heel cup is all the way back in the shoe.

Removal:

  • Undo the Velcro closures and release the straps. Remove the back, then the front section of the Tibial Fracture Brace.

Wear Schedule:

Wear the orthosis as prescribed by the physician and follow physician orders for weight bearing on the injured leg.

Bathing:

When the physician has given permission to clean the leg, or to change the stocking, follow instructions for removal of the brace. Gently clean and dry the leg, then reapply the brace with a clean stocking. Never apply the brace over wet or damp skin.

Care & Maintenance:

  • Spray the inside with rubbing alcohol, and wipe it dry in order to remove body oils and residue. Wiping it out with a damp towel and anti-bacterial soap, or anti-bacterial moist towelettes also works.
  • Wash the cotton stocking in cold water and air dry or machine dry on low.
  • Keep the brace away from excessive heat to prevent damage to the plastic.

Tips & Problem Solving:

  • The orthosis should not irritate the skin. Visually inspect the skin often (having someone help if necessary), and report all suspected problems to the orthotist.
  • Braces will differ slightly depending on the manufacturer. Follow the orthotist instructions for the particular brace.
  • The brace should be worn tight, but not so tight as to be uncomfortable.
  • Do not remove the brace unless instructed to do so by a physician or orthotist.
  • Direct any problems, questions or concerns about the brace to an orthotist.

 

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