Q. How long does it take to get my prosthesis after my amputation has been performed?
A. While still in the hospital you may be fit with a protector (IPOP – immediate post operative prosthesis) shortly after your amputation surgery to help protect your limb as it heals. This is not meant to walk on and is a temporary device used during the healing stage. Your residual limb will need to be well healed before beginning the process of fitting you with your final prosthesis to ensure that an optimal fit is achieved.
Once your suture line has closed and the staples have been removed, you will likely be fit with a “shrinker,” a compression type sleeve that is worn on your residual limb throughout the day to further promote final healing and help manage edema, while also shaping the limb to prepare for prosthetic fitting. This usually takes six to eight weeks.
An initial consultation will be done with a clinic practitioner to evaluate the limb and discuss prosthetic design options specific to your individual needs. Once your residual limb is ready to begin the prosthetic fitting process, a cast and measurements will be taken of your residual limb to be used to fabricate a custom shaped test socket. A test socket will ensure a proper fit is achieved prior to making your final (definitive) prosthesis.
Q. What is the difference between a test socket and a definitive socket?
A. A test socket is fabricated using a heat moldable clear plastic that allows the practitioner to see the pressures within the socket and allows for adjustments to optimize the fit This is meant for diagnostic use and is not safe for long term daily use. Your definitive socket is fabricated using ultra-light material, such as carbon fiber and resin, to yield a light weight, but durable socket to withstand everyday use. The definitive socket can be finished with a skin color or a design of your choosing, such as your favorite sports team.
Q. What are the different parts of a prosthesis?
A. Below Knee (BK):
- Socket – The section that fits directly on your residual limb. This is custom shaped to match the contours of your residual limb. A properly fit socket will contribute to your ability to wear the prosthesis without pain or skin breakdown.
- Pylon – The “shin” of the prosthesis. A tube, typically constructed from aluminum, titanium, or stainless steel, that connects the socket to the prosthetic foot.
- Foot – Various designs are available based on activity level and individual needs. Such designs include: SACH (solid ankle cushioned heel), composite fiber, carbon fiber, etc.
Above Knee (AK):
- Socket
- Pylon – Connects the prosthetic knee to the prosthetic foot and also connect the socket to the prosthetic knee.
- Knee – Various designs are available based on activity level and individual needs. Such options include: mechanical, locking, hydraulic, microprocessor, etc.
- Foot
Upper Extremity (Transradial/Transhumeral):
- An upper extremity prosthesis typically includes a socket connected to a harness and cable system that requires body movement to open and close a terminal device such as a hand or hook. Microprocessor devices can also be fit that use muscle contraction to operate a terminal device. Custom silicone prosthesis can be used for partial hands or digit amputation(s).
Q. Can I change the shoe I wear with my prosthesis?
A. Yes and no. You can change the sock and shoe on your prosthetic foot. However, certain footwear may not be safe (i.e. flip flops, high heels, etc.) and/or may affect the alignment of your prosthesis, causing discomfort and making it difficult to ambulate with the prosthesis. A supportive athletic shoe is suggested for new amputees to improve balance and stability while learning to use your prosthesis. Your prosthetist will align the prosthesis to mirror your sound limb and promote a smooth, comfortable gait.
Q. How often can I get a new prosthesis/orthosis?
A. This varies depending on the fit of your current prosthesis/orthosis, if certain qualifications are met, and your insurance coverage. Some insurances will only allow a certain quantity in a particular time frame.
During your first year with your new prosthesis, your residual limb will likely exhibit the greatest reduction in volume and will require socket adjustments. At a certain point, your original socket will no longer fit the size and shape of your residual limb and a new cast will be taken of your residual limb to fabricate a new socket.
Q. Should my prosthesis/orthosis hurt when I stand and/or walk?
A. No. Pain can indicate the socket is not fitting properly and can lead to problems with gait, skin breakdown and wound development. Redness is a primary indication that your device is not fitting correctly. If you are experiencing redness or pain, please stop wearing your device and contact our clinic as soon as possible.
Q. How should my prosthesis fit on my residual limb?
The socket should be a snug, total contact fit. If there is gapping of any kind, this can lead to socket rotation, pain, and skin breakdown. Your residual limb will fluctuate volume throughout the day depending on your level of hydration, your level of activity, and other factors. You will be provided numerous prosthetic socks of different ply (thickness) to wear with your prosthesis.
When should I add a sock? If your socket feels “loose” or you feel pressure or see redness on the end of your residual limb. Socks are used as “space fillers” to take up empty space as the result of volume reduction. Socks are NOT used for cushion.
How do I know what thickness sock to add? You may have to experiment with various thicknesses or combinations depending on how your prosthesis fits and feels. Sock fit can change hour to hour, day to day. The right amount is when your prosthesis feels comfortable and no redness or skin breakdown is noted. The wrong amount is when your prosthesis is loose, you are experiencing discomfort or redness, or socket rotation occurs.
Q. Do I get to choose my prosthetic/orthotic device?
A. One of our practitioners will discuss various options. Our practitioners will provide their expertise to help guide you to select the most appropriate option to meet your goals and needs.
Q. Do I have to make an appointment to be seen?
A. No, we take walk-ins but encourage you to call and make an appointment to reduce your wait time and ensure a practitioner is available.
Q. How many appointments does it take to be fit with my final prosthesis?
A. Typically, three to five appointments.
- First visit: Initial evaluation, measuring, and casting.
- Second visit: Diagnostic test fitting. It is extremely important to make sure your socket fits properly and no changes need to be made. The test sockets are molded to fit your residual limb. The components are aligned for optimal function. Sometimes additional fittings are required.
- Third visit: Definitive fitting and delivery. Now it is time to take home your prosthesis and begin regaining your mobility.
- Fourth and additional visits: Follow-up. The overall fit and comfort is checked, and the alignment of your prosthesis can be fine-tuned. We also want to make sure you are feeling comfortable with the prosthesis and are not having any issues. A lot of information is thrown at you when being fit with your prosthesis and we want to be there for you during the learning process to make sure all your questions and concerns are being answered.
Q. Will I still need an assistive device such as a walker or cane?
A. An assistive device is encouraged during the initial use with your new prosthesis to assist in ambulating safely and efficiently. You can progress to using less or no assistance.
Q. How often can I get new diabetic shoes?
A. Most insurances will cover a new pair of diabetic shoes and inserts once a year.
Q. When do I need a referral from my doctor?
A. A new referral from your doctor is required when being provided a new device, supplies, or major repairs. We do not charge for an initial consultation, follow-up appointments, or minor adjustments. Our staff will notify you if a referral or payment is required prior to any services being provided.
Q. Can any health professional write a referral?
A. No. Insurances require your referral comes from a specific provider. Please contact our office for clarification for your specific insurance.
Diabetic shoes have specific requirements. For Medicare or equivalent Medicare replacement insurance plans you must be seen by your Primary Care Physician (PCP) for a diabetic foot exam and referral. Your PCP must have the credentials of an MD or DO. Please contact our office for further clarification to ensure the proper paperwork is obtained.
Q. Will I need physical therapy once fit with my prosthesis or orthosis?
A. Physical therapy can play an integral role in helping you regain your mobility.
Q. Where can I find more information?