Cosmetic covering or not? A couple other questions

[greyhnd]

Hi folks. Hope everyone is doing well this fine day.

I'm hopefully going to be casted for a new "inside" liner in the next few weeks. Either that or an entirely new socket which will be decided when I see my prosthetist. I currently have the leg covered in the cosmetic skin. It's the type that almost feels like vinyl and not that hosiery type. I don't have a concern about people seeing the inner workings of my leg and it seems to me the "skin" is easily damaged. I'm sure the women might be more concerned about the look than men, but are there really any benefits to the covering? Or is this a matter of personal preference?

Now my other question. My prosthesis has a hard outer shell with another more flexible insert inside. Then I also use a liner to cover and protect my stump. This setup reduces the amount of knee bend I can get as well as pinching and bunching my liner causing sore spots above my knee. My residual limb is about 7 inches long and there has to be a better type socket than this hard shell I have now. It this type the standard type socket or should I talk to my prosthetist about a different type socket if one is available? Does anyone know what I'm talking about or maybe experience the same type thing?

Any suggestions are appreciated and more than welcome.

Marc Flenar (greyhnd)

[happyem]

Hi Marc,
I'm not as experienced as some members of this forum, so hopefully you'll get some other responses. As far as I'm aware the decision about cosmetic coverings is an entirely personal one. I don't have a cosmesis on my leg. I walk a bit funny, some days I use a stick, or crutches. For me, showing people that my leg is a prosthesis stops all the usual "you been in the wars?" Or "what have you done to yourself?" type questions. The questions do of course come later if I'm spending much time around that person, but people don't tend to come out with them in the same casual way that they do f they think you've sprained an ankle. I'm also, in a funny way, quite proud of my prosthesis. For me it represents how far I've come. It's been a long, tough journey to get here, and I have I fake leg with some fairly funky kit in it. I'm going to show it off, it's a marvel of modern technology and its a hell of a lot more functional than the messed up foot and ankle I had before. However, I didn't always feel this way. My first leg came complete with NHS 'skin tone' covering because I was still worried about scaring small children and how people might react. It took me a while (and some fairly robust support from my partner, who doesn't do social niceties) before I felt so confident. By the way, small children seem to think my leg is pretty cool too.

As far as sockets are concerned, I have a similar set up to you, by the sounds of it. My understanding (from my fairly limited experience) is that the socket itself needs to be pretty robust and, as you describe, a hard shell, to cope with what you're demanding of it when you walk, stand, sit, twist,and maybe even run and jump in it. I've had similar issues with not being able to bend my knee, partly alleviated by my prosthetist taking the socket down a little at the back, but I think they are generally reluctant to take it down too far because it can compromise your stability. There are liners available that are thicker at the end of your stump and thinner higher up, allowing you to bend your knee more easily, so it might be worth asking your prosthetist about that.

Finally, if you're getting sore spots anywhere, I'd advise you to see your prosthetist. Our stumps are precious and need taking care of; the last thing you need is a couple of sore spots getting so much worse that you end up being unable to wear your leg.

Good luck with it all, it's a steep learning curve at first but it does get easier

[allenuk]

Marc: As Em says, cosmetic coverings really are a personal thing, and as far as I know, have no affect on your prosthesis - or shouldn't, anyway.

I'm old and grey, and haven't been over-troubled by appearance for some decades, so I don't bother trying to conceal my one-leggedness, but I can understand that younger people see it as important. If it doesn't bother you, don't bother wearing one. It's just one more bit of (expensive) clutter!

Far MORE important is this bunching business. The outer socket has got to be as hard as steel. Not only has it got to support your standing weight, it's got to do the same job if you're walking, running, jumping, whatever. No compromise is possible. The inner liner, the one that contacts your skin, is different. Most are on similar principles, whether 'pin-lock' (which have a metal rod sticking out of their base), or plain, used in suction sockets. I've had all sorts of inner liners, thicker and thinner - there is a point where they get TOO thick, and you lose stability. Too thin, and your residual bone bangs up against the hard outer liner, and that is painful.

I had trouble with too much going on behind my knee at one point, and it was very easily solved by my prosthetist cutting about 1/2 an inch of hard socket from that position. Made no difference to stability or walking, but made ALL the difference to cycling, enabling me to bend my leg enough to pedal. Again, there is a compromise involved here. Cut too much away and you WILL lose stability, but when they first make your leg, they seem to err on the side of caution, and make that back wall of the socket a bit higher than necessary. It is ONLY that back well - you definitely need the 'wings' on either side of your knee, and the bit that goes over your knee-cap. A good prosthetist will solve the problem in half an hour!

A 7 inch residual limb is fairly normal, by the way. People who have had bad accidents can end up with much shorter stumps, and they DO cause problems for prosthetists and for the poor user.

When you say 'there has to be a better type socket', millions of BKAs would agree, but no-one's got round to inventing it yet. Much of the research has been into AKAs problems, which are of course greater, lacking a knee joint, and into feet - not just running blades, but 'proper' ordinary feet like the Echelon. BKA socket research seems to lag behind.

Good luck with the recasting - make a list of all your questions before you see your prothetist.


Allen, bka, London.

[greyhnd]

Thank you for the responses folks. I think as far as the cosmetic covering I'll do without it this next go round. I'm not concerned about how it looks to other people, I'm concerned about how it performs.

I took a real close look at my leg and to me it appears as though the hard outer shell is cut down enough at the back of my knee. The inner liner that attaches to the shell looks to me to be the culprit causing the bunching and pinching of my "seal-in" liner that rolls up on my stump. It doesn't have much give at the back. I'm afraid I'm not describing it properly so you folks know what I mean. None the less, I'll need to address that issue when I have my appointment.

[allenuk]

You might be right about the bunching, greyhnd - or it could be a combination, i.e. the back wall being a little too high, and that causing the liner to bunch. Liners, of course, have to go on up past your knee, or rather they always do in my experience. As you're seeing your man in the next few weeks, I fear you'll have to be patient a little longer!


A

[ann-]

Hi Greyhnd, just reading what you say about the problems with your liner bunching behind the knee.
There are different types of set ups for below knee amps, its really finding the one that suits you best, most though tend to rely on either a liner or socks and a hard shell, but there are different types of liners, different thicknesses etc. etc., so perhaps you need to discuss this with your man at your next appointment and let him know the difficulties you are having. But as Allen says 7 inches is a decent length, so he may be able to cut the outer shell a bit lower for you, or it could be that you just need to persevere with it a bit longer. I am bilateral and wear a thick liner on one side, I do find the bulk behind the knee slightly restricting, but now nowhere near as restricting as the first six months or so I had it. Check also though the sleeves that your wearing, although they need to be secure they also might be a bit too tight round the knee area. As Allen says, the liners do have to go above your knee, but the way you position the sleeve height could also be a factor, I find I need a bit of room between the top of the liner and the sleeve for it to hold it on comfortably, otherwise the sleeve can also become baggy round the knee. My liner is pretty thick and after a while tends to roll, so I start at a level which is probably slightly higher than I would prefer then usually end up trimming it down a bit.

Personally, if my stump was in good condition I probably wouldn't opt for a liner as sometimes they cause added problems. As I said am bilateral and one side I wear a liner and one side socks, I hold both on with a sleeve and don't really have too many problems with that set up. One of my stumps is probably around the same length as yours and that is the side I wear socks, but find if the socket is fitting me right, I can almost hold the prosthesis on with my stump, I do of course wear a sleeve but the leg itself is pretty secure. Would also say the side with the socks has less problems with sweating and gives me much more knee flexibility, which is partly why I prefer keep to the socks.

The cosmetic covering is more a personal choice, though shouldn't cause any more extra problems with the bunching behind the knee. I do prefer to go for covering, just foam and stocking, mainly because I am so used to prostheses looking like legs, i see my prostheses as my legs and do tend to call them my legs,know that sounds weird, and do realize they are prosthetic, but when I wear them they are like part of me. Funnily enough though I did try silicone covers about a year or so ago and actually didn't like them, found them heavier and also they didn't look like 'my legs', so its all down to what you want really, though worryingly I am now hearing that some amps in the UK sometimes can't get covers routinely provided, but that's a whole other thread.

[greyhnd]

Allen - You are right, I'll have to tough it out until my appointment gets here. My liner does roll up on my thigh about 6 inches above the knee. This is my 4th prosthesis since 2006 and this is the first time I've had problems of this kind. Seems like a lot of legs, but after I had a revision surgery I was refitted.

Ann - I have a friend that uses only socks instead of a liner. He says it's quite comfortable and has no issues with the fit. This is the first time I've used the Ossur Seal-in wave type liner, and I wonder if perhaps it isn't the best type for me. The surgeon who did my revision told me I'm thin skinned so I also wonder if that might be part of the reason for the skin irritation problems I've been having. Just another thing I need to talk to my man about.