"Applied Physics 101"

[snarfler]

My look at All the lovely options. Right then, back to work. I don't think I've got it quite right yet as I don't sdee the photo. I will try again

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[snarfler]

I see it now then. Here we go. This is the White flexible insert you should try to avoid. Used them twice with no success.

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[allenuk]

Yes, precisely what my inner liner is made of. And like you, not with any success.

Cherylm - is that the stuff you're talking about?

I know you're right, snarfier - ideally, my socket should fit more accurately round the bottom end of my stump, then I wouldn't need bits of falsies or gels ( and they don't work well, either!)

Allen

[snarfler]

Here we have the Pe-Lite insert. Notice the higher density added to the bottom for distal support. Next photo, I have pulled the leather down for display purpose. The problem with the silicone insert is that you need a heat gun to make adjustments which you rarely get right. Pe-Lite is simply sanded or if you need to add to a spot you glue on more Pe-Lite with contact cement

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[snarfler]

Now a straight in shot. You can see the anatomy. The Pe-Lite and leather have conformed to every bump. It would be similar to a shoe with a good quality insole. It's smooth at first but in a weeks time it conforms to your shape. Ta Ta's (Bolt on) and such were not designed to conform but to retain a specific shape. You must focus on products designed to conform to your anatomy. In Engineering it's called, "Rigid Flexibility"

[snarfler]

Feb 19, 2014 14:20:04 GMT -7 snarfler said:

Now a straight in shot. You can see the anatomy. The Pe-Lite and leather have conformed to every bump. It would be similar to a shoe with a good quality insole. It's smooth at first but in a weeks time it conforms to your shape. Ta Ta's (Bolt on) and such were not designed to conform but to retain a specific shape. You must focus on products designed to conform to your anatomy. In Engineering it's called, "Rigid Flexibility"

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[ann-]

Thanks for the pics Snarfler, could see them ok.

What you have explained goes what I have learned from the sockets I wear, in that my stump actually changes to fit the socket and after a few weeks/months etc of wearing takes on a different shape.

Have now been told that virtually all our sockets and liners we are given here are designed to be total surface bearing, which includes taking weight on the bottom of the stump, which is the main problem I am experiencing. There doesn't seem to be any option on this though.

I've been walking on prosthetics for a lot of years now and it seems these problems have mainly begun since the introduction of TSB type sockets and remembering back to when I first became an amputee was told that I should 'never bear weight' on the end ........ the old PTB's that were made of aluminium and leather took weight round the knee area and left the rest of leg sort of free floating in the socket to some extent, which seemed to work better for me.

I'd really like to know how prosthetics .... sockets in particular are made in other countries and if they are made differently to how they seem to be being made now in the UK, or whether this is just a fitting problem.

[allenuk]

Apart from the technical advice, snarfier, you are exposing one weakness of state-provided health care (like our NHS).

Great for being FREE (apart from what we pay through our taxes of course), but when it comes to choice of prosthetics, it gets limited to what the NHS supplies. You can argue the case (for example) for a special type of foot (an Echelon, in my case), or a special type of running foot, or leg, and get them, but changing their way of casting and fitting prostheses is probably a bit too radical. Point being that we're stuck with our total contact systems, and have to try and work within that framework.

If we go private in this country (which we can if we're rich enough) we can pick and choose a bit more, but even then the prosthetists tend to be ex-NHS trained, so similarly set in that way of working).

A.

[snarfler]

Now now. I'm sure the NHS is acting in your best interests. It's only slightly better in the US in that we pay an insurance company who then dictates coverage. Our only choice is in the quality of coverage we select. With the communists now in power that may all change as we're being forced to purchase a type of National (Nazi) policy which will only leave us all with the worst of coverage.

The only thing wrong with a full contact socket is that in time as you shrink you will be placing too much weight on the distal area. When this occurs you can apply Moleskin to the PTB and lift yourself up a bit. Meanwhile if you should develop a sore spot in your socket, here's a very simple way to identify the problem.

Don your liner. Now apply masking tape over the sore area. Now press with your thumb to find the sorest spot. Now apply a liberal amount of Super High Pigmentation Pressure Sensitive Transfer Medium (lipstick) to the offended area. Don you leg. Wiggle. Remove your leg and examine the socket for the Lipstick spot. If the spot on your leg is Red, then you want to remove from the socket. If the spot is Purple  then you want to add to it.

[snarfler]

Here's another possible fix. Purchase a roll of 1/16 cork gasket material at any auto parts store. Cut a piece in the shape of a bow tie. Sand the edges. Glue it in place across the anterior  PTB with contact cement. If it doesn't lift you enough, cut another piece in the shape of a W and affix to the posterior of the socket as well.

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[allenuk]

Feb 20, 2014 17:39:14 GMT -7 snarfler said:

....With the communists now in power that may all change as we're being forced to purchase a type of National (Nazi) policy which will only leave us all with the worst of coverage.

Blimey, that was a quiet revolution. Not a word about it in the British press - perhaps they're trying to keep it quiet in case we launch our own Bay of Pigs to liberate our American cousins from a fate worse than death.

(Do Americans REALLY not do irony?)

A

[snarfler]

I always find it amusing when a foreigner tries to understand American politics. Yes. Our current President, (insert his name here. I can't or I'll be put on a list of subversive international "T" words) is a Communist. He is very popular among the dead as 1.8 Million dead people voted for him twice. In fact, the president is not elected by the people but a group known as The Electoral College.

Our Civil Rights once held sacred under the Constitution are being taken away. If you drive down a road you may be held at a police checkpoint. If they want, they can kick in your door, search your house, arrest you and put you in prison for as long as they wish. Without just cause or even a formal charge. No lawyer. No phone call.

Meanwhile, Our phones are tapped. Emails are monitored along with all social media. The government has stockpiled more than One Million plastic caskets. Each with the capacity to hold Four dead adults and built interment camps on military bases all across the country designed to house entire family's. But fear not.

They still need to contend with the 80 Million well armed citizens. They are working hard to try and disarm us. Going so far as to make large purchases of ammunition by federal agency's (1.7 Million rounds) that don't use weapons to make it scarce and expensive.

Who can say where it's all heading. I think it will all depend on the election in 2016 but most people feel an armed revolution

[allenuk]

Ah well, maybe it's all a question of definitions then.

I'll just wear a big hat.

A

[allenuk]

Feb 17, 2014 4:36:36 GMT -7 ann- said:

Well, I got new peanut butter from a revision and reconstruction ... which might bit more radical than you are wanting Allen. It was done for slightly different reasons, but that side is now much less problematic to fit, though of course is somewhat shorter.

Thinking back, I've realised that I gave up trying to make my leg comfortable about 4 years ago, which is when I started cycling.

Cop-out, of course. Cycling is fine, as far as it goes (which in my case is to the hospital, clinic, wherever within a 10 mile radius I need to go), but it is solitary. My partner and me used to enjoy trips down to Kew Gardens, and we haven't done that for years (as you have to walk when you get there).

So, I'm going to have more of a push on this latest new (pin-lock as usual) leg, and try and get it to be more comfortable, at least enough to walk without wincing.

Certainly don't want revision surgery. I heal well, but slowly, so it would knock another year or so off my ever-shortening life-span!


A

[snarfler]

So we cut the Pe-Lite or cork into the shape of a Bowtie, The reason becomes apparent. Coat this and the socket area with a thin layer of contact cement. Apply when ready. Note the condition of the old socket after having been repaired many times over the years.

I've just heard the communists have installed party members in all the major newsrooms to monitor and censure any information regarding "Little Stalin". We already have to tune in BBC to get the truth.

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[allenuk]

Having a new leg made at present - I discussed the business of PTB/pinlock with my prosthetist, and he agreed with you, at least to the extent that he thinks pinlock (and the total contact that goes along with it) doesn't suit everyone.

What he's trying this time with me is a compromise, taking (hopefully) the best of each. So it's a pinlock, which I prefer (tried suction, not keen), but only NEARLY total contact. Where my painful bit of front stump contacts the socket, he's pt in an old-fashioned 'bulge' leaving a hole. When I tried it with the test socket I could see what he'd done (test socket being transparent), and it felt marvellous. Enough contact everywhere else, side of knees, front of stump, etc., even a bit around the base, but nowhere near my painful bit.

I'll report back in a couple of weeks when I get the finished leg. Oh, one other change - I've been using an Echelon for some years, but my weight is now banging up against Echelon's top limit, so he's giving me a different type of foot (name currently escapes me) but when I walked with the test socket, the foot felt great, too - it rolled through like an Echelon, using some sort of rubber coupling rather than Echelon's series of hydraulic shunts. Again, I'll report more fully on the Echelon/other foot, plus I'll get the proper name!

I still think the Echelon is a marvellous invention, but it does give 125kg as an upper limit, and once it hits that point, it is a bit harder to control.

A.

[SteveInMd]

Mar 8, 2014 8:32:38 GMT -7 allenuk said:

Having a new leg made at present - I discussed the business of PTB/pinlock with my prosthetist, and he agreed with you, at least to the extent that he thinks pinlock (and the total contact that goes along with it) doesn't suit everyone.

What he's trying this time with me is a compromise, taking (hopefully) the best of each. So it's a pinlock, which I prefer (tried suction, not keen), but only NEARLY total contact. Where my painful bit of front stump contacts the socket, he's pt in an old-fashioned 'bulge' leaving a hole. When I tried it with the test socket I could see what he'd done (test socket being transparent), and it felt marvellous. Enough contact everywhere else, side of knees, front of stump, etc., even a bit around the base, but nowhere near my painful bit.

....
A.

Allen,

I'm really pleased with your news.  I'm glad to hear the NHS system has some flexibility in their approach.
My own first (disastrous) socket was temporarily fixed also by his grinding a hole through the front, at the end of the tibia.  This was done just temporarily while a new socket was being made, but it made such a great improvement that I was ambivalent about actually taking the second socket.
 
A nice bonus to the hole there is that if the pin isn't going into the lock, you can poke a finger in to guide it in.  

I have little to contribute on feet, as all I've had so far are (inadequate and inappropriate) SACH feet (Solid Ankle Cushioned Heel, for those readers new to all this).  On that, using a significantly undersized foot was really helpful, as my own natural foot is big.  Because that reduces weight at the most weight-sensitive region, I'm likely to request an undersized foot whenever I upgrade to a more sophisticated mechanical foot.

Best wishes,

Steve

[allenuk]

In my case I'm not having a full-out 'hole', rather a bulge and a void. He wants to retain strength around the top of the umbrella. And feet, well I'm in two minds about the importance of feet, Steve. While they obviously play a big part, I can vouch from experience that having a top-notch foot (over here the Echelon costs something in the region of £4500, so about $6000-plus), it doesn't make up for an ill-fitting socket!

Conversely, when I was first amputated, and walking 20 miles a week almost pain-free, it was on a bog-standard foot that they issue to all new amps. Dead basic, cost equivalent about £400. And I went up hills, down hills, along fields, roads, everywhere, without complaint. Yes, I knew that sharp slopes would have been easier with an Echelon, but by the time I DID get an Echelon the socket was such a poor fit that I couldn't walk more than a few hundred yards.

The socket is still key to overall comfort. The foot is useful, and a badly-aligned foot can be painful, of course. But I met a guy at my prosthetic clinic a month or so back who was using a CRUTCH base in place of his foot, which had broken. He just sawed the bottom few inches from his aluminium crutch, and fixed it into the place where the pylon should have gone! And he claimed it was quite comfortable once he'd got used to it.