Nylon Socket

[kapteenkoukku]

Question for Ted:

I have been trying to get my socket right for 10 months now.

I made a new leg last December, Variflex foot, shuttle lock/ pin system with Ossur Liner and first socket that I requested was carbon fibre. The cast was made with bladder pressure on plaster of paris. The socket was first quite fit, but as I previously had PTB supracondylar socket the shape & volume of my stump changed rapidly after starting to wear the liner, just in few months and the socket was getting loose.

So I asked to make a new socket. To make a new socket I had to pay for it. New bladder casting was done and to my disappointment it was no more carbon fibre, it was nylon socket and furthermore it was not that much tighter than the first one. I tested it in the prosthetic clinic, but the testing time was too short and already on my way home I realised the socket is dangerously wobbly as it was flexing too much on the top. I got home and phoned my old prosthetist that is it possible for me to change back to old socket myself, he gave instructions and I did it plus got the alignment right. I could not have gone to work with so wobbly socket the following Monday. I phoned to my (new) prosthetist that the socket flexes too much and is too soft and she asked me to come back.

I went back and she reinforced the the nylon socket with carbon fibre, it got quite thick. After walking with it I felt it still wobbly but less than before and started thinking that it should be higher like PTB socket to give more stability. I changed back to the first carbon fibre again because it felt better and less wobbly and I liked it being rigid. I phoned again the prosthetist and told what I think, she asked me to come back.

Again we took a cast with the bladder. Once the socket was ready I went back to install it to my leg. And it was true the higher socket gave me the stability that I wanted but to my disappointment again it was a nylon socket. Now I have been on this socket for couple of weeks, yes, it is much more stable but I feel that the top part has stretched making the top loose while the bottom is just nice and fit. I also now have the patellar bar as I asked for it.

I am already hesitant going back after so many changes, but I really want my socket to be fit enough so that I can run for some distance, at least to catch a bus. I do not trust the fit to be good enough for running and indeed is still wobbly at the end of the day after some volume change even though I add three four-ply Ossur socks.

I would like to ask what could be the rectification for this:

1. Add thickness of the socket on the top rims on inner side of socket and increase the depth/ thicness of patellar bar.

2. Reinforce it with carbon fibre and add the thickess as above.

3. Make again a whole new socket, this time of carbon fibre.

Also, I like to ask you opinion on nylon socket, to me it is just not rigid enough. Can it stretch and become wider on the top in use because of its softness or am I just imagining??

I like that it is now higher, stability improved, but there is still room to improve as it wobbles until the extent that the higher wall stops the wobble.

And why they are so keen on pushing that nylon socket instead of carbon fibre, is it price of material? My original was carbon fibre, so why not stay with it.

And one more question; does something happen to the fitness during the process of male cast drying and fabricating the socket causing the socket still not be "glove fit" despite the pressure used in bladder exceeded the normal, prostetist told me that if she increases any more pressure it might burst. The reason of high pressure was to get the tight fit, so much so that it was difficult to get the cast off the stump.

When I asked why they do not use direct method with carbon fibre direct on the stump, the answer was that they do not have enough experience on it.

[tedatrowercpo]

Oct 10, 2009 19:27:48 GMT -7 kapteenkoukku said:

Question for Ted:

I like to ask you opinion on nylon socket, to me it is just not rigid enough. Can it stretch and become wider on the top in use because of its softness or am I just imagining??

First off I don't think your socket is nylon. It could be nylon fabric in a resin lamination but I'm wondering if it isn't a thermoplastic socket of either polypropylene or a polypropylene/polyethylene co-polymer. These would have a white appearance quite similar to nylon. None of these would stretch thru the day without remaining permanently distorted. The thermoplastic socket might soften a bit with environmental and body heat but the effect wouldn't likely be very great.

Oct 10, 2009 19:27:48 GMT -7 kapteenkoukku said:

I like that it is now higher, stability improved, but there is still room to improve as it wobbles until the extent that the higher wall stops the wobble.

And why they are so keen on pushing that nylon socket instead of carbon fibre, is it price of material? My original was carbon fibre, so why not stay with it.

There is certainly a difference in the price. In addition many prosthetists dislike working with carbon fiber products due to the irritating nature of the material when it is cut, ground and shaped. There are a few prosthetists who claim that carbon fiber is a carcinogen but I've looked into that myself and there just isn't any evidence to support that.

Oct 10, 2009 19:27:48 GMT -7 kapteenkoukku said:

And one more question; does something happen to the fitness during the process of male cast drying and fabricating the socket causing the socket still not be "glove fit" despite the pressure used in bladder exceeded the normal, prostetist told me that if she increases any more pressure it might burst. The reason of high pressure was to get the tight fit, so much so that it was difficult to get the cast off the stump.
it.

Any loss of accuracy in the cast probably occurred when the cast was removed. You state that removal was difficult. At that point the cast is still "green", not fully set and rigid.

[kapteenkoukku]

Thanks Ted,

I am getting to understand some of these things.

1. I understand that the socket is nylon laminate. It is of skin colour. And now I understand that if it is laminate it would not stretch. I also get to think fromn your point three answer that the top part of the socket got wider when removed from my stump in first place as it was very tight (not pulling it straight out but trying to free it by opening the top part by moving up-down/ sideways left-right. I would like to add that this socket's wall is quite thin. My old prosthetist did fiberglass laminate, it was more rigid, but he made it also thicker, some parts more some parts less.

2. Ok, now I understand why nylon and not carbon fibre.

3. So we had to wobble the cast out and thats why the top part got a bit too wide. I understand.

I spoke to my prosthetist today, I am going to see her on 31/10/09 or earlier if I can get one weekday off the work. Am I now right to say that what I suggested and she agreed that we add some pelite strips on the top edges of the socket and the patellar bar to stabilise it more?? Now that I got the answer that the material does not stretch (I got the same answer for stretching from your-good-self and from her as well).

P.S. This place where I am going now is ok, but I am used to my old prosthetist who has over 40 years experience making sockets and legs for people and he is really good. The reason I changed was the price as I get subsidy from new place as it is Government hospital run. Another reason is that the boss of my old prosthetist is a greedy crook who lies bout the origin of the materials he uses. I am now paying half of the crook's price for same components (the subsidy is not that much). And he is not prosthetist himself. I keep in touch with my old prosthetist all the time because I know there is none as good as he is in Singapore, he has commitment. He also understands why I switched and we are kind of friends because I am not shy telling people that he is the best and he knows it. Well, I just have to be patient with these younger people, I think we are getting there.

Thanks so much to you Ted.

[kapteenkoukku]

I have now got some fillers for my socket which are of material that looks the same as the pelite liner I used in my old socket.The filler is at the brim on outer side extending about 5 cm downwards from the brim and another filler on the patellar bar. The socket became more stable with that but is not perfect. I am adding two (2) 3-ply filler socks at the first donning in the morning and around noon I add the third one. Isn't this a bit too much for a new socket? And sometimes I feel wobbly with this arrangement at the end of the day, particularly if I am dehydrated that day.

I do have daily fluctuation on my stump, but if I could get a snug fit in the morning with plain liner without fillers then I would need to wear less fillers at the end of the day or could be better able to adjust for that dehydration day.

That fluctuation thing:

I work in an office where the aircon is always set to too low temperature, that is part of the dehydration I believe. The strange thing is that during weekends at home where we never use aircon my stump does not fluctuate so much.

Then I am trying to keep the volume up whilst in my office to avoid socket becoming wobbly by removing my leg if I know that I am going to sit at my desk for some time. Also, not very good way of keeping the volume up is to over-eat which I just do in fear that I need to go to prosthetist to make again a new socket if I lose weight. I would like to lose weight as I believe the fluctuation is due to having excess body weight. So I kind of feel of being in a treadmill; if I lose weight I again need to have a new socket made and there has been so many attempts of getting the socket right that it is becoming embarassing. I am not grossly overweight, I just have that beer belly and enjoy good food too much and having an excuse of keeping the belly to keep the stump volume up. I am 180 cm with weight around 85 kg or a little more which is 10 kg over of that 75 kg I used to be not too long ago.

Now I am thinking again that I should get that Ossur carbon fibre socket that is made directly to the stump. I may be travelling to Finland for a summer break next summer and been thinking to make it in there since in Singapore nobody wants to make a socket with that method for whatever reason, the biggest centre says they have no experience. I will have to study whether I as a non-resident Finn can get subsidy for the socket.

Would like comments from Ted or anyone else to my story above.

[allenuk]

Jukka: I think you are on the right lines, i.e. about trying to modify YOU as well as the socket, but overall weight loss or gain probably isn't an easy answer: too slow, and too likely to cause other problems.

Fluid is a different thing. You might need a consultant-level dietician on this one, someone with the intelligence and imagination to go with you as you experiment. I should imagine that the sisters amongst us could give you more accurate guesses as to the effect of increased and decreased fluid retention over their natural cycles.

Carbohydrate consumption, particularly refined carbs or more pure glucose, affect individuals differently; crudely if you are urinating more or less, then your internal fluids are probably fluctuating in the same relationship, and these might well translate into a thick sock (or more) at your stump. But these are just 'intelligent' observations over the years. As I say, you need someone more expert than me.


Allen.

[kapteenkoukku]

Hi Allen,

Thanks for your comments.

I agree with you that modifying the body is slower than modifying the socket however I have certain things on my side on reducing the weight which I think would reduce the fluctuation of the volume of the stump. It is just that I am in the treadmill of keeping the volume up in avoidance of making a new socket again.

The main thing that is on my side in weight reduction is high metabolic rate that I have inherited from my father. I urinate much, perspire easily and and I move my bowels easily & regularly in large quantity. That would help in not so difficult weight reduction if I just get out of the cycle of trying to keep the weight and go back to what I used to do before: systematically burning the calories, carbs, etc. by way of routine exercise. A couple of years ago I cycled every Sunday at least 50 km in Singapore's hot & humid climate, swam, did routine push-ups and other similar exercises. At the moment I do not have such routines, but out of a habit I am a brisk walker with or without perfect fit of the socket so much so that most of the two-legged do not want to walk with me. But this walking what I do nowadays is just my daily transportation. One more thing on my side is that I eat quite healthily, I rarely consume read meat, I love vegetables, herbs, fish and fruits. I also like bread & cheese but the bread that I eat is not white wheat, it is mostly dark bread and very much of wholemeal rye that my wife bakes. My increased body mass or weight must be because of my social routine "after-work two glasses of beer" in combination of reduced exercise. The same type of beer consumption did not affect my body weight/ mass at all when I did my regular exercises.

I believe that if I get back to my old regime of keeping fit the stump volume fluctuation would reduce as there would be less to fluctuate from. But that change of the socket again and uncertainty whether it goes right ...

I think an indication of excess fluctuation due to overnight fluid retention is that it acts at a bony part, around my knee area at the top of the socket. Although flabby, my stump at the bottom and overall is quite small and shrunken to what it can get. The knee area fluctuation means that the stability is reduced at the end of the day and I do not like it at all because I like to move fast and not not feel clumsy (wobbly) where ever I move.

I think the key is to get the socket to be very snug fit in first place so that there is some allowance for body mass reduction without making the socket very wobbly again. So embarrassing, so embarrassing for showing repeated dissatisfaction of the result of new socket, like being a difficult and over-demanding customer ...

Rgds,

Jukka

[allenuk]

Jukka:

If you don't already do it, keep a diary – (or maybe a log in your nautical case)

– mainly to watch food and drink intake, plus whatever exercise you do manage, and see if it relates to stump comfort. It's possible you'll find a combination which starts to get your stump back into synch with your socket.

Or move back to Finland. Less monsoons.

Allen.

[kapteenkoukku]

Thanks for your thoughts Allen,

I used to keep a record book on my cycling. I have this CatEye speedometer and I transferred the readings of trip distance, average speed, top speed, time spent, etc. to my record book.

For food intake it would be difficult to take records unless one has a boring diet. My wife is a very good cook and I never know what kind of surprise is waiting for me when I come home from work. But it is all healthy.

I do not think it would be a good idea to go and stay in a Northern cold place after very long time in tropics. The tropical weather itself adds to the quality of life. Monsoon season is much less disruptive or limiting to outdoor activities than winter is.

By the way; after I wrote my last post yesterday I went swimming to nearby pool and did 1.5 kilometres. When I came back my son, wife and myself exchanged the Christmas gifts. I got CCR collection from my son & wife and did some more exercise by dancing to CCR's tones. Here some clips:

www.dropshots.com/jukka#date/2008-12-25/21:30:32

www.dropshots.com/jukka#date/2008-12-25/21:31:34

Hope you have a good laugh old hippy era guy dancing.

Jukka

[allenuk]

Jukka: only just got round to watching your epic dance routine. Amazing, for all sorts of reasons.

Thoughts: if you can still move around like that without cursing and screaming as your socket tries to take lumps out of your stump, you ain't doing badly. When I'm just moving around the room doing housework, every time I turn through 180 degrees I wince with pain. So whatever your socket is made of, I would hang on to it if I were you!

Yes, your diet and general lifestyle sound exceptionally healthy, and would put most of us in the west (US/UK etc.) to shame. I'm glad you're still trying to improve matters, but looks to me as if you're starting from a pretty high base.

Best wishes for 2010.

PS why did you have the lights off when you did your dance, or is the answer too obvious?


Allen, bka, London, not a dancer.

[kapteenkoukku]

Dec 30, 2009 7:12:02 GMT -7 allenuk said:

PS why did you have the lights off when you did your dance, or is the answer too obvious?

My son took the video with normal digital camera that has only 4.1 megapixels. Maybe that is why there is not enough light in video picture. And it was in artificial light on Christmas Eve.

Some people run with their prosthetic leg so those must have better fitting socket than I have since mine is not fit enough for running. I do not like jogging but I would like to catch a bus sometimes.

Happy New Year of 2010.

Jukka