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Post by allenuk on Oct 17, 2009 2:28:06 GMT -7
Hello.
Last week, I was fitted with a new liner (plus new socket), and as usual they are about 3 feet too long. So, after making sure it fitted, the prosthetist took it back to the workshop to chop some off the liner. No problem, but it is now two inches shorter than my last liner, and I was wondering whether this would make the new leg uncomfortable.
The new leg IS uncomfortable, but the man said it would be for a week or two, as it was cast in a slightly different way, to give more support from the knee area than the last one.
So, is my short liner a culprit, or should I ignore it? It SEEMS to be contributing to a bit of pistoning, but this might be because it is a 6mm, while the old one was a 4mm.
Any thoughts welcomed.
Allen, bka, London.
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Post by ann- on Oct 17, 2009 6:15:00 GMT -7
do you mean shorter in length Allen? or shorter as in thickness.
If the liner is thinner than the previous one, wearing it in the same socket I imagine might make a difference.
Regards length, I too wear an Alpha Liner (which I think works amazingly well, for me anyway) and have been advised not to trim them down too short above the knee.
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Post by allenuk on Oct 17, 2009 6:35:00 GMT -7
Hello Ann.
Yes, my message was a bit up and down, wasn't it.
Right. I had a new socket made, and as part of the re-casting my guy recommended we use a 6mm thick Alpha liner, as opposed to the 4mm which I had been using for some years (I'm heavier, I suppose).
So, come the new socket, he took the new liner out the back and chopped off some of the length, as they're always far too long. Result: my new 6mm liner is probably no longer than my stump socks. In fact some of my stump socks are LONGER than the liner, which I must say does sound a bit short.
I've never had any problems with the liner in 4+ years, but because it is a brand new socket I'm not sure whether it's the socket that's causing the slight pistoning, or the liner.
Did your people tell you why you shouldn't have too short a liner, i.e. what problems you might experience?
Thanks.
Allen.
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billf
New Member
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Post by billf on Oct 17, 2009 8:12:24 GMT -7
Allen: Assumption; that you are using a sleeve for sealing in the socket. With the long liner length, could you not be getting a good seal in regard to the pistioning you mention? I can attest that modifying the socket design, evidently trying to get more weight bearing support on the patella, AND going to a thicker liner can make a huge impact on what you feel as normal. You mention being uncomfortable, but not pain. You may be expierencing a dramatic change from what was normal, and need to allow time to adjust to the new socket/liner setup. I did not like the "wobble" I experienced with a thicker (9mm) liner I once used.
Bill
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Post by allenuk on Oct 17, 2009 23:26:55 GMT -7
Assumption; that you are using a sleeve for sealing in the socket. With the long liner length, could you not be getting a good seal in regard to the pistioning you mention? Not sure what you mean, Bill. a) what is a sleeve, what is sealing in the socket? b) my liner length is shorter than it was, not longer. I think we're being divided by a common language! Allen. |
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Post by ann- on Oct 18, 2009 5:47:15 GMT -7
Hello Ann. Did your people tell you why you shouldn't have too short a liner, i.e. what problems you might experience? Thanks. Allen. I don't think they did exactly, Allen, but I took it that it was to do with the 'sealing'. I am wearing a fairly thick Alpha liner, and wear it about 3 -4 inches above the knee. My stump socks are almost level with the top of the liner and I tend to roll it back slightly. Am taking it that Bill is referring to the sleeve which a lot of us use to actually hold the prosthesis on which creates a seal around the leg, or perhaps you use some other form of suspension. So not sure if you use a sleeve Allen, but if so, do you reckon that is fitting properly,as that could contribute to your stump pistoning in the socket. Got to say I don't notice any pistoning on the side I use the liner, it fits quite firmly in. Maybe its the socket itself and you need to go back and get it looked at. Good luck Ann |
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Post by allenuk on Oct 18, 2009 8:00:51 GMT -7
Thanks Ann.
Right. This is my leg.
One: leg
Two: Alpha liner (i.e. next to the skin)
Three: stump sock (usually just one)
Four: socket.
And that's it.
I didn't realise that there were substantially different forms, but I stand (sort of) corrected.
I am going back end of next week for a review of the new socket, and will mention the suspected short liner then. If someone HAS cut it short, they'll get a slap (not literally) from the prosthetist, as over here they're about $350 a time, and of course once you've cut too much off, that's it!
Allen.
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Post by ann- on Oct 18, 2009 8:49:03 GMT -7
Yes Understand Allen.
I use the same system as you Allen, on my left side. And have been told those liners are very expensive.
How does your leg actually hold on? Do you use a sleeve ?
Mine holds on with a sleeve, which comes over the top of everything, above the liner and then down over the knee on the outside of the prosthesis. If the sleeve is too loose and doesn't grip it does cause the leg to move in the socket.
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Post by allenuk on Oct 18, 2009 12:09:58 GMT -7
Hello Ann. No, no sleeve, just the stuff as the last message, i.e. Leg, Liner, Sock, Socket. I think (maybe Ted will clarify) that the leg stays on just because the liner sits tight against your skin (plus pin at the bottom which clicks into the base of the socket).
I'll dig out a pic in the morning, as I've got plenty!
Allen.
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billf
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Post by billf on Oct 18, 2009 12:40:27 GMT -7
Allen: Your previous message woke me up from a mental slumber. I was only thinking of suspension systems like mine (suction), completely forgetting about the pin lock system that many use (I never had a pin system). The comments by and large that I have heard of from folks that have worn both types of systems are:
1) Liner can be hard to don so that the pin lines up squarely with the pin latch in the socket. Incorrect alingnment can make the lower residule limb tender or even injury to skin.
2) Loose vertical fit (pistioning) if pin and latch are not secured snugly, also can make a alarming noise.
3) Most persons think that a suction or elevated vacuum system offers a better intiminate fit of the socket to the limb (especially those using elevated vacuum). Most of these suspension systems require a sleeve to maintain suction inside the socket. Sleeves make bending or kneeling cumbersom and can physicially damage the sleeve when kneeling at the point contact of the knee and surface contact point.
4) Those that favor the pin/latch system say it is quick to don and dolf, moreso than and liner/sleeve suction system.
5) Both system users say that if the fit of the liner to the skin is broken, generally by sweat, so that you can twist or piston in the liner, nothing works well. Some people favor certain types of liners for this very reason.
My experience is that I favor the seal in liner system. Low level suction, NO sleeve! This allows me knee movement that is nearly normal and not the ongoing problems of sleeve damage due to kneeling activity. Down side of this liner is that it does not breathe at all, and sweat is a problem.
Sorry to ramble on, hope is removes smoke from the room that I caused in my earlier post.
Bill F
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Post by ann- on Oct 19, 2009 0:24:23 GMT -7
Hello Ann. No, no sleeve, just the stuff as the last message, i.e. Leg, Liner, Sock, Socket. I think (maybe Ted will clarify) that the leg stays on just because the liner sits tight against your skin (plus pin at the bottom which clicks into the base of the socket). I'll dig out a pic in the morning, as I've got plenty! Allen. arhh ... makes sense now Allen, you are using the pin-lock system to hold the leg on. don't have any experience of the pin-lock myself, but sounds like you need to get it checked out. |
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Post by allenuk on Oct 20, 2009 5:23:32 GMT -7
Thanks Bill. Maybe the addition of the sleeve is not so common in the UK, as I haven't seen it around.
Yes, the pin system is quick to put on and take off (on or off, seconds, and maybe a couple of minutes when you first put it on from scratch), and yes, if you don't get the pin lined up it can cause pain, but it's only a knack.
Allen.
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Post by lizzie2 on Oct 23, 2009 10:01:30 GMT -7
Hello. Last week, I was fitted with a new liner (plus new socket), and as usual they are about 3 feet too long. So, after making sure it fitted, the prosthetist took it back to the workshop to chop some off the liner. No problem, but it is now two inches shorter than my last liner, and I was wondering whether this would make the new leg uncomfortable. The new leg IS uncomfortable, but the man said it would be for a week or two, as it was cast in a slightly different way, to give more support from the knee area than the last one. So, is my short liner a culprit, or should I ignore it? It SEEMS to be contributing to a bit of pistoning, but this might be because it is a 6mm, while the old one was a 4mm. Not sure if you'd like me to reply to this, Allen? Firstly, it's bad practice to issue a different thickness liner, when the socket has been designed around a certain liner thickness - it can cause all sorts of problems IMHO. Secondly, cutting it too short can cause a few problems too. Thirdly, I hope you've solved your problem? If not, please can you send me a photo ... I may be able to suggest something? |
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Tom
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Post by Tom on Oct 23, 2009 14:50:42 GMT -7
My previous socket system was an Alpha 9mm liner with pin-lock. I had one old liner cut very short, around 8 inches, that I used for riding the bike or when I had to do something that involved crawling around on the floor or ground. Bending your knee is a lot easier with a short liner. It was fine for those uses, but didn't give enough lateral stability for walking a long distance.
I'd be very surprised if your guy cut your new liner too short, but making it shorter leaves less skin covered up by it, and that's a good thing.
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Post by allenuk on Oct 24, 2009 0:33:46 GMT -7
Interesting replies, thanks.
Lizzie: why WOULDN'T I want you to reply? You know things!
I was recast a month or so back, and it was always the intention to try the thicker liner with the new socket, so it wasn't (just) a whim.
My appointment is this Friday (already brought forward by 10 days after I complained about the wait - now that IS getting to be a problem with the NHS) and I hope to sort it out then. I have had to revert to an older leg, as the new one was wierdly clamping my knee very tightly AND rubbing at the front base of my stump, exarcabating the blister problems, which seems to defy physics.
The short liner for knee-bending sounds interesting. I shall experiment once I have got my 'main' leg sorted out.
(The reason I suspect it MIGHT have been cut too short is that it isn't a job that the prosthetist does, at least not in a fairly large limb-fitting centre. He/she tends to breeze around with a couple of students in tow, and then chucks the mundane tasks (e.g. cutting liners) to the students).
Allen.
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ann58
Female Member 
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Post by ann58 on Oct 24, 2009 6:32:14 GMT -7
Allen, Am I hearing what I think I'm hearing??? Are you complaining about the waiting time to get into your prosthetist?? That is what all the bickering is about in the US....government wants to put everyone on same health plan & wait forever to get in. As far as everyone needing insurance {I agree} Our health system DOES need improvement, but IMHO this doesn't get it !!!  |
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Post by allenuk on Oct 24, 2009 12:16:30 GMT -7
No-one said we had it right over here, just FREE. That is to say, my newly cast socket is FREE, my new 6mm liner is FREE, my so far 3 visits to the prosthetist over this issue have been FREE, my visit next week is FREE, and any subsequent recasts, new sockets, new liners, etc., etc., etc., are, you've got it, FREE.
Yes, we can't phone up and say "I'll come in next Tuesday," as we can with private health. You phone, they say "Four weeks," you argue, they say three, and so on. And it's wrong.
But the wrongness is largely due to the INVOLVEMENT of private, profit-making companies. Without them, the NHS would be a darned sight quicker for all of us. No free-er, just quicker!
Allen.
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Post by allenuk on Nov 22, 2009 7:26:17 GMT -7
Anyway... I've walked a few times using this new (short) 6mm liner, as opposed to the old (longer) 4mm one.
My prosthetist says that the length shouldn't make any difference, and as he is a trustworthy guy, I'll buy it. But the 6mm thickness seems to have made a negative difference - a bit 'sloppy'. A tad like wearing a shoe 3 sizes too big, plus lots of socks (and even a liner!) to fill up the space. Okay, not dreadful, but not comfortable, and I definitely wouldn't want to walk a couple of miles in it.
I'm seeing him in the morning to try this new old-fashioned socket that he's cast, so keep fingers etc. crossed...
Allen.
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Post by ann- on Nov 22, 2009 8:34:36 GMT -7
Bit confused with what you say Allen as wouldn't 6mm be thicker than 4mm? so theoretically the socket would then be tighter, not sloppier wouldn't have thought the length of the liner would make any difference to the tightness in the socket.
I had thought they were supposed to build the socket by casting around the liner, not the other way round - but perhaps I am misunderstanding.
Or is this just a stop gap attempt until you get your old fashioned socket.
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Post by allenuk on Nov 22, 2009 9:19:52 GMT -7
Sorry Ann, my fault.
He cast me for a new leg about 3 months back with the intention of using a 6mm liner.
Unfortunately, he's still got my old socket (cast for the original 4mm liner), otherwise I'd try that combination out and see if you're right!
Allen.
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Post by allenuk on Nov 24, 2009 13:42:47 GMT -7
This should add to the confusion.
I saw my guy yesterday, and told him of my feelings about the 6mm liner, i.e. that it was too 'floppy', and somehow distanced me from the leg. He understood, went to the cupboard, and produced a nice new 3mm liner, which he told me to try out. Well, try out is a bit of loose terminology, as once I've worn it that's it, he's not going to re-issue it to some other poor sod, even on our cash-strapped NHS.
Result? Initially, better, although I obviously had to wear a second sock to make up the difference. But 24 hours on, I have doubts. The leg was cast for a 6mm liner, so wearing a 3mm changes the position of my boney bits in relation to the plastic, and not for the best, and I spent the day trying different combinations of socks, without success, trying to get it right.
Finally I dug out a 4mm liner from my box of used parts, and it seems to be working better, with a couple of socks.
So I'll give it a few days to settle down, and hope for the best. (Oh, and in relation to the original question, the 4mm and the 3mm are the 'right' lengths, and that doesn't seem to make any difference to anything!)
Allen, bka, London.
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