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Post by allenuk on Oct 31, 2009 9:10:07 GMT -7
My prosthetist, a Frenchman and a radical, who doesn't go by the book unless he agrees with it, is working on a theory that many people who wear liners get at the least no benefit from them, and at worst some problems, such as increased perspiration. He has just cast me for an 'old-fashioned' socket, like the ones most of us had when we were first amputees, i.e. a fabric 'cup' into which you stuff your residual limb, which you then push into the hard lining of the prosthesis.
His rationale for this is that the cup will be a far better, closer fit than the liner+soft plastic which most of us (including me) wear.
I am going along with the experiment, although my only continuing goal is one of a comfortable leg, so if it works, it works.
He thinks that alpha-type liners got very fashionable about 10-15 years back, partly because they ARE useful to SOME amputees, and partly because the manufacturers wanted to sell lots of them.
Any views?
Allen, bka, plus Liner, London.
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Post by swisswuff on Oct 31, 2009 10:56:52 GMT -7
Well.. I have two cosmetic arms that I wear with cotton socks. After a day or two the fabric leaves an imprint, the skin gets soggy and if I don't change the humid sock the skin stays soggy. The leather brace that holds the arm in place causes blisters and if these open as they eventually do I have local skin breakdown and that burns and hurts. So really, that is uncool.
Silicon liner / pin lock: I can take it off, dry skin and liner with a towel or let it just sit there - and everything back to normal. The pin lock really holds the prosthesis in place well without exerting local friction on the skin anywhere. So I wear no harness at all to keep my arm in place - the pin lock does that perfectly well and very comfortably.
So I don't believe your Frenchman. Not from my experience. I do wear my cosmetic arms at times - but it will neither be worn when it is hot, nor will I carry a lot, nor will it be for any extended amount of time.
For real work, I really like the silicone liner / pin lock setup that I got.
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Post by ann- on Nov 1, 2009 1:46:21 GMT -7
He thinks that alpha-type liners got very fashionable about 10-15 years back, partly because they ARE useful to SOME amputees, and partly because the manufacturers wanted to sell lots of them. Any views? Allen, bka, plus Liner, London. Partly agree Allen. I am bilateral and now wear an Alpha liner on one side which is grafted, but on the other side just use the socket and socks. The liner is doing an amazing job with the skin graft, and I think without that I would not prob be walking with a b/k prosthesis, however, as you say liners do have their drawbacks, and the main issue for me is probably the amount of flexibility it allows my knee. So on my other side am quite happy to continue with socks. Ann |
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Post by allenuk on Nov 1, 2009 4:54:28 GMT -7
Wolf: what he was saying was that there wasn't enough science behind the decision to go for the pin-lock/liner set-up in all cases, not that it wasn't suitable in some cases. He wants appliances/technology to be evidence-driven, not fashion, which is fair enough. As he says, there are cases where the best solution (so far) is pin-lock and liner.
One thought he threw into the argument as a possibility is that prosthetists who are not very good at casting use the liner system to cover up shortcomings in their work.
Allen.
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Post by lizzie2 on Nov 7, 2009 10:08:20 GMT -7
I'm with Ann on this one - I partly agree too. Last weekend I went away for three days (I don't go away very often) and both my Alpha liners failed!!!  I was not a happy bunny with my AK pistoning up and down about 4cms with every step...! My two implant joints swelled up considerably - I had to increase my pain meds and take an ice pack to bed with me every night (to get rid of the swelling). If I had been in a traditional socket this wouldn't have happened as catastrophically. However, with a traditional fitting I would have had to wear a Tess belt for suspension, which I'm not keen on. There are pros and cons to both traditional sockets and liners. What I would say is liners such as the Apha liners can mask poor socket fitting - I think Ted has said this before and I agree wholeheartedly! Not wishing to upset anyone here, but good fitting is probably more of more importance to leg amputees as we bear weight through our prostheses. |
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Post by ann- on Nov 8, 2009 3:22:30 GMT -7
What I would say is liners such as the Apha liners can mask poor socket fitting - I think Ted has said this before and I agree wholeheartedly! Not wishing to upset anyone here, but good fitting is probably more of more importance to leg amputees as we bear weight through our prostheses. Absolutely, an with you on this Lizzie, and its not the first time I have heard this said about masking poor socket fitting. I think liners have their place and work well in some circumstances, but maybe not used automatically for amps who may not necessarily need them. |
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Post by allenuk on Nov 8, 2009 8:59:29 GMT -7
Well, my personal take (and that's all it is, i.e. just my experience) is this.
For the past few years my prosthetists have tried and failed to equip me with a comfortable pin/liner/socket system, so if this experiment works, in a few weeks I shall have a comfortable 'old-fashioned' cup-type socket.
I will, of course, be letting you know the outcome!
Allen, limping off into the sunset.
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Post by ann- on Nov 10, 2009 0:13:21 GMT -7
For the past few years my prosthetists have tried and failed to equip me with a comfortable pin/liner/socket system, so if this experiment works, in a few weeks I shall have a comfortable 'old-fashioned' cup-type socket. I will, of course, be letting you know the outcome! I have been wearing this type of socket for the best part of 40 years on my right leg Allen ... I didn't realize it was old fashioned <grin> .... I do however, wear a silicon sock over the stump which I find makes quite a difference .... they are usually readily in stock at most centres ... if they don't suggest it, might be worth mentioning. |
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Post by allenuk on Nov 24, 2009 13:54:38 GMT -7
Results now in from the 'old-fashioned' socket experiment, and they ain't good.
He made a soft fabric 'cup' type of socket, very close cast, and then made the hard outer plastic socket.
We used a jig for me to 'stand' in, so we didn't bother attaching the ankle/foot mechanism. I put on the soft inner and hard outer sockets and then stood up, with my stump stuck into a 'ring' on this jig (adjustable for height, etc), to see what problems there'd be once I put my weight on it.
And there were, problems that is. It hurt like heck. We tried socks, thicks, thins, in various combinations, and still it hurt (towards the base of the stump).
So we tried to pin down the point of pain, by taking a handsaw and cutting off the bottom of the hard socket, and the soft socket, so that the bottom of my stump was sticking out. Back into the jig, so that NOTHING was touching the last 3 inches of stump, and it STILL hurt, and the odd thing was that it hurt at the base, i.e. where NOTHING was touching me.
Strange indeed.
He's arranging an MRI scan next, to see if I've got some odd sort of nerve bundles which are transmitting the pain down from the top part of the stump to the bottom end.
Currently my useable leg takes my weight largely around the knee area, with a bit on the high stump, and almost nothing at the base. This works, but not well, and what my guy wants is to be able to use the whole of the stump for weight bearing, i.e. as usual for a bka.
(If you happen to glance at this, Ted, your professional opinion would be interesting, and if anyone else has experienced similar problems any pointers would also be most welcome).
Allen, bka London.
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Post by ann- on Nov 25, 2009 9:19:34 GMT -7
I am bilateral Allen, but on the side I wear a similar style socket to that you mention, I have never been able to total weight bear. My sockets have been made in a PTB style and all of the weight is taken mainly under and around the knee. The end of the stump is now quite pointed, but even years ago was told it was not suitable to take weight on the end, I can't even tolerate a pin liner on that side. However, must admit these days it often takes a few fittings to get it comfortable.
Don't think though the jig gives a true picture of how comfortable the socket is, myself I would much rather prefer they put a foot etc. on it so the weight is more naturally distributed.
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Post by allenuk on Nov 25, 2009 13:29:27 GMT -7
Point taken, Ann. In fact the jig is (I believe) designed as a load-bearing CASTING device, rather than to be used in the way Christophe used it. But I see his point, in that if the sockets are utterly unwearable on the jig, the addition of a pylon and foot probably won't improve them that much!
A.
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Post by tedatrowercpo on Nov 25, 2009 19:42:24 GMT -7
(If you happen to glance at this, Ted, your professional opinion would be interesting, and if anyone else has experienced similar problems any pointers would also be most welcome). Allen, bka London. I've intentionally avoided responding to this thread so far just to encourage a free exchange of ideas. That said, I too believe that gel liners have been oversold as the solution to all ills for all amputees. I have seen a number of individuals for whom the use of a gel liner was the cause of pain rather that the solution. This is especially true for the pin lock systems that pull on the distal end of the limb. For individuals with heavy or adherent scar tissue on the distal end this can be a source of considerable pain when any pull or stretch is applied. The other common problem I see is the very "efficient" construction of the prosthesis with the modular pyramid mounted on the bottom of the locking mechanism. This quick, easy and low cost assembly tempts many prosthetists but it causes many alignment problems. If the pylon is attached at the bottom of the lock instead of under the balance point, then the prosthesis will torque about the limb and apply forces that will result in skin irritation and limb pain. Maybe not right away, but it will happen. Just won client away from a competitor because he hasn't figured this out yet. |
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Post by lizzie2 on Nov 26, 2009 10:46:22 GMT -7
Results now in from the 'old-fashioned' socket experiment, and they ain't good. He made a soft fabric 'cup' type of socket, very close cast, and then made the hard outer plastic socket. We used a jig for me to 'stand' in, so we didn't bother attaching the ankle/foot mechanism. I put on the soft inner and hard outer sockets and then stood up, with my stump stuck into a 'ring' on this jig (adjustable for height, etc), to see what problems there'd be once I put my weight on it. And there were, problems that is. It hurt like heck. We tried socks, thicks, thins, in various combinations, and still it hurt (towards the base of the stump). So we tried to pin down the point of pain, by taking a handsaw and cutting off the bottom of the hard socket, and the soft socket, so that the bottom of my stump was sticking out. Back into the jig, so that NOTHING was touching the last 3 inches of stump, and it STILL hurt, and the odd thing was that it hurt at the base, i.e. where NOTHING was touching me. Strange indeed. He's arranging an MRI scan next, to see if I've got some odd sort of nerve bundles which are transmitting the pain down from the top part of the stump to the bottom end. The MRI scan is a very good idea, although you can get similar pains if the soft tissues are being stretched. Also, it may be that he needs to try casting you again...or it may be his casting technique...? Btw you're not the only one having limb probs, Allen. I won't bore you all with my limb woes at the moment, as I wouldn't know where to start...  |
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ann58
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Post by ann58 on Nov 26, 2009 19:21:05 GMT -7
I'm sorry you are also having problems Lizze2....go ahead & bore us....nobody else is talking.  must be Christmas Shopping. |
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Post by ann- on Nov 27, 2009 0:08:26 GMT -7
And there were, problems that is. It hurt like heck. We tried socks, thicks, thins, in various combinations, and still it hurt (towards the base of the stump). The MRI scan is a very good idea, although you can get similar pains if the soft tissues are being stretched. Think Lizzie is right here Allen, I have had similar experiences where I have been told it can't possibly be hurting at the end because I am not touching it, yet it does. Did your prosthetist try a clear check socket, if so could you see through to tell if anywhere was unusually tight or had pressure. My stump is fairly long and thinish and it doesn't take much for it to pull up the tissues, if I walk on it for any length when its like this it will make the end quite red, and usually it looks visiby more pointed and prominent than usual, but suppose you weren't on it long enough to notice that. Good luck with the MRI, your prosthetists sounds very thorough, I have never been offerred one of those! Sorry you are having probs at the moment Lizziel. Ann |
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Post by allenuk on Nov 27, 2009 1:47:11 GMT -7
.
I wonder if any of you share this one: sometimes, in the very early hours while puzzling over just 'how' to start climbing out of the problems, a nagging thought occurs that I may be becoming fixated over the damned things!
It's not the 'woe is me' syndrome, which I know you don't suffer from, and I don't think I do, either. Maybe we need a sympathetic psychiatrist to explain. How about you, Ted, do you know what I mean, and have you seen (or even cured) this in your patients?
My partner, Maggie, had an uncle called Peter, now long dead, whose answer to most modern ailments was that all he or she needed was a good kick up the arse. I wonder...
Allen.
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Post by lizzie2 on Nov 27, 2009 6:47:00 GMT -7
. I wonder if any of you share this one: sometimes, in the very early hours while puzzling over just 'how' to start climbing out of the problems, a nagging thought occurs that I may be becoming fixated over the damned things! It's not the 'woe is me' syndrome, which I know you don't suffer from, and I don't think I do, either. Maybe we need a sympathetic psychiatrist to explain. How about you, Ted, do you know what I mean, and have you seen (or even cured) this in your patients? My partner, Maggie, had an uncle called Peter, now long dead, whose answer to most modern ailments was that all he or she needed was a good kick up the arse. I wonder... It's not us, Allen, we just need people who know what they're doing ... not a lot to ask, is it? |
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Post by tedatrowercpo on Nov 27, 2009 9:13:46 GMT -7
. How about you, Ted, do you know what I mean, and have you seen (or even cured) this in your patients? Allen. I certainly do see this from time to time. I don't think I'd go so far as to claim any cures but I have been able to improve things from time to time. I must also admit there have been cases where my contribution was not very helpful as well. The unfortunate truth is that for the most part we prosthetists are just guessing when we work our profession. Educated guesses and or guesses based upon experience sure, but still they are still just guesses. Not too long ago I attended a symposium sponsored by Orthocare Innovations on the future of prosthetics, where a group of leading researchers and clinicians tried to identify the where the profession needs to focus it's efforts in the immediate future. I found myself repeatedly asking for a better way to measure a limb for a prosthesis. Here's the problem, we are required to fit a limb/socket on an amputee with no information except the surface contour of the extremity, anything we can glean from feeling the tissues thru the skin and from what ever history the amputee can share with us. In truth we need to know much more about the interior anatomy of that individual's limb, precisely where various structures and tissues are located and especially how they are bound together by any scar tissue present. Congenital amputees lack the scar tissue but their anatomy is completely unpredictable. Add to that information details as to what happens to the nerves, muscles, bones, connective and vascular tissues when weight bearing forces are applied and we might be able to actually "know" what to do to produce a comfortable and functional fit. Until then you are all stuck with our "best guess" in the fitting room and I apologize for that. For now the MRI sounds like a very reasonable idea. |
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Post by allenuk on Dec 12, 2009 3:56:59 GMT -7
Thanks for the interesting and thoughtful answer, Ted. I'll let you know when I eventually get to see the consultant and hopefully get inside the mri machine.
For now, working on Maggie's Uncle Peter's theory of life (i.e. that most aches and pains are self-induced or self-perpetuating), I've decided to try Mind over Matter instead, so for the past 2 or 3 weeks I've been out walking every day, on the basis that if it hurts like hell on day 1, then on day 20 it will hurt less. Which so far is true, but not sure how far I should push it. Good for the soul, though.
I will keep you informed (bet you can't wait)...
Allen, bka, London.
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Tom
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Post by Tom on Dec 17, 2009 10:58:23 GMT -7
So how's the walking program going, Allen?
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Post by allenuk on Dec 20, 2009 3:17:09 GMT -7
Hello Tom, and thanks for asking.
Not a great success. About 5 weeks now, and I only missed the odd day or two because it hurt too much.
What has happened is that I am able to walk a little further each time, but not yet to the point of enjoying it. I enjoy managing to get 3/4 mile up the road and another 3/4 back, but more on the basis that I've just done a mile and a half.
Maybe it will improve on the comfort front, too. I don't know, but like Dr.Johnson on re-marriage after divorce, that expectation does seem a triumph of hope over experience.
An analogy I use for non-amputees is this. Try wearing a shoe 1 or 2 sizes too small. It is better than NO shoe, and you might even get used to it, but it ain't ever going to be comfortable.
Never mind. As the Buddha said, to live is to suffer.
Allen, bka, London.
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Tom
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Post by Tom on Dec 20, 2009 6:59:20 GMT -7
Sounds like a pretty good success to me. The Buddha might also say, "Sometimes the effort is more important than the accomplishment."
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Post by allenuk on Dec 21, 2009 4:05:21 GMT -7
Wisdom indeed. Yes, accomplishment (at least in the form of Goals) is certainly far less important than the effort.
A
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I was not a happy bunny with my AK pistoning up and down about 4cms with every step...! My two implant joints swelled up considerably - I had to increase my pain meds and take an ice pack to bed with me every night (to get rid of the swelling). 
must be Christmas Shopping.