Liners or socks?

[allenuk]

Hello.

I've got a new socket - pretty good fit. The inner is made of some sort of material that is softer than usual, and easier to work - you can't quite mould it just with body heat, but it doesn't need the sort of hairdryer heat that you usually need.

Anyway, I have my socket, which is not a bad fit, and I have THREE different liners, all of which fit. There is a 6mm, a 4mm, and a 3mm. My prosthetist, knowing that I don't mind experimenting with my bits and pieces, tells me to find which suits me best.

I CAN walk with the 6mm and no socks. I can also walk with the 4mm and a thin or maybe a thick sock, and so on.

I don't mind the 6mm, but in prosthetic terms, is it best to have the softness of extra liner or the slight harshness of socks? My gut instinct is to have as thin a liner as possible as long as it's still comfortable, as there is then less movement leg/socket.

Ideas, expert opinions?

Thanks.

Allen, bka, London.

[tedatrowercpo]

I can't argue for anything but that you should use what ever combination you like best.

[ann58]

Allen, personally I would rather have NO socks...I can bend my leg easier. Not an expert opinion; just my opinion.

[allenuk]

Take your point, Ann, but it's the THICKNESS of the liner that I think is a problem.

You can (I understand) have 12mm liners, which might give great softness, but which must make the stump/socket very strange - a bit like wearing a shoe 2 sizes too big, and filling up the gap with foam.

Having said that, currently I'm working on the 6mm liner and no socks - the 4mm and no socks makes it a bit too loose.


Allen.

[ann-]

Feb 10, 2010 13:24:20 GMT -7 ann58 said:

Allen, personally I would rather have NO socks...I can bend my leg easier. Not an expert opinion; just my opinion.

Haha, this is the other Ann here, and I think this demonstrates just how different we all are in what we prefer etc. etc.

I wear a pretty thick liner, on one side too, and prefer socks with it. Mainly because I don't like the prosthesis tight fitting, and also because I change in volume,(am bilateral and also find that changes in volume on one side affect the weight distribution on both sides) so like the leeway of being able to put on an extra sock or two on either leg throughout the day.

[allenuk]

Hello the other Ann. Yes, doesn't it just (demonstrate how different we are...)

It is always a little humbling to hear from a bilateral, too. Here am I, putting on my leg and walking a mile, maybe a bit uncomfortably, and complaining about it.

This in fact is the thinking behind my other current thread about Hypnosis ("You are feeling very sleepy...." on the General Board), as I really think the more minor discomforts I complain about might be as much in the mind as in the body.


Allen, bka.

[ann-]

Could be Allen ... but if it feels uncomfortable ... it could be telling you its not quite right.

Mind you, if you are walking a mile, on a regular basis - and its not causing any sores, blisters, or the like ... I think that is pretty good going.

[ann58]

Would love to be able to walk a mile....I have trouble with blood flow in my legs. Any suggestions.

[allenuk]

Ann58. It's all relative, isn't it. Yes, I know I'm lucky to be able to walk a mile without major problems, but then I think back 2 or 3 years when I was walking 3 or more. Each setback limits our horizons, but our memories still tease us with what we once had.

Blood flow. Well, if I had that problem, my first port of call would be a trustworthy physiotherapist, as I've always found the 'hands-on' end of the medical profession more use than the so-called upper end.


Allen.

[allenuk]

An update on the new 'liner' (that is, the new SOFTER socket - my prosthetists call it a liner, which can be confusing, as we all call our LINERS liners!) I'm calling it a 'soft socket' to differentiate it from a) an Alpha Liner, and b) the hard outer socket.

Anyway, here are some pics:

www.dropbox.com/gallery/1503128/1/new%20inner%20socket%20%26%20pads?h=2d3c92

One pic of the release pin's hole shows how the inner socket managed to slip down inside the hard outer socket - about 10mm+ - which caused a lot of discomfort, as my stump was then being 'held' in the wrong place, if you see what I mean. Anyway (prosthetists please note) one answer was to RIVET the inner to the outer socket - in the longer term we may try a 'shelf' inside the hard socket, for the soft socket to rest on.

But I am still pleased with the way the soft socket and its fast-reacting heat properties is working out. This might also be helped by the two padded areas that my guy built into the soft socket - you can see these in the pics, they're the dark patches on the left and down at the base near the pin-hole. These two places (fib head and front base of stump) were where I was getting a lot of annoying 'minor' pain, and the padding has stopped this.

Apparently the 'ordinary' inner socket material isn't conducive to having pads stuck to it, whereas this type is. They are not moveable, which is a pity, but on the other hand you wouldn't want them drifting about in use.

Not the answer to all one's problems, but certainly progress.


Allen, bka, London.

[mitchee]

The sock vs liner discussion really shows how different we all are when it comes to our preferences.

I wear an Iceross sport liner (w/ a locking pin). I also prefer to wear two socks. The socks provide some extra cushioning and as a result the front of my tibia does not get sore from my daily activities. It really benefits me when I participate in sports. I trim the socks down so that they do not come over the top of my socket. This eliminates the bunching of socks behind my knee.

[allenuk]

Now that is interesting, Mitchee. I thought that getting soreness on the front of my tibia (which I have for years) was the result of some defect in my sockets, but the implication of what you say is that it happens anyway, particularly if you engage in more than just watching TV or cooking.

My front bottom tib is fine for the latter activities - even fairly vigorous housework, cleaning windows, etc. But when I get out on the streets and walk a mile, THEN it gets sore, and I start rubbing in cream, etc., and looking for pads, or anything to stop it touching the socket.

It doesn't 'bash' the socket, not harshly - I think it just brushes it, and the constant brushing of walking a mile adds up to the soreness.

But I'm sure that a few years ago I didn't have this problem - that was in my first year or so of amputation, and all I can think is that I had much more 'padding' from my shrinking stump, which I no longer have.


Allen, bka, London.

[mitchee]

Hi Allen.

For me, the pain in the front of my tibia is directly related to how much activity I do. It tends to be sore on the days that I cycle 30+ miles or go rollerblading. I think it must have to do with how my tibia is pushing on the socket during those two sports. I don't have any soreness relating to going for long walks or even jogging. I signed up for a 1/2 marathon at the end of April. It will be interesting to see how sore my tibia is after that.

I don't have any pain on the bottom of my tibia, only soreness on the front of it. It doesn't turn red and it doesn't hurt to touch it but it feels sore and achy after I'm done cycling or rollerblading.

I just got a new 'everyday' carbon fiber socket a couple of weeks ago (due to volume loss). The new socket fits great and I haven't had any problems. It took 3 months of test sockets to get to this point but it was worth it. My prosthetist is in the process of making me two other sockets. One for cycling and one for jogging. I just purchased my first cheetah foot and I'm looking forward to using it. My cycling socket will be trimmed lower on the backside and will also have some modifications for my tibia.

When I do add foam pads to the inside of my socket, I stick them on each side of my tibia. I don't put any padding directly in front of my tibia or underneath it. The two socks that I wear do add quite a bit of cushioning for me. I tend to lose volume when I cycle, so after about 10 miles I stop and dry my limb/liner and then I add a third sock. The third sock eliminates the pistoning and helps reduce the pain in my tibia.

I didn't have any tibia soreness when I first became active again (post amputation). It has been a gradual onset. I agree that it probably has to do with the limb maturing and the padding shrinking.

Michelle :-)

[cherylm]

Mitchee makes a good point, Allen...I have a perpetually tender spot at the base of my tibia, to the point that my sockets are actually "ground out" right at that point to give me a bit of space without any pressure. Then I wear at least one 5-ply sock for "padding" purposes. Putting a pad directly on the area where the tibia hits would just increase the pressure, wouldn't it? With my little "cave" for my tibia, I can walk pain-free...it's not a large space or very deep, it just keeps the end of the bone from rubbing.

[allenuk]

Cherylm, Mitchee.

Thanks v.much for the additional information. (Blimey Mitchee. 30 mile cycle rides? You must be one fit amputee...)

Anyway, for the sake of accuracy (on my part), have a look at these pics of my leg:

www.dropbox.com/gallery/1503128/1/tibia?h=cde8fe

(Click on them to make them bigger). I have marked the area which hurts - it centres on the cut end of the tib (which for whatever reason is slightly curved in my case), but whether it's the skin or the bone that is painful, I don't know.

It's okay around the house, and in fact this morning it was okay for the first 4-500 yards walking. Only then did it start kicking in as painful, and when I got home and took the pics, it was quite sore. And like any sore point, the more you touch it, even quite gently, the worse it gets.

I'm pretty sure it's not a load-bearing point (Ted? true, or am I making it up?), since the weight down at that end is carried on the sides of the stump, and under normal (i.e. not energetic activity) there's no problem. Walking for me (old and heavy) is an energetic activity.

Anyway, I'm seeing my prosthetist tomorrow, and having chatted to him on the phone, he thinks stage one will be to cut a window around the area, although that is difficult in that particular spot.


Allen, bka, London.

[mitchee]

Hi Allen.

I checked out the pictures. I can see your prominent tibia in the photos. My tibia also protrudes, maybe that is why we seem to have problems with that area? My pain is located slightly higher than yours but it doesn't extend to the end of my tibia.

My prosthetist did relieve the painful tibia area on my last test socket by heating it and pushing the warm plastic outward. This created a small "cave" area like Cherylm mentioned. It seems to have worked. My new socket has greatly reduced the pain. I hope it continues.

On my last socket, the padding that was placed on each side of the tibia did help. It prevented my tibia from rubbing on the socket.

I have never had a cut out window. I'm curious as to how it works. How big is the window? I would fear that my tibia would want to push through the window and cause pain above the window. ??

Good luck with your prosthetist tomorrow. I sure hope he can relieve your pain and have you back to your old self soon.

Take care.

Michelle

[cherylm]

Oooh, that does look irritated, Allen. Actually, it reminds me of what my early sockets did to me...before I figured out that I could tell my leg guys that it hurt and they could fix it.

Good luck with your prosthetist...I hope they can find an adjustment that works for you!

[ann-]

Same area as I had problems a few weeks ago Allen.

The end of my tibia is prominent too, on both sides, suppose it makes sense really, because the softer tissue, muscle etc. shrinks down, or gets pushed in, but the bone doesn't.

In my case I was too deep in the socket, and am now wearing a new one, I also had a bit ground out of the socket in this place which seems to have sorted it out.

[allenuk]

Thanks for the responses, Mitchee, Cherylm, Ann.

If we do a 'window' tomorrow I'll post a photograph. I have had them before, and they work wonders. You cut a hole in the outer socket, bigger than the problem area, and the stump sort of pushes the softer inner socket into the hole as much as it wants - just a few millimetres at most. This works both on the 'older' inner socket, the one you have to heat with a hairdryer to make it instantly malleable, and the newer inner sockets, which almost respond to body heat. (I have the later sort this time).

Allen, bka, London.

[tedatrowercpo]

Allen-

That point is one that gets sore mostly due to lateral pressure. Ask your prosthetist if they can outset your foot a bit.

[ann-]

Mar 4, 2010 8:04:06 GMT -7 tedatrowercpo said:

Allen-

That point is one that gets sore mostly due to lateral pressure. Ask your prosthetist if they can outset your foot a bit.

Interesting. Thanks for that Ted ... I will be mentioning that next time I go.

[allenuk]

Thanks Ted (too late for today's meeting - that's transatlantic time differences for you) but many thanks.

Anyway, no photographs as no windows this time.

My guy reckons (harking back to an older thread) that it's the pinlock liner system that's not working for me - he thinks my stump is moving up and down, just fractionally, in relation to my socket, which with most people wouldn't cause a problem, but with me causes that nasty rubbing on the front tibia (but only when I'm walking distances!) Complicated, ain't it.

Anyway, he's making a new leg based on suction rather than pinlock, which will only take a week or two, as he thinks my leg and the socket will move against each other far less with such a system. I'm easy, and only glad that he's a guy who's prepared to try different solutions.

I shall, of course, keep you informed (and when I see him in a week or so I will mention the foot offset, or I might get out my allen keys and have a pop myself).


Allen, bka, London.

[ann58]

Allen, I had to go from a pinlock to a suction outfit....the other was pulling me up & down in the socket. Now I just need a new socket {PERIOD} as I'm going down too low and hitting bottom. I am using the silicone patches under the knee to keep me higher. I got these from Ohio Willow Wood.

[allenuk]

Hello ann58, and thanks for the Ohio details.

Well, there's a coincidence then - that's precisely what my man says is happening to me, i.e. that I'm going up and down in the socket which he thinks is causing the rubbing on the front tib. I have had pinlock since very early on, so a suction socket will be a novelty.

Also, probably, a new foot, but that's another story (which I will tell you about if it happens!).


Allen, bka.

[Tom]

I recently went from pinlock to elevated vacuum, which is a stronger version of suction. Otto Bock's Harmony system. The improvement in my stump health was dramatic after the pistoning was eliminated. And the connection of leg to body is much more secure than before.