Prosthetic Leg Fitting Problems

Leg amputees need to take special care to maintain a consistent stump volume to ensure their prosthetic leg fits well and doesn’t hurt or rub their residual limb.

Sometimes in my gym, I will be ready to treat an amputee and they will arrive unable to don their prosthetic leg, which is a frustrating outcome for everyone.

An increase in stump volume can be caused by many things and some common ones include:

  • Leaving your stump unbandaged overnight.  In the initial 12-18 months after leg amputation, an elastic bandage or shrinker sock must be worn overnight or whenever the prosthetic leg is not being worn to prevent swelling of the stump.  If you have heart or kidney problems you may need to keep bandaging always, to prevent your stump swelling overnight.
  • Sitting for long periods with your residual limb hanging down (for below knee amputees) may cause swelling because there is no muscle pump and your lymphatic drainage system has been disrupted by your amputation.
  • Meals high in salt and/or alcohol content can cause your stump to swell, especially if combined with the above factors.
  • Some ladies experience stump swelling at certain times throughout their menstrual cycle and may need to bandage at those times to ensure continuity of fit of their prosthesic leg.
  • Prolonged periods of inactivity or bed rest (for example a hospital admission) may cause an increase in stump volume because by not wearing your prosthestic leg fluid accumulates in your stump and is not pumped out by weight bearing.  In cases like these, always have your bandage or shrinker sock at the ready to avoid fitting problems when you are ready to be back on both feet

I hope you have found this checklist for prosthetic leg fitting challenges useful.

Let me know what you think.

Until next time…. Cathy… The Amputee Coach

 

 

20 Comments to “Prosthetic Leg Fitting Problems”

  1. kevinbrennan 21 February 2012 at 6:51 pm #

    hi, i am btk into my 10 month,do well into my third prosthic. i pick my new one on thursday.i need some advice

    • Cathy Howells 21 February 2012 at 11:41 pm #

      Hi Kevin
      For sure, how can I help?
      You can reply here or if you would like to contact me directly, please email me at:
      cathy@theamputeecoach.com
      I look forward to hearing from you.
      Cathy – The Amputee Coach

      • kevinbrennan 22 February 2012 at 12:34 am #

        hi cathy, before my btk amputation, i lost half of my foot in a motor cycle accident.in 1982.the last 2 years before my amputation i was working on a farm with beef cattle. very physical work,and i read your first page of your book. about frustration anger etc.. that is how i feel.i don’t feel sorry for my self its the other side frustration etc..in my head i could do the job on the farm, but physically i cant do it. i am motorvated enough,can i ever go back to that kind of employment again.and i need to lose weight i am 126 kg, to heavy. my stump does not hurt, which i thought it would with all the weight.at present it aches after three hours, will that change as time goes on. thankyou

        • Cathy Howells 22 February 2012 at 9:49 pm #

          Hi Kevin,
          The short answer to your question is “Yes, you can go back to that type of work.” I have quite a few patients who are farmers and do all the heavy work necessary on their farms.

          As you point out though weightloss would be an advantage for you and also some specific strengthening exercises for your leg and core to make it easier to cope with the loads you have to carry. This would also help to decrease the aching you experience after 3 hrs at the moment. The fact that your stump does not hurt is very encouraging and puts you in good stead to improve your functioning with your prosthesis.

          You would benefit from reading the rest of The Amputee Coach Book- it has the exercises you need, advice to help you lose weight and deal with your frustrations. You can order the physical book online or it is now available as an ebook.

          Keep putting in the effort Kevin and you will reap the rewards. Just make sure the effort is SPECIFIC to your needs.

        • kevinbrennan 23 February 2012 at 7:00 am #

          hi cathy, thank you for the advice i will get on to it straight away,and thank you for your time. i will keep in touch if thats ok. kevin

          • Cathy Howells 23 February 2012 at 9:00 am #

            Hi Kevin,
            You are most welcome.
            Please keep in touch. We’d love to hear how you are going!

  2. jim stine 26 November 2012 at 11:03 am #

    im an 11yr amputee lbka i have never been able to find a leg that would even fit half comfortable. im a very active person ,i get soars but dont want to take the time off to heal as that would be 3 weeks out of a month now due to the rubbing have caught mrsa in my stump and this is a bran new leg. im very aggitated cause i no it dosnt have to b this way ive tried in my location yankee bionics, hanger some of the top places for theese problems any ideas on what maybe could b done?

    • Cathy Howells 24 January 2013 at 6:35 am #

      Thanks for your question.

      I can understand your frustration at the constant breakdown and infections in your leg. You are right when you say it doesn’t have to be this way!
      You need to keep going back to your prosthetist so that he can make adjustments to the fit of your prosthesis- don’t give up after the first fitting. Perhaps there are other liners that would suit your skin better also.

      When you have an infection you need to stay off your prosthesis until it heals because if you don’t it will only get worse.

      To help avoid further episodes of infection good hygiene is very important. Wash your stump daily. Wear clean stump socks daily or if you wear a liner you need to clean it every night. Your prosthetist will tell you the best way to do this depending on what you are wearing.

      I know that this stuff can be tiresome but if you do it you will get a better outcome eventually.

      Regards
      Cathy

    • bka from ga 1 June 2013 at 12:43 am #

      Use hibiclens.you can get it from Walgreens.I work a full time job and have two year old twins so iam very active.I use to
      Get infections all the time, after I started using it I never get infections anymore.I still get sores and stuff like that when the prostetic isn’t fitting right.But,not one infection since I started using it.wash with it every night before bed.hope this helps.

  3. nmurchison41 2 May 2013 at 10:24 pm #

    Hi Cathy, I am a BKA I noticed that after long periods of wear I began to hear a slapping sound when I walk.What is this?

    • Cathy Howells 15 May 2013 at 3:11 am #

      Thanks for your question.
      Because the sound is not there when you initially wear your prosthesis, it may be due to your stump losing volume over time with walking. Its too difficult to tell by description only so I recommend that you visit your prosthetist to ensure that all is well with your prosthetic fit and componentry.

  4. bka from ga 1 June 2013 at 12:43 am #

    Use hibiclens.you can get it from Walgreens.I work a full time job and have two year old twins so iam very active.I use to
    Get infections all the time, after I started using it I never get infections anymore.I still get sores and stuff like that when the prostetic isn’t fitting right.But,not one infection since I started using it.wash with it every night before bed.hope this helps.

  5. sandra 1 July 2013 at 12:30 am #

    I have no insurance(could not afford it have my job let me go) &I do not have much money. How can I afford a prosthetic leg. I am at my wits end. Please help

    • Cathy Howells 4 July 2013 at 5:26 am #

      HI Sandra,
      I don’t know what to tell you because I don’t know where you are from. However in Australia all medicare card holders are entitled to a prosthesis funded by the government. They just need to attend an amputee clinic at a public hospital.

  6. chris riley 23 July 2013 at 9:43 pm #

    hi cathy I am new bka about 2 months finding I get very sore
    on the front of my leg where the bone was cut tried all sorts of bandage someone said about using cling film
    can you help me with this thanks chris riley

    • Cathy Howells 24 July 2013 at 11:08 pm #

      Hi Chris,
      You don’t mention if your stump is sore from wearing a prosthesis or just bandaging.
      A shrinker sock may be more comfortable than a bandage as the pressure is applied more evenly to the residuum.
      If it is from wearing a prosthesis, your socket may need to be eased in that area by your prosthetist, or you may need a different type of interface (liner). Cling film is not a long term solution but it can help to reduce friction over the prominent bone until you see your prosthetist, it won’t reduce discomfort from excessive pressure though.
      Regards
      Cathy Howells

  7. DJ Richar 9 November 2013 at 10:09 pm #

    I’m a BKA with 38 years as a patient. I wear a ICEROSS Synergy sleeve against my stump. Have had a long term issue with these “Milking” the end of the stump. When I change to new the problem can cause fluid leakage.

    Recently, new unit had to be produced to replace a that broke without notice. New unit had to upgraded for a 440# rating. Resulting increased unit weight. Milking issue has increased. High activity level that requires strength in units. Broken most before…

    Any suggestions my local shop can’t solve this ..

    • Cathy Howells 14 December 2013 at 2:06 am #

      HI,
      Thanks for your question.
      “Milking” the end of the stump when wearing these types of liners will occur if your fitting is too tight, or if you were cast using the Ice-cast system and there was too much elongation in the cast.
      Kind Regards
      Cathy

  8. mary ellis 19 March 2014 at 8:33 pm #

    Hi there. I am only 6 months post BKA and will be moving on to my definitive socket shortly here. I was wondering if you have seen a below knee prosthetic that does not come so far up. I know that it is meant to hug to knee to provide for total surface weight bearing but it drives me crazy that when I sit there is such a large gap between my knee and the prosthetic. I was wondering if there has ever been a prosthetic that has been developed and used successfully that stops below the knee and doesn’t extend up the sides.

    • Cathy Howells 20 March 2014 at 10:12 pm #

      Hi Mary,
      Thanks for your email.

      The height of socket trim lines for below knee amputees depends on the length of your residuum and the stability of your knee joint. Obviously the better control you have of the muscles of your knee the lower your trim lines can be, if your stump is not too short.

      Your prosthesis will also be more streamlined as your residuum continues to mature (shrink). 6 months is very new. It won’t be mature until the 18-24 month mark.

      The trim lines will always however, need to extend above your knee joint for adequate suspension.
      The only other way to attach a prosthesis is via the osseointegration method where the whole socket is no longer required and the prosthesis attachs directly to the bone of your residuum.

      Kind Regards
      Cathy Howells OAM


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