One of the most common questions is:

What is the best type of shoe to wear on my prosthetic foot?

This is a very important question for several reasons.

Firstly, the most important issue for an amputee is taking care of your remaining foot.  The shoes that you choose should be comfortable and supportive of your foot and also offer some shock absorption.  They should not cause rubbing, blisters or pain in the foot.

Things to consider regarding the shoe for your prosthesis include:

• The heel height that you choose will be the heel height that your prosthesis is aligned for.  This is important because it means that if you change the shoe on your prosthesis and it has a different heel height, you will alter the alignment of your prosthesis and this will affect your walking pattern and possibly the safety of your prosthesis.  For example, an increase in heel height for an above knee amputee will cause the knee to be less stable and give way more freely which could result in a fall.

• The heel of the shoe should have a significant surface area to assist with balance on your prosthesis

• The shoe you choose should have a firm heel counter (the part of the shoe that encompasses the heel of your prosthetic foot).  This will prevent the heel of the prosthesis slipping off the shoe as in the case of sling back shoes.

• Avoid long pointy toed shoes as these will make it harder for you to clear the ground as you swing the prosthesis through when walking.

• The sole should not be slippery

• If you are a diabetic amputee, you should always consult your podiatrist about appropriate footwear, especially in the case of Charcot’s deformities.  In this situation, I recommend that you will need to have your shoes especially made.

• If you are unsure about the  heel height of your shoe and the alignment of your prosthesis, always consult your prosthetist.

Please let me know if you have any other questions, comments or feedback. 

Until next time,

Cathy … The Amputee Coach

Cathy Howells - The Amputee Coach - rockclimbing at the amputee camp for teenagers

A few weeks ago I had the pleasure of joining a very inspiring bunch of people who just happened to be   amputees at the second annual Teen Ranch Amputee Camp.

The idea of the camp is to provide contacts, information, support, confidence and friendship to teenage amputees and their families.  One of the ways in which the camp does this is through participation in all sorts of activities, such as archery, canoeing, art, horse riding, walking on high wires and rock climbing.

To my way of thinking rock climbing is the ultimate terrain.  For a start it’s vertical and all you have to heave yourself up that thing is a few “rocks” or lumps poking out from the wall.

Having never rock climbed before and seeing all the other camp participants clamber up and abseil down like a bunch of helmet wearing spiders, I thought I would give it a go.  After all how would it look if The Amputee Coach piked?

Starting that climb gave me a new appreciation of the concept of vertical, clinging onto those little bumps.  Half way up was not too bad, until I started to puff and the muscles in the forearms and legs started to shake and the psychology of the HEIGHT kicked in.  So one girly scream later and I was dangling off the wall thinking that was it –lower me down.  But looking down and seeing the campers yelling encouragement, I gave myself a quick pep talk – I go to the gym, I’ve got a reasonable core and all my limbs, I’m getting the hell UP THIS WALL!

And so I did and then performed an encore by completing my first abseil.  The best part of it was realising that I had done something that I THOUGHT I never could.  It was so empowering and all I had to do was give it ago. The worst part was – there was no worst part.

So when you are confronted with “tricky terrain”, back yourself- you might be in for a surprise.

Until next time … Cathy … The Amputee Coach

Everybody remarks how much harder it is to walk up the slope and I am afraid physics is to blame.  (You may have begun to notice that I think physics has a lot to answer for!)

Firstly, in walking up the slope, you are working against gravity and trying to push your body weight up.  The good news is that this is excellent exercise for your buttock muscles, especially if you concentrate on contracting them strongly along with your core as you “power” over your leg prosthesis up the hill.

You will also find some handy buttock strengthening exercises in Chapter 9.  If you do these amputee exercises regularly, you will notice how much easier it is to go up hills.  This in turn will make walking on flat ground easier and you may well walk faster on the flat.

1. Take smaller steps – as these are easier to control
2. Stay on the heel of your prosthetic foot and keep your prosthetic knee straight by pushing backwards strongly with your stump
3. If the slope is too steep, walk down it sideways with your leg prosthesis down first.  This way you won’t have to worry about it bending at all.

So, if you are an above knee amputees just starting out -  just take your time, take small steps and stay safe.

Until next time …  Cathy … The Amputee Coach

The muscles responsible for a smooth walking action down slopes are the quadriceps and they are often weak “eccentrically,” that is when performing a lengthening action.  The reasons for this can include: the inability to practice this type of exercise before the fitting of your prosthesis and pressure around the muscle itself from the suspension of your prosthesis.

Therefore, it is important to do some “eccentric” or specific knee control exercises to smarten up the action of your quadriceps as you smoothly descend slopes.  There are 3 exercises to achieve this in Chapter 9 of the Amputee Coach Book that are marked for “below
knee amputees only”

1. the buttock and knee strengthening exercise-step
2.  the squat
3. the innerrange knee strengthening exercise.

If you put these exercises into your routine you will find that your knee control going down slopes will improve.  Not only that, but you will walk up slopes with greater ease and may eventually be able to progress to walking up and down stairs, step over step instead of one step at a time.

Please feel free to leave your questions, comments and feedback below.

until next time … Cathy … The Amputee Coach

Whenever I lecture to physiotherapists who train amputees in the use of their leg prosthesis, I stress the importance of avoiding an “unsuccessful experience.”  To do this, it is essential for the therapist and amputee to heed some basic laws of physics and plain old common sense.  A common scenario would be in learning to go down stairs, especially in the case of an above knee amputee.

Here’s what to do if you have a  * mechanical knee that WILL NOT support your body weight when it is bent:

1. Start your practice on the lowest step
2.  To come down stairs safely, the leg prosthesis must always come down first.  It should be placed in the middle of the step below you
3.  Aim to keep your body erect, firmly push back with your stump to help keep your prosthetic knee straight.  Bring your unaffected leg down to the same step as your leg prosthesis.

By doing it this way, the safety of your prosthetic knee will not be compromised.  Common sense recommends practicing this on the lowest step first.  It’s safer and you don’t have to deal with the psychology of starting to learn from any great height.

Here’s what to do if you have a  * microprocessor knee joint or one that WILL support your body weight when it is bent:

1.  Seek out training with a physiotherapist/physical therapist that is experienced in training an amputee with this type of knee joint
2.  Start your practice on the lowest step
3.  Two thirds of your prosthetic foot should be placed over the edge of the step
4.  As you put your weight onto the leg prosthesis, your microprocessor knee will bend under your body weight.  This will allow you time to place your intact leg on the step below.  You must put your weight on the prosthetic leg as soon as it     starts to bend because the amount of resistance to knee bending is at its greatest in the first few degrees.
5.  This method of descent needs a lot of training and practice but the results are great and make it worthwhile.
From mastering stairs, you will then be able to learn to safely go up and down a large flight of stairs and walk down slopes.  But like anything worthwhile in life, it requires practice, practice and more practice.

* If you are unsure of the type of knee you have, check with your prosthetist first.  The most important thing is that you receive the correct prosthetic training in the use of your particular prosthetic  componentry.

Until next time … Cathy …. The Amputee Coach

Now, moving on to higher levels of amputation, the knee disarticulation amputee has a number of distinct advantages over the trans-femoral amputee and yet they are both classified in the T42 category and must compete against each other.

The knee disarticulation amputee has a longer lever to control the prosthesis, produce power and in most cases they can end bear on their residual limb which allows for increased proprioception and confidence in the prosthesis and renders a socket extending to the ischium unnecessary.

Despite these disadvantages for transfemoral amputees, the world record for the T42 women’s long jump and 200 metres is held by Australian Paralympic athlete Kelly Cartwright.  Kelly’s world records for these events are 4.19m and 35.98 sec respectively. Her sporting prosthesis comprises an ischial containment socket with silicone liner and pin lock suspension, single axis hydraulic knee joint and carbon fibre sprint foot.  Currently numbers in amputee competition do not allow for these levels of amputation to be distinguished.

These two cases provide a window into the world of amputee track and field competition and its fascinating myriad of controversy in terms of classification and “legal” prosthetics.  Increasing personal performances pushing the boundaries of disabled sport truly test the abilities of the prosthetist and physiotherapist to help keep the amputee athlete competitive.  But without a doubt it is the courage and dedication of the athletes that cause the competition to come alive and thrill of the race to be all the more exciting.

An Aside about Oscar:

If you would like to delve a bit further into the story of Oscar Pistorius – there was a great story by Michael Sokolove In the New York Times earlier this year – The fast life of Oscar Pistorius http://www.nytimes.com/2012/01/22/magazine/oscar-pistorius.html?_r=1&ref=oscarpistorius , just as interesting is the “behind the cover story” opinion piece that they published in their blog http://6thfloor.blogs.nytimes.com/2012/01/23/behind-the-cover-story-michael-sokolove-on-oscar-pistorius/?ref=oscarpistorius.

A fantastic “graphical” representation of the “amputee advantage?” using Oscar was put together by the New York Times – http://www.nytimes.com/ref/sports/20070514_RUNNER_GRAPHIC.html?ref=magazine

Until next time … Cathy … The Amputee Coach

On the face of it, such a question sounds ludicrous, how could it be an advantage for sprinting when your feet are not your own?

So back to Oscar Pistorius … with Oscar’s performances improving prior to the meet in South Korea in 2011, there had been numerous attempts to either sanction his competing in able bodied athletic competitions or to ban him from them.

Are his “legs”, prosthetic legs or assistive devices?

This is an important distinction for participation in the Olympic Games.  Without them, he doesn’t have legs to run on, with them, some claim he has an unfair advantage.

Oscar’s participation in both pre-olympic and paralympic competitions raises some interesting issues. Against able bodied runners his carbon fibre sprint flex feet undeniably offer energy return, he can’t develop lactate in them and some say his stride length is artificially increased.  Stride length has been an issue in past paralympic competitions when a bilateral competitor was made taller than he would have been with anatomical legs, thus artificially increasing his stride length and speed.  The prosthetic height of bilateral amputees must now be commensurate with anthropometric measurements of able bodied limb length.

On the other side of the coin, an amputee will tell you about the lack of “proprioception” – knowing where you are in space – having lost your foot/ankle mechanism, your reduced muscle mass and the requirement for increased proximal control to walk, let alone sprint – none of these things can be seen as advantages.  Oscar’s bilateral carbon fibre feet mean that he is necessarily slower out of the starting blocks and unable to stay “lower for longer” as we see in sprint competition, but may be an advantage as the length of his races increases.

In Paralympic sprint competition bilateral trans-tibial amputees have greater symmetry in their sprinting gait, when compared to their unilateral trans-tibial competitors. A congenital amputee has had a lifetime to adjust and perfect their loco-motor technique versus those who have more recently acquired their amputation. Should there be considerations for this in paralympic classification? Currently there are not.

The jury is still out on Oscar’s alleged advantages and there have been interesting studies in the literature supporting both sides of the argument.  One problem with some of the studies of the amputee mechanics of such elite performance is that Oscar is a population of N =1. We will see later this year at the London Paralympics if that population grows with other outstanding bilateral trans-tibial amputee performances.

Please leave your comments, feeback and suggestions in the space below.

Until next time …. Cathy …. The Amputee Coach

or “Will Jerome Singleton beat Oscar at the Paralympics?” http://www.universalsports.com/news-blogs/article/newsid=581354.html . 

 As we pointed out in Part 1 there is the suggestion that Paralympic amputee sprinting has evolved to such an extent that if you are not wearing the latest technology, you will no longer be competitive.  So, today we will talk a bit more about the key elements of “Paralympic Amputee Sprinting” – the sport that is getting currently getting all the “Press.”

Success at the paralympic level, much like amputee exercise and rehabilitation itself, requires a co-ordinated multi-disciplinary team approach.  The team comprises of the running coach, prosthetist, physiotherapist, doctor, nutritionist and psychologist, all of whom liaise with each other and work together with the athlete, who provides the skill, courage and determination in order to compete.  The purpose of these next couple of posts is to present some of the innovations in prosthetics that enable amputee athletes to compete at an elite level and some of the interesting controversies currently facing the sport.

Prosthetically speaking, sprint foot design principles have not changed a great deal over the last 15 years.  The foot is made from carbon fibre which stores and releases energy under load.  The key though, as with all prosthetic components is the ability of the athlete to use the foot.  ie It won’t run for you!

From a physiotherapist’s point of view, there is a great deal of work that needs to be done in the preparation of the athlete’s body to be able to control this type of foot, harness its advantages, be able to perform correct sprint technique while avoiding injury!

(NB:  These amputee exercises are “progressions” of what you have been shown in chapters 7-11 of The Amputee Coach Book.  It all starts with your core.)

Socket and interface (what connects the prosthesis to the athlete) components have changed dramatically over this time, from liners made from open cell foams like the innersoles used in shoes, to liners made from silicones and polyurethanes, capable of transferring sheer forces and absorbing shock with flow characteristics.  When used in conjunction with mechanical pin lock systems or negative pressure suspension, friction to the athlete’s skin is minimised, abrasion and stump breakdown are eliminated and the athlete is able to train longer and harder on their prosthesis to achieve the elite levels of fitness and performance that we see at the Paralympic level today.

Like in rehabilitation, the physiotherapist and prosthetist liaise during the training program as the athlete’s body and performance improves.  As the athlete improves, component and alignment changes need to be made to the prosthesis to continue to enhance their performance.

The impact that prosthetic technology has had in amputee sprinting was exemplified last year during the 2011 13^th IAAF World Championships in Athletics held in Daegu, South Korea.  A great deal of focus was not on the performance of able bodied sprint athletes, but on an athlete with a disability, South African, Oscar Pistorius.  Oscar caused controversy because he had qualified for the meet and was beating able bodied athletes, leading people to ask, “Is having NO legs an advantage when sprinting?”

Be sure to leave comments with your feedback, suggestions and questions.

Until next time… Cathy …. The Amputee Coach

PS  Find out the answer to the question “Is having NO legs an advantage when sprinting?” next week in Part 3 of Amputee Exercise – Prosthetics in Sport

(Yep – that would be your goal – the one that you thought about at the beginning of the year.  You may want to jump back to the 24^th of Jan blog piece to remind yourself.)

For the next few posts I thought in the spirit of “exercise for all amputees” we would think about “prosthetics in sport”.

There are a couple of reasons – I am very excited.  First, I will be heading across to London to cheer on our Australian athletes at the Paralympics in August and second there has been a lot of “buzz” around the athletes who will be competing and what they will be competing on in 2012.

Here is a piece with an Australian athlete talking about whether technology gives an advantage to the individual amputee athlete.  Check it out here

Please let me know your thoughts, comments and feedback.

Until next time… Cathy … The Amputee Coach