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Fit, Fit, Fit!

Posted Jan 12 2009 12:00am
For the amputee, what are priorities 1, 2 and 3? Trick question. The answer is fit, fit and fit!

I have lived with a prosthesis for 36 years and for all the fancy technologies we talk about for feet, ankles and knees, none of them are worth a hoot if the socket doesn't fit perfectly. And I mean perfectly. Never accept poor fit. Go find a better prosthetist if you aren't getting a fantastic fit. Only after the fit is perfect does it many any sense to even think about advanced technology in the other components. I will elaborate using my situation as illustrative.

I have a fairly short (5 inches) stump. That means there is a lot of leverage put on my residual limb by the prosthesis. I am also fairly large at 6'1" and 185 pounds (but not overweight) so I put a lot of pressure on the skin-plastic interface at the socket. I am active especially when I am in a phase when I am doing a lot of business travel. But I am not crazy active in the leg as I have chosen to do a lot more legless as I have gotten older and much less concerned about being stared at compared to when I was in my 20s. You would think with this much experience with a prosthesis I would have it wired and would always have a comfortable fit. Not!

How can this be and why is this the state-of-the-art? I am writing this post because I just took a many years backward step in terms of comfort in spite of the fact that "nothing changed" with my leg or my body. I took a long couple of plane flights over the holidays and it turned my stump into a very sad character indeed. When you have any pain, no matter how much of a stoic you are, you start to walk badly and worse, you start to avoid doing things and insidiously, you naturally begin to withdraw. Keep that going too long and without realizing it, you might find yourself permanently withdrawn from much of life. Point being, its just too important to be comfortable in your prosthesis to leave it to chance.

So what happened? My setup is an Iceross Silicone Prosthetic liner with a long pin in the end that is ratcheted into the bottom of the socket. The socket is plastic but quite flexible at the rim. This is supposed to be about as comfortable as it gets. Which is not very. I am always dealing with abrasion, pinches, skin stretching and lots of other things that just plain hurt. My wife calls me "Mr Creams" because I am always using one cream or another to help my skin recover from normal days in the leg. Even though I consider my current setup as comfortable as I have ever been, my pain issues are ongoing but sometimes it gets much worse as it did on this recent trip. The liners (which cost about $1000) only last about 4 months and I pushed this one to six and when they weaken and stretch it causes comfort problems. If your weight changes and you sit higher or lower in your socket that can change everything. Even if your weight is very stable as mine is, just going from summer to winter can change the geometry of your stump enough. Point is that while fit is the most vital thing in your prosthetic life, its not static and you have to stay on top of it.

So, if when buying a house the mantra is Location, Location, Location, our rallying cry must be Fit, Fit, Fit!
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