interventions in lower extremity pros the tics

8/6/2019 Interventions in Lower Extremity Pros the Tics

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Interventions in Lower Extremity

Prosthetics

Walter Racette CPOAssistant Clinical Professor

Director, Orthotic and ProstheticCenters @ UCSF


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Unique patient population

In many cases, theamputation is not themajor issue that thepatient is dealing with


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Unique patient population

Homeless Drugs; Rx and self

selected Mental status Other medical issues Transportation Hygiene Medical insurance


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Prosthetic terms

Prosthetics Prosthesis Socket Suspension Inner face prosthetist


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Prosthetic terms

Redundant tissue

Prostheticcomponents Anterior/toe lever

arm Posterior/heel

lever arm


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Prosthetic Feet

It is the transmissionof the lever armforce to the body

that can eitheraccelerate the COGfrom heel strike tomid stance and then

decelerate/stabilizethe knee from midstance to toe off


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Prosthetic Feet


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Prosthetic Feet


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Prosthetic Feet


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Lower ExtremityProsthetics

levels of lower extremity amputations Post operative care Socket fitting and volumetric changes The prosthetic care process Common patient issues


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Common amputation levels

Partial foot

prosthetics Missing anterior

stability, push off inthe gait cycle andbalance


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Partial foot


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Partial foottrans metatarsal

Ankle disarticulation


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Ankledisarticulation;

- disarticulationof the foot


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Major issues with ankledisarticulations

Not capable of distal

end bearing Length under heel

pad to the floor forprosthetic foot

Cosmetic Distal migration of

pad to the medialside


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Trans tibia


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Trans tibia


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Trans tibia


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Trans tibia amputation

Function varies with length as well asreason for amputation

Good mobile skin coverage distally ismore important than trying to

maintain extra length Knee flexion contractures of more

than 25 degrees are difficult to fit astrans tibia

Very short trans tibia have ML and APinstability


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Trans femoral-length is a majorissue.

Better control ofknee

More weightbearing surface


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What predictors indicateprosthetic success?


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Trans femoral amputation

The need for a prosthetic knee at thislevel significantly complicates andlengthens rehabilitation

Much higher energy consumption toambulate

Much more difficult to don and doff The major weight bearing area is high

in the groin Weight gain/loss is the major reason

for socket replacement not edemaand atrophy


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Bilateral lowerextremityamputations


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Post operative management

Good wound healingenvironment

Prevent contracture

Compression Protect the limb Ambulation?


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Post operativemanagement


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Prefabricated rigid stumpprotectors

24 hours after surgery Pull into through strap

and hole in the bottom 6 compresso grip for

mild compression and tohold on the dressing

Contracture preventionand residual limbprotection


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Post operative management:why is it so important?

Reducing the volume of the

limb prior to casting. A two tothree inch reduction at midcalf level would not be unusualduring the first 6 months postamputation.

Less margin for patient errorin volume issue

Reduction in cost


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Post operative management:why is it so important?

Contractures limitand compromisesuccessfulprosthetic use

Reducing the timebetween surgeryand woundhealing keeps thewindow ofopportunity open


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Prosthetic care process

Evaluation,casting, andmeasurements


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Casting andmeasurements


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Clear testsocket

Dynamic


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Suspension


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Dynamicalignment


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Alignment issue


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Protective/cosmeticrestoration


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Prosthetic components

Prostheticfeet

Static

Dynamicresponse


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Prosthetic Feet

So whats so

important about theprosthetic foot?


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Prosthetic Feet


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Suspension of the prosthesis

Good suspensionprevents pistonaction

Reduces the feelingof weight

Safety andconfidence


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Suspension of the prosthesis

Ankledisarticulation-self suspending:

pass the largerdistal limb pastmore narrowproximal


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Suspension of theprosthesis


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Suspension of theprosthesis


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Common prosthetic issues

Volume of residual limbchanges and educating

patient on how tounderstand and makegood decisions

Prosthetic socks Pads placed

inside the socket Grinding material

out of certainareas Replace the

socket


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Common prosthetic issues

VOLUME changes What happens and

what can changevolume???

Loss of edema Weight gain/loss Dialysis Medications Trauma to the

limb Not wearing

consistantly


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Common skin issues

Pressure sores Lack of distal total

contact Soft tissue adhesions Hygiene of the residual

limb


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Common skin issues


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Common skin issues


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Common skin issues


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Common issues

Hypertrophic bonegrowth

Neuromas Bone spurs


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QUESTIONS?

interventions in lower extremity pros the tics

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