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An Introduction to Below-knee Prosthetics
Transtibial or below-knee amputations isa surgical procedure performed to remove the lower limb below the knee when that limb has been severely damaged or is diseased. About 54% of all surgical amputations result from complications of vascular diseases and other conditions that affect blood flow, such as diabetes and peripheral arterial disease (1). Poor circulation limits healing and immune responses to lacerations and infections. Any ulcers that develop may not heal causing infections to spread to the bone and become life-threatening. Amputation is performed to remove the diseased tissue and prevent the further spread of infection. Most BK amputations are performed mid-shin, but may be adjusted according to infection location, deformities, surgical preferences.
Parts of a Prosthetic
Prosthetic legs come in all shapes and sizes. There are thousands of parts that can be used in even more combinations. Typically the parts of a prosthetic can be organized into a few component types. The following are the basic parts of a below knee (transtibial) prosthesis.
The Socket
The socket is the part of the leg that is custom made to you. It is used to attach the foot to your body and control the pressures exerted on your limb. They are typically made of carbon fiber and
The Pylon
Typically when someone refers to the pylon it is the pipe that determines the length of the leg. This pipe is adjusted to maintain hip alignment. The angle and position of the pylon also determine the stability and efficiency of your gait, meaning the better the placement the easier it is to walk! The small parts that change the angle and placement are called endoskeletal components and are adjusted by the prosthetist.
Suspension
Suspension is the word used to describe how the prosthesis attaches to the body. There are many types of suspension including pin lock, suction, elevated vacuum, lanyards, supracondylar, and belt. Each system has benefits and detriments. Your prosthetist will design a leg that uses the most appropriate and beneficial style of suspension for you.
The Foot
Prothetic feet can be made of many materials including carbon fiber, fiberglass, even wood. They are categorized by the activity level they are designed for, which means the more you can move the more advanced the foot you will likely receive. Click on the pic to learn more about different prosthetic feet.
What Every Amputee Should Know
Below we will go through basic topics that every amputee, whether seasoned or new, should know.
K Levels
Most insurances categorize amputees by their current or potential activity level. These levels are important because they determine what level of components insurance will approve for an amputee. This means the higher level you qualify for the more options you will have including more advanced technologies that are not covered for lower levels. The K levels are as follows:
Level Zero
The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. This level does not warrant a prescription for a prosthesis.
Level One
The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. This is typical of a household ambulator or a person who only walks about in their own home.
Level Two
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. This is typical of the limited community ambulator.
Level Three
The patient has the ability or potential for ambulation with variable cadence. A person at level 3 is typically a community ambulator who also has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.
Level Four
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. This is typical of the prosthetic demands of the child, active adult or athlete.
Liner Washing Instructions
To maintain the hygiene and performance of your Prosthetic Liner, follow these washing instructions:
Daily Cleaning: Wash the liner daily with mild soap and lukewarm water. Gently scrub the liner using a soft cloth or sponge to remove any dirt and sweat.
Rinsing: Thoroughly rinse the liner with clean water to remove all soap residues, ensuring there are no remaining traces that could cause skin irritation.
Drying: Pat the liner dry with a clean towel. Allow it to air dry completely before wearing it again. Avoid direct sunlight or heat sources, as these can damage the material.
Weekly Deep Cleaning: Once a week, perform a deep clean by soaking the liner in a solution of mild soap and water for a few minutes. Rinse thoroughly and allow it to air dry.
Avoid Harsh Chemicals: Do not use bleach, fabric softeners, or harsh cleaning agents, as they can degrade the material and reduce the liner's effectiveness.
Regular cleaning will help extend the life of your Prosthetic Liner and ensure it remains comfortable and effective.
Proper Prosthetic Sock Use
Choose the Right Sock: Select a prosthetic sock that matches the size and thickness you need for comfort and proper fit. Ensure the sock is clean and dry before use.
Inspect the Sock: Check the sock for any signs of wear, holes, or dirt. A damaged sock can cause discomfort and skin irritation.
Put On the Sock:
Turn the sock inside out, leaving the toe section.
Place the sock over your residual limb, starting at the end and unrolling it gently upwards.
Smooth out any wrinkles or folds to ensure an even and comfortable fit.
Adjust the Fit: Ensure the sock fits snugly without being too tight. If using multiple socks, layer them carefully to maintain comfort and proper alignment of your prosthesis.
Monitor Throughout the Day: Check the fit and comfort of the sock periodically. Adjust or change socks as needed to accommodate changes in limb volume or comfort levels.
Wash Regularly: Clean your prosthetic socks when dirty with mild soap and water. Rinse thoroughly and allow them to air dry completely before the next use.
Replace When Worn: Replace prosthetic socks when they become worn out, stretched, or damaged to maintain comfort and effectiveness.
Following these instructions will help ensure your prosthetic socks provide optimal comfort and fit, contributing to a better prosthetic experience.
Prosthetic Sheaths (Liner-Liner)
Putting on the Sheath
Clean and Dry Residual Limb: Ensure your residual limb is clean and dry before applying the prosthetic sheath to maintain hygiene and comfort.
Inspect the Sheath: Check the Knit-Rite Liner-Liner for any signs of wear, holes, or dirt. A damaged sheath can cause discomfort and skin irritation.
Put On the Sheath:
Turn the sheath inside out, leaving just the toe section.
Place the sheath over the end of your residual limb.
Carefully unroll the sheath upwards, smoothing out any wrinkles or folds for an even and comfortable fit.
Check for Comfort: Ensure the sheath fits snugly without being too tight. It should provide a smooth layer between your skin and the prosthetic liner, reducing friction and enhancing comfort.
Adjust as Needed: If the sheath feels too tight or loose, adjust it to ensure it provides the necessary comfort and protection.
Daily Use Tips
Monitor Throughout the Day: Check the fit and comfort of the sheath periodically. Adjust or change it as needed to accommodate changes in limb volume or comfort levels.
Replace When Necessary: Replace the sheath when it becomes worn out, stretched, or damaged to maintain comfort and effectiveness.
Washing Instructions
Daily Cleaning: Wash the Knit-Rite Liner-Liner daily with mild soap and lukewarm water. Gently scrub the sheath using a soft cloth or sponge to remove any dirt and sweat.
Rinsing: Thoroughly rinse the sheath with clean water to remove all soap residues, ensuring there are no remaining traces that could cause skin irritation.
Drying: Pat the sheath dry with a clean towel. Allow it to air dry completely before wearing it again. Avoid direct sunlight or heat sources, as these can damage the material.
Avoid Harsh Chemicals: Do not use bleach, fabric softeners, or harsh cleaning agents, as they can degrade the material and reduce the sheath's effectiveness.
References
Amputation. Johns Hopkins Medicine. (2021, August 8). Retrieved August 3, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation
Suspension picture from https://silipos.com/symptoms-conditions/prosthetics/
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