Friday, January 16, 2009

Prosthetic Fit - If the leg fits, wear it!

This post is for the millions of amputee readers I have....  it may be of some interest to non-amputees but it might also bore you to tears.  If it is the latter I do apologize...

Prosthetic Fit

Your prosthesis should fit nicely - great function without pain is the goal.  Why then do we spend days, weeks, months and sometimes years accepting a less than ideal fit?


 "I don't want to be too much of a pain in the @ss to my prosthetist."

 "I need to adjust to the socket."

"My limb is changing.  I might as well wait."

"I lost a limb - nobody said it would be all roses."

"Maybe this is as good as it gets."

"Maybe if I put more cream/vaseline etc. on the spot it will go away."

These are a few of the reasons I have put up with pain for longer than I should have.  None of them is particularly valid.  I have learnt over the years that I can reasonably expect a VERY high quality of service from my prosthesis.  When everything is perfect with my leg I don't think about it at all...  and I can push it to some pretty exciting places on the activity chart.

So then, what do I do when the fit is less than ideal?

The first thing is to realize it.  This sounds obvious but it is often the hardest part.  Often my fit will deteriorate so gradually that I won't notice until it is WAY off.  This process can, and often does, take months.  Try to pay attention and when others say "Hey are you limping?" or "Hey are you limping more?"  think hard about it.  Are you?  Probably.

Then I try to figure out why things are off.  I look for red areas on my limb after wearing the prosthesis for a few hours.  I do some rudimentary leg length measurements to see if I am in too deep or wearing too many (or few) sock ply.

Often I can figure out what is going on this way.  Part of this is experience - after you duff your foot on the ground for the thirtieth time you remember, "Hey the last time I did this I was wearing too many socks!"

Often hot spots or sensitive areas will develop when my prosthetic socks get a bit too old.  They don't have the same fluff-factor (thickness) as they did when they were new.  That means 5 ply = 4 (or maybe 3.5) either way it will very gradually start to fit wrong and hurt.

Skin problems will more than likely be the symptom that first alerts you to an issue.  It is important to know the difference between a skin problem that is a symptom of a bad fit and one that is a symptom of life...  i.e. super-red painful areas where there is some binding = bad fit.  Sudden red inflamed areas can be an ingrown hair or other issue....  experience will help you to figure out the difference.  You can read my post on skin problems for help.

I like to exhaust my own ideas before I trouble my prosthetist.  This is not because it is so much trouble for him, but because it is trouble for me too.  It's a whole lot better for everyone if I can learn to diagnose a bad fit and try a few things to relieve it.

If that doesn't work though, you can bet his phone will be ringing.  I tell him the issues and get some input from him.  Sometimes I will have been doing exactly the wrong thing to try to fix it - thus exacerbating the situation....  hey, at least I tried!

Nine times out of ten he can instruct me and I will not require any actual work to be done on the prosthesis.  Sometimes, I have decided that a new socket is the answer...  these decisions are yours and his/hers to make together.  In my experience the prosthetist should be willing to exhaust himself trying to make it fit.  There should be no limit to the number of adjustments he is willing to make in order to help you with your fit. 

The prosthetist should also be willing (and able) to teach you everything you need to know about your leg.  There are numerous small adjustments you can make yourself on most legs if you know how.  It isn't difficult and you shouldn't be afraid to ask.

Once I have a new socket I like to test it extensively in the first few days.  

- If it is a running leg - I run.  

- If it is a walking leg - I play golf.  The golf course is perfect for testing out legs - 6 miles of walking - uphill, downhill, sidehills, rough terrain (where my ball always is), flat terrain etc.  You know if the leg fits after walking the course.  (Note:  If you are a new amputee you will want to pick a challenge that is a bit less demanding - but use the same theories.)

Ultimately, I feel that you should "expect" comfort and function that will allow you to do the things you want to do in your life.  You should also "expect" that it won't always be easy...  There WILL be problems and you will need to get as good as you can at diagnosing them and working with your prosthetist to establish a great fit and maintain it.  Like almost everything in life it will get easier with experience and time. 

If anyone ever needs advice or to ask a question please leave a comment or drop me a line at:


P.S.  If this helped you please leave a comment - it feels good to help!

Tweet this!


BreeWee said...

MJ you are such a stud... not boring, just really new... I am clueless on any of that (Thank God I have both legs) but I care a lot and believe a lot in you (and others) that have to enjoy sports with other challenges. Nice post.... I am so rooting for you 2010!

Your country is not only cold by the way, the fog is so bad my plane can't leave, I am going on hour 8 of airports, reading blogs ALL day! Have fun here, stay warm :)

Chad in the AZ Desert said...

That's a very cool thing to post. I'm sure - as with most things - people don't even realize that it can be better than it is. I'm sure someone is going to benefit from your information - and it doesn't get any better than that.

Have a great weekend, Meyrick!

Scott Rigsby said...


Good job on the post! All the best this year!


Claire Grantham said...

I found your post very useful. My husband is a new amputee and has been having a lot of problems with fit. This helped us both to understand what is possible and what we can reasonably expect. Good luck with your racing!

Linda Pendleton said...

Hi Meyrick,
Thanks for the new info. You are very good at expressing what we amputees go through with fit and with skin problems. At times it can be a little frustrating. I've had a new socket for a week, and it's taking a little getting used to this time. I often find it difficult to explain to Jon, my prosthetist, exactly what it feels like. The socks: how many, put one on, take one off, etc., can often be a challenge. Of course I have only been at it 12 months. And I've made a lot of progess. I hope you received my two emails in response to yours a few days ago.
My best, Linda

PC Ironman said...

as you know, my leg works at a less than desireable level and countless times I have thought I would rather be without it. After reading this I changed my nine and will keep the gimpy one. It was a great read though. Oh! By the way, its almost 25 here in Phoenix, wish I brought my bike. Have a good weekend. DS

trickeychick said...

Thanks for this very helpful post. I am right in the middle of trying to decide if my prosthetic fit can and/or should be better. Now I have my answer!

Mike said...

Great post! Looking forward to getting my first set of wrenches (and first leg for that matter) and doing some tinkering. Might have to start shopping for some "leg bling" of my own to jazz it up a bit. :)

Missy said...

That first picture on this post is my new favorite. That visual of the 'tools' you will need for the bike is very striking to me. 2010!!!

Malcolm said...

Hi Meyrick,
As a guy with 2 legs I find it morbidly humorous to find your leg hanging out with your bike at transition.

Ron said...

Found this on Google and thanks so much. I am a new BK and have been dealing with pain with 2 legs now. I think after reading this its time to find a new prosthesis. Thanks man!