Friday, April 6, 2012

My Three Feet

My Rights - walking, running, convenience

On my prosthetic planet I typically have 3 different legs I wear in a 24 hour period. One is for walking, one is for running - you might note I run a little, and one is for backup/convenience. I am going to write about each one, with the new walking leg finally getting some press since I haven't talked about it much.


The Prosthesis for Convenience aka "Old Paint"

My plastic slipper
This leg is from my previous prosthetist. I walked in it for perhaps a year or more as my everyday leg. With my longer residual limb, I do not have a suspension system employed in this leg, that is, nothing holds it on except the friction between the residual and the socket; there is no suction or even a sleeve required, just prosthetic socks to insure a snug fit.

The design is simple: thermoplastic socket and frame, an Ossur silicone liner, varying number of prosthetic socks, and the foot is a very good Freedom Innovations Renegade LP (low profile). It didn't need to be low profile, which has less energy return than full size, but that is another story. I ran some of my first races on this foot.

I can don (put it on) in less than a minute. If the house was on fire I could don it and escape. It's great for midnight kitchen raids or pit stops, and for walking around first thing in the morning before showering and dressing for the day. Also for travel it's great because in a tight airline seat my knees are jammed against the chair in front of me, and with this leg I can simply pull my residual out of it to have a little more room.

The downside is if I wear it for more than 30 minutes, sometimes less, I have to start adding prosthetic socks as my residual is squeezed like a tube of toothpaste; the fluid goes out of the anatomical leg and the volume decreases. The thing could fall off if I had to run or jump since it is only held on by friction. Lastly, the overall fit is not quite right. This is the same socket I ran some races in, and it irritates the fibula head if I wear it for several hours.

This is also why it and suspensions other than vacuum is less healthy for the limb; it is far less of a natural environment for the residual. Only vacuum systems like the Ohio WillowWood LimbLogic VS that I wear or the Otto Bock Harmony provide this outstanding feature.

Elevated vacuum does not work for all amputees, but for most transtibial (below the knee, aka BK or BTK) gimps like me it should be the suspension of choice in my opinion. It does take a dedicated CP to properly fit it, as considerations like keeping the system airtight is imperative in the prosthesis. The amputee must be educated to the advantages of elevated vacuum to offset what might be seen as inconveniences, particularly the longer donning/doffing processes.

These issues are largely solved by having a "convenience" prosthesis like Old Paint for times when donning/doffing the elevated vac is unreasonable, i.e. the aforementioned fire or the "I gotta go NOW!" 3 a.m. moment. Also if I am having my everyday leg worked on, I can wear this old thing and not lose my mobility.

I believe many who have other systems and particularly elevated vac need something like this that can be donned quickly. I did not have this prosthesis for a few weeks when I was first trying elevated vac and missed it every day. Now I have the best of both worlds and highly recommend this solution.

Although it sees less wear time than my other two legs, it definitely is a great convenience and I would miss not having it.


The Prosthesis For Running aka "Jato"

My right wingman
Here is my cool friend Jato. In the current iteration, Jato consists of these major components:
  • Freedom Innovations Nitro foot. 
  • Ohio WillowWood LimbLogic elevated vac
  • ProCare high tech proprietary socket and frame
  • Otto Bock custom polyurethane liner
  • Otto Bock Derma ProFlex sleeve
This incredible prosthesis was designed, fabricated, and fitted by the forward and innovative team at ProCare Prosthetics and Orthotics. With athletes and patients like Scott Rigsby, Jason Gunter, Cadie Jessup, Shea Taylor, Rajesh Durbal, Jarryd Wallace and many others, ProCare has the resources to help amputees achieve their dreams and open new horizons to others.

When I see other high level amputees using yesterday's technology because of other commitments like employment or because an organization requires them to use a particular prosthetist, well, that seems tragic to me. To settle for less than the best should not be the choice to make.

Is Jato perfect? No. No prosthesis is, but then again, neither is the anatomical body. The body remains the most incredible machine I know of, capable of healing itself from many injuries. Yet even the healing process may weaken it over time, or cause things like the very arthritis that rendered my old right foot deformed and painful.

I do know Stephen Schulte and his staff at ProCare never sit still, looking for ways to improve their products to help the disabled excel in life. And I am here to tell you now, my life has been richer since my amputation.


The Prosthesis for Everyday

This is my current everyday prosthesis. Aside from the OWW LimbLogic VS pump, the brand new Freedom Innovations Renegade A•T All•Terrain prosthetic foot is the real star here.

Originally we tried an Otto Bock Harmony pump, but the length of my residual limb meant the prosthetic foot had to be very low profile. That foot that felt awkward, did not have the rollover characteristics of my old foot, and was uncomfortable. With the more compact LimbLogic electric pump, I was able to use the newly designed Renegade A•T and wear a full height foot on my everyday prosthesis.

Holy cow was I impressed!  For the first time I became UNAWARE of my prosthetic foot, the Renegade A•T is so natural and comfortable and a joy to wear. Rollover is entirely transparent to me; I remember thinking "if only my anatomical foot felt this good!" I believe this foot would be an excellent choice for running trails or other uneven surface where Jato is not as well suited to the terrain. I haven't tried this because the socket is not really designed for running.

As I've already mentioned, the elevated vacuum suspension system utilized in this prosthesis is key. Why is this so much better than any other suspension system? Because the residual limb is not squeezed, rather, uniformly pulled toward the socket, and as best I can tell, in similar position as a normal limb. An article appears here that discusses this giant step for amputees. 

My limb is in a healthy environment and I rarely (meaning nearly never) have to adjust my prosthetic socks.  Another huge plus is when set up properly, sweat can be removed from the prosthesis. In my old suction prosthesis this had been a huge issue for me. Now no more horrid Drysol or other anti-antiperspirants that made my skin far less healthy than normal. I have less issues like ingrown hair because the residual is not being compressed.

Socket comfort is usually outstanding, but after my recent meniscus surgery and subsequent return to running, I have felt some discomfort at the distal end of my fibula where the Ertl bone bridge is formed. This is in both my everyday and running prostheses. I believe the shape of my residual has changed some causing this, along with the fact there seems to be no specific loading on the end of my residual. Most "guillotine" amputees cannot tolerate load bearing in the end of their residuals;  Ertl amputees can because of the nature of the procedure. That said, I have contacted my CP and we'll see if an adjustment is in order.


So there is my current lineup of right feet. These give me a life where I don't cringe at the thought of walking good dog Baxter to the field to play, or even to my vehicle to go to work. Prosthetics continue to evolve to improve the lives of people with limb loss. For me, running is a large part of my life, and that loss would be been the true tragic amputation.

I'm Baxman!

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