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Transtibial Prosth.

Transtibial Prosthetics Presentation

Types of Prostheses Post-Operative; Temporary; Definitive
Post-Operative Prostheses Eliminates contracture potential; Reduces time to fitting of preparatory prosthesis; Restricted use on vascular/diabetic pt due to skin abrasion & inability to monitor residual limb
Preparatory Prosthesis Basic- socket, pylon, foot; Allows early ambulation, promotes residual limb shrinkage; ~4-8 months Adjustable socket/interface Adjustable/interchangeable components; No cosmetic finish; 2nd socket req'd w/ extreme edema/rapid limb reduction
Definitive Prosthesis Fit once limb stabilizes shape/size; Typically 3-5 yrs; Cosmetic & finished; Replace PRN
Endoskeletal Design Modular; Anatomically shaped foam w/ soft cover; Pylon- aluminum, stainless steel, titanium, carbon; Adjustable, lightweight
Exoskeletal Design Hard outer covering-laminated; Durable- pts in construction/farming; Not easily adjusted
Conventional Fabrication Cast residual limb (- impression); Fill w/ plaster (+ mold) Add- tibial tub & crest, distal tib/fib, fib head, hams Remove- patella tendon, tib flare, popliteal area, calf mm Dx socket- static & dynamic alignments; Definitive socket laminated, foam s
Computer-Aided Fabrication (CAD/CAM) Cast/scan residual limb; Converted to computer; Modified on computer; Sent to carver, + mold created out of foam; Same as conventional fabrication
Prosthetic Feet Used on 90% pts
Foot Failure- Alignment Socket & components not set in appropriate alignment; Forces improperly interacting with foot components & causing pre-mature wear
Foot Failure- Pt. Selection Pt's activity level doesn't correspond to foot design; Pt's weight/activity has increased since initial fitting
Foot Failure- Proper Use Pt abuses foot: walking w/o shoes; improper heel height; water damage; dust/dirt damage; lack of maintenance
Foot Failure- Shoe Selection Pt has change heel height; Shoes old & in disrepair; Shoes don't provide adequate support for prosthetic foot
Choosing Appropriate Foot- Physical Pt. height, weight & functional age; Knee disarticulation; trans-femoral; hip disarticulation; hemi-pelvectomy; bilateral; pediatric; adult; geriatric
Choosing Appropriate Foot- Functional- FL 0 No ability or potential to ambulate or transfer
Choosing Appropriate Foot- Functional- FL 1 Ability/potential to transfer or ambulate on level surfaces at fixed cadence
Choosing Appropriate Foot- Functional- FL 2 Ability or potential for ambulation with ability to traverse low level barriers
Choosing Appropriate Foot- Functional- FL 3 Ability/potential to ambulate with variable cadence
Choosing Appropriate Foot- Functional- FL 4 Ability-potential to ambulate which exceeds basic ambulation skills
Choosing appropriate Foot- Financial Initial investment; Maintenance; Replacement parts; Long-term replacement; Future insurance status
Choosing Appropriate Foot- Functional Stability factor; Maintenance; Durability
Choosing Appropriate Foot- Patient Priorities Function; Durability; Cosmetics; Comfort
Prosthetic Feet Functions Joint stimulation; Shock absorption; Stable WB BoS; Muscle simulation; Cosmetically pleasing
Prosthetic Feet- Conventional Solid-ankle cushioned heel (SACH); Stationary-attachment flexible endoskeletal (SAFE); Single-axis; Multi-axial; If not conventional, dynamic response/energy storing
SACH Foot Solid Ankle Cushion Heel Simple design, low cost, lowest fxn; Cushion heel compresses on heel strike, rigid keel provides resistance during mid-stance; flexible forefoot provides rollover capabilities
SAFE Foot Stationary Attachment Flexible Endoskeleton; Flexible internal keel permits tri-planar mvmt & easy "rollover"; Foot stiff & stable during stance
Single-Axis Foot Provides PF & DF motion; Very stable at heel strike for AK amputees; Can adjust & exchange bumpers to modify foot response
Multi-Axis Foot Multi-axial foot mvmt (PF/DF; Ev/Inv; IR/ER); Preferred for uneven terrain; Absorbs gait torque to reduce shearing forces on residual limb
Energy Storing/Dynamic Response Internal keel structure "absorbs" energy during mid-stance & temrinal stance; "Releases" energy at pre-swing (toe off) to provide smoother/more energy efficient gait; Extremely lightweight & durable
Special Activity Foot Accomodates unique & specific demands of athlete & sport; Typically customized foot can only be used for 1 specific activity or sport
Foot Enhancements- Vertical Shock Absorber Built into foot or attached as separate component; Reduces impact forces during stance/heel strike; Reduces shear within socket; Improves rotational forces at heel strike
Foot Enhancements- Rotational Torque Absorber Built into foot or attached separately; Absorbs gait torque to reduce shearing forces on residual limb; Provides rotation mobility for standing & twisting mvmts
Specialty Foot Considerations- Heel height adjustable foot Pt can make adjustment to foot to accommodate various shoe heel heights while maintaining uniform distance from heel to the knee center
Socket Design Patellar Tendon Bearing (PTB) Total Surface Bearing (TSB)
PTB- Areas of WB Patellar tendon, medial tibial flare, fibular midshaft
PTB- Areas of Relief Lateral tibia, head & distal end of fibula, tibial crest, distal end of tibia
PTB- Functions Medial/lateral control rotation & provide ML stability; Posterior wall applies anterior force to PTB
Total Surface Bearing Same areas of relief & WB as PTB, just not as aggressive; Idea is total global reduction; Distribute weight & pressure equally throughout limb
Liners No liner; Pelite liner (custom); OTS gel liner; Custom gel liner
No liner Hard socket- no liner, just sock or soft interface
Advantages & Disadvantages to No Liner A: Less bulk, easier cleaning, fewer perspiration issues D: More difficult to fit, less comfortable
Advantages & Disadvantages to a Liner A: Total contact= decreased edema; Modifications to liner D: Deterioration over time; Sanitation due to perspiration absorption; Increased weight; Difficulty donning
Pelite Liner Commonly used with PTB socket; Distal end pad- plastazote or formed form
OTS Gel Liner Even pressure distribution; Minimal shear forces; High shock absorption; Most limbs; Various thicknesses
Custom liner Used with "problem" pts; Otto Bock TEC liner; Can vary in thickness; Increased cost with better fit
Types of Suspension Supracondylar cuff; Supracondylar system; Supracondylar/suprapatellar system; Thigh corset; Waist belt; Suspension sleeve; Locking liner
Supracondylar Cuff Cuff suspended above femoral condyles & proximal patella; Resists hyperextension
Supracondylar System Wedge suspension on medial wall; Removable for donning & doffing; Wedge holds over femoral condyle
Supracondylar/Suprapatellar System (PTB SC/SP) High walls encompass femoral condyles & patella; Used for extremely short limbs or ML instability
Thigh Corset Leather lacer or laminate around thigh; Provides max ML stability; Controls hyperextension (check strap); Atrophies thigh
Waist Belt Used most often in temporary; 2" webbing around waist attaches to supracondylar cuff; Inverted "Y" design
Suspension Sleeve Gel liner next to skin; Sleeve over prosthesis pulled up over thigh sealing against skin; Creates sealed chamber & suspends leg
Locking Liner Gel liner with locking mechanism; Pin attached to bottom; Slide into socket-locks; Press button to release
Vacuum System Lower- mechanical pump out; expulsion valve; negative vacuum; Upper- higher vacuum with electric pump; sucks air out
Exam/Checkout Procedure Static (standing); Static (sitting); Dynamic (walking)
Standing Exam Foot flat on floor (with shoe); Correct height; No leaning pylon
Sitting Exam Adequate hamstring relief; Liner pulled up; When donning- invert liner completely to avoid any excess air
Walking Exam Gait deviations noted; Pistoning minimal; No leaning pylon
Sock Wear As limb shrinks inside socket- replaces lost volume to maintain total contact; Different thickness "ply"; Add cushioning; Reduce friction
Liner Care Wipe, wash, rinse well daily; Allow to dry thoroughly; Don't invert; Inspect for cracks
Socket Care Wash with soap & water; Allow to dry thoroughly
Created by: 1190550002
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