I hit a bit of a writer’s block and was unsure what topic to cover today. I got some great suggestion and will use them in the future. Today, I will address something that many people have mentioned to me before; most people do not understand some of the terms I use in my blog. I have also heard a lot of questions about my prosthesis and the make up of it. Today, I will address some of these terms and questions so you can better understand what an amputee goes through and have a better understanding of the wording I use in future blogs. Today I will include a lot of pictures!
Many people (me included, prior to my amputation) refer to the artificial limb as a prosthetic. I use three terms a lot and they all start with pros.
First, there is PROSTHESIS, which is the actual artificial limb, as in, I just got a new prosthesis. PROSTHETIC is an adjective. An example would be, I just received a new prosthetic limb. PROSTHETIST is a person who makes or fits prosthetic devices. My Prosthetist’s name is Rich. Simple, right?
Many people have told me they glaze over a little as I talk about the prosthesis because I have never fully explained the parts, so things get confusing for the two-legged reader. I will break down the prosthetic limb for you. There are many different types of prosthetic limbs, but for today’s purpose, I am mainly using pictures of my own. I have two “legs”. One is for everyday use and the other is for water use. Since I mainly use the everyday leg, I will use that for my description.
My below the knee prosthesis (and most others) are composed of three major components. There are other parts necessary in order to wear the prosthetic limb. Here is the general process and the parts (note: these are for my leg only, the names and parts of your limb may be different).
First, I make sure I-Lean (my “stump” or “residual limb”) is clean:
Then I put the liner on. This is a “sleeve” that slides over the residual limb. My liner has a pin at the bottom that will lock into the prosthesis later. There are other types of liners and prosthetics, but again, the main components are pretty similar. The first picture below shows the full liner. The center picture is a close up of the pin. The bottom picture is the gel inside. This is what helps the liner stay tightly on my limb. Yes, it can get extremely hot and sweaty inside there. During the warm months, I use Aveeno or another unscented powder and lightly cover my leg before putting the liner on.
The next step is putting on the number of socks needed for a comfortable fit. Sometimes finding the right fit is a little difficult, especially as the limb is decreasing in size. The Prosthetist will ask “how many ply are you wearing?” The ply refers to the thickness of socks. Mine comes in one, three and five ply. I have been as low as zero ply and as high as 18 ply. I also have older socks that I cut because sometimes I need less ply in the bottom than the top or vice versa. My sock has a hole in the bottom to put the pin through. I put on the necessary ply and then move to the next step. The first picture shows what a sock looks like. The second picture is an example of a cut sock. The third show the hole in the bottom of the sock.
At this point, I will put on my shoe if it is a tighter fit. If it is a sneaker, sandal, flip-flop etc., I can wait. I guide my limb into the socket. The socket is the black shell at the top of the actual prosthesis (you can custom design them with, like I did with my water leg, but talk to your Prosthetist about that). The top photo is a close up of the socket. The bottom picture is the inside. At the bottom of the socket, you can see where the pin lock in. I will step into it and press down until I hear it lock into place. The white on the sides is padding. As my leg shrinks and I lose weight, my socket is getting too big, but I don’t want to get another just yet because the size is changing so rapidly. My Prosthetist, Rich, added padding to help fill the space without wearing a ton of socks.
As I mentioned, I recently got a new foot shell. My old one got stained and dirty. I discovered that wearing brand new balck moccassins without a sock was a bad idea. I wanted a cleanfoot for summer. The “skin” looking foot is the shell. It goes on over the bottom of the prosthesis. The first picture below shows my new foot shell. The second and third show the difference between the old one and the new one…..see why I wanted a new one?
The shell goes on over the “foot” of the prosthesis. The below photos show what the prosthesis looks like without the shell. If you look at the picture in the middle, you can see the way it was designed to have the split toe I wanted for flip-flops. The picture on the right shows the original design (and description of the parts). As you can see, there is no split toe.
As you know, I chose to wear my prosthesis with the metal showing and no “flesh” covering. The covering is called a cosmesis. According to the Hanger Prosthetics and Orthotics website (http://www.hanger.com/prosthetics/services/Pages/Cosmesis.aspx), Cosmesis is the art of making a prosthetic limb appear lifelike. Sometimes cosmesis refers to a removable covering such as a glove that fits on a prosthetic hand, or flesh colored stockings that slip over a prosthetic leg. Cosmesis has advanced to the point where it is often difficult to tell by simply looking that a hand, arm or leg is not “real.” The newer cosmeses are made of urethanes and silicones, while older styles are usually a type of vinyl called PVC. The shape of the cosmesis is based on an impression of the person’s sound limb so that the proportions are exactly the same. Airbrushing the surface can allow for subtle variations in color, especially around the joints and on the palm of the hand. Fingers and toes can have acrylic nails, complete with half moons at the base and white nail tips. Details such as veins, freckles, hairs and even tattoos are now routinely included as part of cosmesis. It is truly a personal choice whether or not to cover or uncover. Below are some examples of what a cosmesis looks like:
A few months ago, I started following a woman on Pinterest who pinned a lot of amputee information. Recently, we became Facebook friends. Her name is Lindsey and she lives in England. She is a very recent double below the knee amputee. She is quirky, and positive and funny and is truly an inspiration to me. She has chosen to have the cosmesis. Here is a picture she has given me permission to use, of what she calls her “Barbie feet” (bleow).