The next step in the process is to have the patient fit with a liner. The liner is a soft interface that the patient wears over the skin. It is donned before the socket. The main function of the liner is to absorb the forces created when ambulating in your prosthesis, to keep your residual limb healthy, and to allow you to wear the prosthesis for longer.
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There are many different liners on the market and your prosthetist will pick the best liner for you. This is based on many factors, including suspension type, activity level, skin issues, hand dexterity, boney prominences , shape, etc. There are off-the-shelf (OTS) and custom liners. If the residual limb is an uncommon shape or very boney, custom liners may be used. These are made by taking an impression of the patient’s limb via a plaster cast or scan using our several different scanners/software. The process of obtaining a custom liner takes longer than obtaining an OTS liner. If the shape of the limb is common, measurements are taken to order the proper sized OTS liner.
Once the liner is ready to be fit on the patient, they are called to come back into the office for a casting appointment. The liner will be donned onto the patient’s limb and the fit will be assessed. If the fit is well, measurements and a cast of the limb will be taken over the liner. Different casting methods will be used based upon the suspension style that was previously decided upon by the prosthetist and patient. From here, the cast will be filled and modified appropriately to make your custom AK diagnostic prosthetic socket.
The first prosthetic socket you will receive will be called a diagnostic socket. This socket will be made of a clear plastic, utilizing the appropriate suspension method (pin/locking, elevated vacuum, suction). The socket will be donned while the patient stands and puts weight onto the residual limb. Usually, these sockets are made to not be taken home by the patient at this time, but can be made to walk on to check alignment at the second diagnostic fitting appointment. A plastic diagnostic socket is used to start with as parts of the socket may need to be modified to appropriately contour to your limb. This can be easily done by heated and flaring the plastic.
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A second diagnostic socket may be needed to adjust the first diagnostic socket to give the patient a better/more appropriate fitting socket. The better the fit of the socket for AK prosthesis, the higher the rate of success is in ambulating with one.
Once we have confirmed the diagnostic prosthetic socket fits the patient well, we can move on to the laminated socket. The laminated socket is fabricated using carbon fiber, which means it is much lighter than the plastic socket and has a higher tensile strength. Carbon fiber is also more durable, son the socket will be able to last up to a few years, depending on activity level and any limb changes. The patient can choose to have the socket custom designed/colored to meet their personality, which may to have the socket color match their skin tone or have their favorite sports team logo on the socket. Depending on the style of suspension, there may be an inner socket may of Proflex, which is a softer plastic inside the outer carbon shell.
The prosthesis will be donned with the patient several times, allowing the patient to be able to don/doff it themselves. Height and alignment will be adjusted accordingly. Gait training will be performed to help the patient get use to using the limb. Physical therapy will play an important part of gait training and strengthening their lower limb muscles outside of appointments with your prosthetist.
There are many different types of knees to choose from in the market today. When you are coming up with a plan for your prosthesis, your practitioner will ask you about your lifestyle and activities you participate in. This will include how far you walk, what sport(s) you play, are you on uneven terrain for camping, hiking, hunting, and how often you are on your feet. All these different activities you do every day play a crucial role in deciding what foot will be best for you. Each knee offers different benefits to different activities from having stance stability to a Microprocessor Otto Bock C-leg 4 that can swing and flex the knee during the gait cycle. The different types of knees are as follows:
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