Author Topic: A angry leg  (Read 8141 times)

Offline Steve C

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A angry leg
« on: January 15, 2012, 05:50:49 PM »
I've winged about my current leg loads of times. Heres another rant to blow off some steam...
Has anyone had a thin liner seem to create a fold in the skin (my problem area is in the back about 5'' below the knee) and make it seriously painful? It seemed to have made a blister but to be honest I can't really tell. The edge of the crease was white until it scabbed over (sorry for the mental picture)
It's right about where 'real' skin meets skin graphs. I'm wearing a large adhesive bandage on it now which does seem to help with the pain...
Any way to prevent this from happening again? It seems that the more I wear my leg the bigger chance of it happening.
Where ever I go, I'll always have one foot in Ireland   /   I'm not a complete fool. Some parts are missing.

Offline chrysochloridae

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Re: A angry leg
« Reply #1 on: January 16, 2012, 02:12:18 PM »
Hi steve, Happy new year to you!

This sort of thing can cause a problem. I find that skin grafts can be problematic as the skin is not as elastic as the undamaged section. I've found thinner liners absorb less shear and so can cause problems over sensitive areas.

An Invaginated scar (deep, healed scar which produces a 'crater' in the flesh - often caused by slow healing wounds) is always problematic. Changing the liner is one option, but this would likely mean new sockets and all the fun and games associated with that. Alpha Custom liners can be made to have gel filling these areas - but they are expensive.

The simpler answer is trying some of the various prosthetic lotions and potions on the affected area. I have a few people who swear by Alps Prosthetic Lotion. Otto Bock Derma Repair and Derma Prevent are also really good.

Has this been an ongoing problem Steve or has it only begun recently? I tend to find people struggle with this sort of thing in hotter weather or by being more active than usual

Offline Steve C

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Re: A angry leg
« Reply #2 on: January 17, 2012, 08:30:12 AM »
Happy New Year Golden Mole! ;)

Thanks for the information! I do have a good few invaginated scars as you mentioned. The problem areas is one of those. Actually there are a three problem more areas but one seems to be the main culprit.

I was using alpha liner with extra cotton socks and suspension sleeves on the old leg and there was never a problem. The liner now is very thin with the pin system. It seems like I can't do any physical labour anymore with the new leg and its thin liner. It just hurts too much and thats even if the problem areas aren't acting up. To be honest the new leg has to be taken off or loosened from time to time even if I'm not doing physical work. The lotions may work great to fix the problem areas but may not address the other problems.

I'm thinking I just need a thicker liner and a new socket to fit. I may just need that extra bit of padding for whatever reason... problematic nerve endings, having the physical work 'pump up' the muscle in the back and making the socket too tight etc...

I seriously don't relish the thought of starting over but I tend to think I'm at the 'point of diminishing return' with the new leg. My and my limbfitter have been trying to make this leg work for 2(?) years.
The fact I've had the leg for 2 years makes me nervous. My opinion is the leg has never been right or without causing pain so it needs to be fixed or replaced. I hope they feel the same way!

I was onto my new prosthetist (the one who made me this new leg went off to a impoverished area to help out people there about a month or two ago) and I have a appointment on Monday with my new prosthetist.

On a side note, I'm in the process of repairing my old bombproof, work leg. I cracked the socket and had it repaired by a man who does bodywork in fibreglas on cars. It cracked again so I repaired it again myself. It cracked again so I am back mixing up resin and hardener etc. Hopefully, it will last long enough to see me with a new, pain-free leg I can use everyday, doing everything!

Where ever I go, I'll always have one foot in Ireland   /   I'm not a complete fool. Some parts are missing.

Offline pin-hi

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Re: A angry leg
« Reply #3 on: January 17, 2012, 11:55:18 AM »
Steve,

I think in general, as end users of prosthetic devices and products, we need to be more assertive with our legists. If they are making sockets or pin systems or let's say, "upgrades" that make wearing the leg impossible, they are not doing their job. We are entitled to comfortable, functional prosthesis and if that's not what we are getting, they need to re-do them until they are right. Period.

Please don't sign off on the next adjustments or new socket until you know it will work for you. If you have a greater comfort level with the thicker Alpha liners and suspension sleeves, he should be able to retro-fit the newer leg pin socket to match your older leg's socket.

Just my opinion.

David in Canada.
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Offline chrysochloridae

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Re: A angry leg
« Reply #4 on: January 17, 2012, 05:46:33 PM »
What thickness Alpha liners has he got you? I find the 3mm one problematic for bony/scarred stumps. I would say 6mm Alpha liners are the best.

Willow Wood have brought out 2 new pin liners since you last had sockets made the Alpha Hybrid and Alpha Silicone range. They only do these in the 6mm version. Might be worth having a chat with the new prosthetist guy about trying one of these new types - i've found em pretty good and a bit more durable (and a longer warranty on them!)

If your old Work Leg is proving comfortable still then it could be worth asking for a copy of it to be taken using a CAD-CAM system or using duplicating foam http://www.ottobock.se/cps/rde/xbcr/ob_se_sv/materials_3_plaster_forming.pdf (page 41)

IMHA 2 years is plenty of a breaking in period! If its not right after 2 years then i personally would start from scratch / copy a functional socket.

Offline Steve C

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Re: A angry leg
« Reply #5 on: January 17, 2012, 09:25:33 PM »
David,
I agree completely. My worry is that they insisted I pay in full for the leg before taking it home. I am going to press them to make my end product a leg that I can wear for all occasions. I'm sure they will but the incentive of being paid is gone.

Chrysochloridae,
I measured one of my somewhat worn Alpha liners from the old leg and they appear to be 6mm in the front, about 2-3 mm in the back. I also need to use four thick cotton socks on average as the leg was my first weight bearing leg (from 2001) and my leg has reduced in size. The liner (pin) for the new leg is a grey Icecross 1mm (or a compacted 2mm). He advised me to use that liner to make the leg more responsive. He's a lovely fella with good ideas I just don't think they worked for me personally.

Two years is a massive amount of time. In their defence I didn't wear it first because if the discomfort. It a scandal on my part. I paid for the thing myself, about E6400 (euro) and no health insurance, but dispite the cost to me I still found it easy to just wear the old leg. Especially if a outdoor job needed to be done and the new leg would have made it impossible. I just donned the old one and ended up getting into the habit. I did cop on and made myself wear it. Thats when the numerous visits and leg tweeking started.

I would love a clone of the old leg. Of course if they could make it without me needing the 4 extra cotton socks it might be perfect. Maybe thats why the old leg feels so good, all the padding!
Where ever I go, I'll always have one foot in Ireland   /   I'm not a complete fool. Some parts are missing.

Offline pin-hi

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Re: A angry leg
« Reply #6 on: January 18, 2012, 04:41:10 AM »
I may be mistaken Steve, but I'm quite sure Alpha has a 9 mm. thickness liner as well. (this may allow you to not use the extra socks with your older leg.)
 I have the luxury of having full coverage for legs and liners etc. having gone under the train while working. Workers Compensation Board pays. I can't imagine what I'd do in your position of having to pay out of pocket. You may not have the option of shopping around for a prosthetist  considering your location.

Well, give the fellow the opportunity of making it all good for you. Take everything into him, the new leg, the old leg, liners and in no uncertain terms tell him the new leg is shite and you need it made right. Maybe copy and print the contents of this thread so he can see the comments we've made.

Please let us know how it goes. David
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Offline pin-hi

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Re: A angry leg
« Reply #7 on: January 18, 2012, 05:02:19 AM »
My retired prosthetist once made an internal cast copy socket of an old leg of mine. He used what looked like an oversize condom type thing and filled it with mold or casting material and it made a very close copy of the original socket. I believe he did this to make new socket inserts for my right leg which had a soft leather insert to protect the short, bony residual limb. (stump)

I have some 9 mm. Alpha liners kicking around here, which I used on my old left leg, which I will wash thoroughly and send to you if you want to give that size a go without having to pay for them. (used of course, but in good repair). Let me know.

David.
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Offline chrysochloridae

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Re: A angry leg
« Reply #8 on: January 19, 2012, 02:10:00 PM »
Alpha liners do do a 9mm. Really good for bony residual limbs i find.

Sounds like you've got an Iceross Dermo or Synergy. They are alot thinner than the standard Alpha liners and don't have gel at the front (well, their new cushion one does but thats their first!) - Excellent for very fleshy stumps with no scarring; on the whole not so good for very bony stumps with heavy scarring.

Alpha liners have always gone for comfort, if they worked for you then i'd stick with them. Some of their new kit seems pretty good (Hybrid and Silicone), but i can't give you any long term experience of these liners till i get some feedback from the people testing them.

If your prosthetist has CAD-CAM machine then they could copy and reduce your big socket and make it 3 socks smaller... (assuming your overall shape has remained roughly the same). Also steve, if the big socket is for an Alpha liner, they do Volume Management pads http://www.willowwoodco.com/products-and-services/suspension/suspension-aids/volume-management-pads

Offline annieg

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Re: A angry leg
« Reply #9 on: January 19, 2012, 08:41:21 PM »
Wow, I'm always impressed when someone asks for advice and gets such informative answers.  This site has such helpful people!  Hope you are all doing well in the new year.   annieg
He who limps, still walks.

Offline Steve C

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Re: A angry leg
« Reply #10 on: January 20, 2012, 08:50:39 AM »
I am too Anne. When I go in I will have loads of information so hopefully I can steer them in the right direction.

Thanks again Pin-Hi and Chrysochloridae!

Sometimes I think a exact copy of the old socket may be good and just get a thicker liner, but I'll ask if my limbfitter has a Cad-cam. I kind of doubt they do but I haven't a clue really. If they can copy the old one slightly smaller that might just do the trick. I would think that my leg has changed some though. It could be all the padding that is making a socket feel great that if it were smaller wouldn't feel good. A new socket from scratch might end of being what I have to do.

I'll pick your brain some more,
I think I know the answer to this one but if a abrasion appears on the leg I'm assuming the best thing is to not wear the leg at all. Or at least keep it to a minimum so that air can get to it and heal it. Is there a way to speed up the healing? I have to wear it at times during the day for errand/chores but even with a bandage it seems to set back the healing.

Also, can some amps just not be suited for a pin system? Or is it just a matter of putting the leg on correctly?

By the way I finished the repair on the old leg. I'll put a few pictures up later for a laugh. It won't win any beauty contests but hopefully four layers of fibreglas will keep the crack from worsening.
Where ever I go, I'll always have one foot in Ireland   /   I'm not a complete fool. Some parts are missing.

Offline pegleg jack

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Re: A angry leg
« Reply #11 on: January 20, 2012, 07:25:06 PM »
OHIO WILLOW WOOD COMPANY, handles ALPA-MAX on the 9-MM  size for i am wearing two of them right now as i type this and have ordered twomore today cause i have worn a hole in one of the cause of the way my left leg is shaped. and i cant do any thing about it right now cause it would take a major surgery to fix it, my tibula bone sticks way out to  the front  of my leg and it rubs up against my socket therefore wearing a hole in it, usually takes about 3 years to do it so i get my moneys worth, and then i use LOCTITE SUPER GLUE LIQUID and rub it over the area on the outside of my liner and it will give me a couple of more months of wearing.
you-all have a great day.

Offline pin-hi

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Re: A angry leg
« Reply #12 on: January 20, 2012, 07:58:56 PM »
Some wearers, like myself, are not suited to pin systems. I tried them and always felt a severe tugging feeling at the end of my stump, especially the right one. Also, they said moisture in the liner would diminish as time went on but it never did for me. I would take off the pin system leg and I would be sore and swimming! I had them get me back to the no pin liners and sleeves pretty quick as I wasn't going to be doing much walking with the pin system. Just my experience of course. David
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Offline herb

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Re: A angry leg
« Reply #13 on: January 21, 2012, 12:20:50 PM »
Hi Steve

sorry to hear you are having problems. My residual leg also has a lot of scarring and skin grafts. In two areas I have only skin grafts covering the bone. Because those 2 areas can not tolerate any pressure at all my prosthesis has small windows cut out over those areas in the outer socket and then the inner socket is heated and pushed out slightly in those windows so I do not get any contact on those areas. It works for my situation. I also check those areas every morning when I shower and if there is any tenderness or redness I use the crutches without wearing my prosthesis for a day or two to let the area heal. If I do not take that time off the prosthesis I am big trouble for a month with an infection.
I know you have been having problems for some time and you really need to find a prosthetist that can make you a properly fitting prosthesis.
Come to new hampshire and meet mine and visit for a while.
good luck
Herb

Offline chrysochloridae

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Re: A angry leg
« Reply #14 on: January 21, 2012, 04:05:42 PM »
I'd definitely leave it off for a few days until it heals - open wounds and liners (warm moist) environment are good breading grounds for bacteria.

Herb has hit the nail on the head, stopping problems before they become major is definitely the way forward.

I've seen many people on liner systems to try to prevent skin breakdown, but many of them experienced problems due to the distal pressure required for a pin system. (Most) Liners also come in a Cushion option (i.e. no pin and lock) and use a suspension sleeve; this has a number of advantages 1) you can put a cushioned end pad into the socket to give more gel cushioning to the end of the stump, 2) you can add a valve in and turn it into a suction socket which in itself has numerous advantages.

if you came in to see me and told me that you'd battled on with a socket for 2 years without success then i'd likely have a rethink and make a new socket.

PLJ, good to hear from you! The Alpha liners are notorious for that happening. I found a great trick is to use one of the Alpha Gel cups on against the skin then the Liner over the top of it - that way the hole wears in the gel cup (which cost a fraction of the price of a new liner)