Lower Extremity Care
An amputation can be life changing and it can be very challenging to return to the way of life you used to live.
There are many levels of lower extremity amputations, and with each one comes a different method of rehabilitation as well as different options of prosthetic solutions. With a customized treatment plan, P&O Care practitioners will work with you, your doctor and your physical therapy team to develop a solution that fits your goals and lifestyle.
Levels of Lower Extremity Amputation
Hemicorporectomy / Translumbar
A hemicorporectomy or translumbar amputation is the removal of the body below the waist often due to severe trauma or osteomyelitis (cancer in the bone) of the pelvis or spinal cord. A body “bucket” style prosthesis has been well documented in scientific literature, however early designs failed to address pressure sores and severe skin breakdown within the socket.
P&O Care Co-Founder and Clinical Director Jon Wilson is nationally recognized for his contributions to hemicorporectomy management, pioneering the use of DRY FLOTATION® Technology to improve the comfort and intimate fit of the body bucket design. Originally designed as wheelchair cushions to prevent severe skin ulcers by the ROHO Group, Jon proposed to use the small, manually adjustable air cells to line the inside walls of the hemicorporectomy body bucket. Regarded as the leading expert in Hemicorporectomy prostheses, patients from around the country travel to P&O Care to be fit with Jon’s innovative design.
Hemipelvectomy & Hip Disarticulation
While less than 2% of amputees have a hemipelvectomy or hip disarticulation amputation, P&O Care is specially equipped to help these patients. Often the result of a traumatic injury or cancer, the hemipelvectomy amputation involves the removal of half of the pelvis and all lower extremity structures on the same side of the body. A hip disarticulation involves the complete removal of lower extremity from the hip joint.
These levels of lower extremity amputations require expert prosthetic care due to the loss of three joints: the hip, knee and ankle. The complexity of a hemipelvectomy or hip disarticulation prosthesis demands the highest levels of experience, dedication and compassion.
Similar to other levels of lower extremity amputation, the “socket” is the custom-made rigid frame designed to support the user’s body weight and is the main attachment point of the prosthetic components. Due to the removal of the hip and surrounding structures, the sockets and suspension techniques are slightly different at the hemipelvectomy and hip disarticulation levels and can be quite complex. Therefore, your practitioner will fully discuss the fitting process, type of suspension and specific socket design on an individual basis. Lightweight materials, advancements in socket design hip joint technology have enabled both hemipelvectomy and hemicorporectomy amputees to walk with more security, comfort and confidence.
Transfemoral & Knee Disarticulation
Recent advancements in socket design and prosthetic componentry have given many above the knee (“AK”) amputees the opportunity to push the boundaries, transform their lives and regain their independence. P&O Care prosthetists are equipped with the compassion, experience and training to get you back on your feet.
A transfemoral amputation involves the removal of the lower extremity above the knee joint. A knee disarticulation involves the removal of the knee joint at the condyles (where the bones meet) and is typically considered a “long” transfemoral amputation due to a prosthetic knee joint still being required to walk. Both transfemoral and knee disarticulation prostheses consist of an intimately fitting socket, prosthetic knee and foot.
A transtibial, or below the knee (“BK”), amputation is the most common level of lower limb alteration. Due to the preservation of the knee joint, many amputees are able to return to or exceed the level of activity prior to their surgery! P&O Care prosthetists have extensive experience with transtibial prostheses, including bilateral, or both side involvement.
Because you can no longer bear weight through the bottom of your limb, we must rely on the pressure tolerant areas, or areas that can tolerate some pressure, of the remaining limb. Examples of pressure tolerant areas include sides of your shin bone (tibia) and calf muscle. Gentle pressure is applied to these areas then offloads the pressure sensitive (or tender) areas like the very end of the bone.
Symes & Partial Foot
There are more than 12 different amputation levels commonly seen in the foot and ankle.
The Symes amputation describes the amputation procedure in which the ankle joint is removed from the lower extremity and the heel pad of the foot is placed on the bottom of the residual limb to allow for weight bearing. The full length of the lower extremity limb is maintained.
The partial foot amputation is the most common type of amputation in the United States, occurring twice as frequently as transfemoral or transtibial amputations. Proper care of the partial foot amputation prevents further complications and higher-level amputations. Partial foot management typically involves some type a custom designed foot orthosis or insert with a “toe filler” to fill out the remainder of the shoe. A carbon footplate may also be used to restore the push-off lost from the removal of the front of the foot. Generally, the shorter the residual limb, the higher device extends above the ankle to re-distribute the forces. Many partial foot prostheses can fit directly into your existing shoe.
P&O Care practitioners will discuss all of your options, ensuring you have a say in your care. With so many choices and advances in technology, it is easy to get lost in all of the medical jargon. We want to eliminate confusion.
“Suspension” is the term used to describe how the prosthesis “suspends” or connects to the residual limb.
The most common methods of suspension incorporate some type of gel liner to pad the limb and reduce friction within the socket. Gel liners have revolutionized the field of prosthetics, introducing added cushioning, more comfort and enhanced connection of the prosthetic limb to the amputee.
There are hundreds of prosthetic liners to choose from, made with different materials, fabrics and features. Many gel liners even incorporate Aloe Vera and other minerals to rejuvenate and moisturize the limb.
Landyard Locking Liner
A lanyard locking liner has a Velcro strap connected to the bottom of the liner that is fed through passage in the prosthesis. This strap is then looped through a buckle on the outside of the prosthesis and secured (using heavy duty Velcro) to hold it into place. This is a secure and simple suspension solution for above the knee amputees.
This simple system has a pin locking liner connected to the gel liner that “ratchets” into a lock inside the prosthesis. This solution is great for below the knee amputees because you can hear the clicks as the pin engages with the lock and knows that the prosthesis is secure and safe to walk. A small button is depressed to disengage the lock to take the prosthesis easily. This system works well for many transtibial amputees and does not require the use of a knee suspension sleeve.
A liner without a pin (a “cushion liner”) and a knee suspension sleeve are the main components of this solution. Instead of a locking mechanism incorporated into the inside of the socket, a valve or a pump is used. When the limb is pushed into the socket, air is expelled out of the pump or valve. A knee sleeve is rolled onto the thigh and seals off the system, preventing air from entering the socket and holding the prosthesis on the limb.
- Passive – A one-way valve is used to expel the air out of the system. Air is allowed out of the system, but not inside the system.
- Active / Vacuum – A mechanical or electric pump attached to the prosthesis is used to expel or evacuate the air from the system. There are two basic types of elevated vacuum pumps used to push air out of a prosthetic socket.
- Electrical Pump – As you step, air is pushed down and out of the prosthesis (and not allowed back in), creating a vacuum environment. No batteries or chords, and the system is very quiet.
- Mechanical Pump – A battery powered pump actively sucks the air out of the socket when the vacuum level dips below a certain level. Daily charging is required and these pumps are louder than the mechanical vacuum pump.
Contact us to schedule an appointment or speak with one of our clinicians.
Whether you’re faced with limb loss, need a brace, or are advocating for a patient, P&O Care has built a community of care professionals and supportive peers that are committed to innovative and custom orthotic and prosthetic solutions.