What You Should Know Before Getting a Prosthetic Leg

Prosthetic legs, or prostheses, can help people with leg amputations get around more easily. They mimic the function and, sometimes, even the appearance of a real leg. Some people still need a cane, walker or crutches to walk with a prosthetic leg, while others can walk freely.

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If you have a lower limb amputation, or you will soon, a prosthetic leg is probably an option you're thinking about. There are a few considerations you should take into account first. 

Not Everyone Benefits from a Prosthetic Leg

While many people with limb loss do well with their prosthetic legs, not everyone is a good candidate for a leg prosthesis. A few questions you may want to discuss with your doctor before opting for a prosthetic leg include:

• Is there enough soft tissue to cushion the remaining bone?
• How much pain are you in?
• What is the condition of the skin on the limb?
• How much range of motion does the residual limb have?
• Is the other leg healthy?
• What was your activity level before the amputation?
• What are your mobility goals?

The type of amputation (above or below the knee) can also affect your decision. It's generally easier to use a below-the-knee prosthetic leg than an above-the-knee prosthesis. If the knee joint is intact, the prosthetic leg takes much less effort to move and allows for more mobility.

The reason behind the amputation is also a factor, as it may impact the health of the residual limb. Your physical health and lifestyle are also important to consider. If you were not very active and lost your leg due to peripheral vascular disease or diabetes, for example, you will struggle more with a prosthesis than someone who was extremely active but lost a limb in a car accident.

When it comes to amputation, each person is unique. The decision to move forward with a prosthesis should be a collaborative one between you and your doctor.

Prosthetic Legs Are Not One Size Fits All

If your doctor prescribes a prosthetic leg, you might not know where to begin. It helps to understand how different parts of a prosthesis work together:

• The prosthetic leg itself is made of lightweight yet durable materials. Depending on the location of the amputation, the leg may or may not feature functional knee and ankle joints.
• The socket is a precise mold of your residual limb that fits snugly over the limb. It helps attach the prosthetic leg to your body.
• The suspension system is how the prosthesis stays attached, whether through sleeve suction, vacuum suspension/suction or distal locking through pin or lanyard.

There are numerous options for each of the above components, each with their own pros and cons. 'To get the right type and fit, it's important to work closely with your prosthetist ' a relationship you might have for life.

A prosthetist is a health care professional who specializes in prosthetic limbs and can help you select the right components. You'll have frequent appointments, especially in the beginning, so it's important to feel comfortable with the prosthetist you choose.

Rehabilitation Is an Ongoing, Collaborative Process

Once you've selected your prosthetic leg components, you will need rehabilitation to strengthen your legs, arms and cardiovascular system, as you learn to walk with your new limb. You'll work closely with rehabilitation physicians, physical therapists and occupational therapists to develop a rehabilitation plan based on your mobility goals. A big part of this plan is to keep your healthy leg in good shape: while prosthetic technology is always advancing, nothing can replicate a healthy leg. 

Getting Used to a Prosthetic Leg Isn't Easy

Learning to get around with a prosthetic leg can be a challenge. Even after initial rehabilitation is over, you might experience some issues that your prosthetist and rehabilitation team can help you manage. Common obstacles include:

• Excessive sweating (hyperhidrosis), which can affect the fit of the prosthesis and lead to skin issues.
• Changing residual limb shape. This usually occurs in the first year after an amputation as the tissue settles into its more permanent shape, and may affect the fit of the socket.
• Weakness in the residual limb, which may make it difficult to use the prosthesis for long periods of time.
• Phantom limb pain could be intense enough to impact your ability to use the prosthesis.

A Note on Phantom Limb Pain

Phantom limb pain, or pain that seems to come from the amputated limb, is a very real problem that you may face after an amputation. About 80% of people with amputations experience phantom limb pain that has no clear cause, although pain in the limb before amputation may be a risk factor.

Mirror therapy, where you perform exercises with a mirror, may help with certain types of phantom limb pain. Looking at yourself in the mirror simulates the presence of the amputated leg, which can trick the brain into thinking it's still there and stop the pain.

In other cases, phantom limb pain might stem from another condition affecting the residual limb, such as sciatica or neuroma. Addressing these root causes can help eliminate the phantom pain.

Your Leg Prosthesis Needs May Change

At some point, you may notice that you aren't as functional as you'd like to be with your current leg prosthesis. Maybe your residual limb has stabilized and you're ready to transition from a temporary prosthesis that lasts a few months to one that can last three to five years. Or maybe you've 'outwalked' your prosthesis by moving more or differently than the prosthesis is designed for. New pain, discomfort and lack of stability are some of the signs that it may be time to check in with your prosthetist to reevaluate your needs.

Your prosthetist might recommend adjusting your current equipment or replacing one of the components. Or you might get a prescription for a new prosthetic leg, which happens on average every three to five years. If you receive new components, it's important to take the time to understand how they work. Physical therapy can help adjust to the new components or your new prosthetic leg.

Prosthetic Leg Technology Is Always Evolving

There are always new developments in prosthetic limb technology, such as microprocessor-driven and activity-specific components.

• Microprocessor joints feature computer chips and sensors to provide a more natural gait. They may even have different modes for walking on flat surfaces or up and down the stairs.
• There are also specialized prosthetic legs for different activities, such as running, showering or swimming, which you can switch to as needed. In some cases, your everyday prosthetic leg can be modified by your prosthetist to serve different purposes.
• Osseointegration surgery is another option. This procedure involves the insertion of a metal implant directly into the bone, so there is no need for a socket. The prosthetic leg then attaches directly to that implant. While this procedure is not right for everyone and is still under study, it can provide improved range of motion and sensory perception.

It's important to remember that you're not alone in navigating the many different prosthetic leg options. Your care team will help you weigh the pros and cons of each and decide on the ideal prosthetic leg that matches your lifestyle.

Johns Hopkins Comprehensive Amputee Rehabilitation Program

Having the support of a dedicated team of experts is essential when recovering from the amputation of a limb. At Johns Hopkins, our team of physiatrists, orthotists, prosthetists, physical and occupational therapists, rehabilitation psychologists and other specialists works together to create your custom rehabilitation plan.

Learn more about our amputee rehabilitation program

Often not given the proper attention they deserve, prosthetic liners are crucial for added comfort and greater efficiency. These devices can dramatically improve an amputee's quality of life, so choosing suitable prosthesis liner material is vital for maximum protection and healthy recovery.

PrimeCare produces custom prosthetics in Albuquerque and Las Cruces. We've helped many patients with various needs choose suitable prosthetic liners. This brief guide covers the different types of liners and their benefits, as well as prosthetic liner care and technological innovations.

What Is a Prosthetic Liner and Why Is It Important?

A prosthetic leg liner is a unique lightweight sheath, like a second skin, made from silicone or other synthetic materials that fit snugly and comfortably around an amputee's residual limb.

Wearing amputee liners offer better fitting, increased comfort, and protection against moisture and skin issues. They keep prosthetics in place and reduce the risk of sores and itching.

If you require a prosthesis either above or below the knee, wearing a prosthetic liner is imperative. Essentially, amputee liners provide comfort and protection to the residual limb throughout the day.

Types of Prosthetic Liners

When looking at prosthetic leg liners, the two main factors to consider are pliability and durability.

Below are the most commonly used types:

' Durable Silicone Liner

Medical-grade silicon liners for prosthetics are non-irritating and comfortable on the skin. They do not cause a reaction with substances such as sweat and have excellent shock-absorbing properties to lessen shearing forces that harm the limb and scar tissue.

Regarding its softness and robustness, silicone liners are a mid-range choice that holds some of the elasticity of TPE liners but has more durability than urethane liners. Additionally, they are hypoallergenic and capable of withstanding prolonged usage and daily stretching.

' Urethane Liners

Stiff, inflexible urethane liners offer high durability and aid even pressure distribution. Urethane liners are particularly well-suited for users with a high degree of activity who use prosthetic limbs with active vacuum sockets. These liners have a higher tensile stiffness, which provides improved suspension for active users.

For more information, please visit Prosthetic Parts Manufacturer.

' Thermoplastic Elastomer (TPE)

TPE liners are the perfect choice for those with atypical residual limb shapes, as the liner's soft and pliable material molds to an individual's limb shape over time, allowing for ultimate comfort and convenience. Moreover, the ability of TPE to absorb shear forces makes it a popular material for prosthetic liner design. This property enables prosthetists to pre-stretch the liner before fitting, making it a comfortable option for amputees, particularly those with sensitive skin or skin grafts, allowing them to walk without straining their limbs.

' Mineral Oil Gel

Those with a bony residual limb or hypersensitive areas can benefit greatly from mineral oil gel liners. They are soft and forgiving and protect against rubbing within the prosthetic socket. Additionally, mineral oil gel liners contain vitamins that help keep the skin healthy and moist, reducing the risk of skin breakdown. The only drawback is less durability compared to other types of liners.

' Polyurethane

Urethane liners have exemplary "flow properties," which gives them the capacity to shift their gel away from areas where the pressure is higher, allowing for an even distribution of pressure and a more comfortable fit. These characteristics make them a good choice for sensitive, bony, or scarred residual limbs and active individuals who need a liner to withstand high levels of wear and tear.

' Copolymer

The copolymer is best for amputees with sensitive skin or low activity levels due to its soft, cushiony, and highly elastic properties. This thermoplastic elastomer also contains skin-friendly white oil, which provides extra protection to residual limbs with dry skin. When it comes to suspension, copolymer performs best when used with pin or suction suspension.

' Prosthetic Sleeves

Prosthetic sleeves are elastic garments worn over prosthetic limbs to provide a comfortable and secure fit. They also help to reduce skin irritation caused by friction during wearing and movement. Made from soft, stretchy materials such as spandex or lycra, which allow the limb to flex easily, they also contain fabric liners that reduce sweat and keep the prosthesis from slipping. Prosthetic sleeves may also be fabricated with pockets for storing small items and providing additional support to the limb.

To clarify and reiterate: A prosthetic sleeve (shrinker sleeve/stockinette) makes it easier to wear a prosthetic liner. It distributes pressure and reduces volume, friction, and rotation. Prosthetic liner cushions and shapes the residual limb provides an even interface between limb & socket, and reduces friction/provides feedback.

Prosthetic Liner Shapes & Thicknesses

Prosthetic leg liners vary in shape and thickness, with cylindrical and conical shapes offering more uniform protection. Cylindrical liners range in thickness from 5 mm to 10 mm, while conical liners usually vary between 3 mm to 7 mm.

Custom liners are also available to accommodate those with typical limb shapes. These liners are thicker in areas such as the bottom front or side, which protects prominent bones. They also have thinner areas that allow for a greater range of motion, such as behind the knee, to accommodate knee flexion.

What's the Typical Lifespan of Amputee Liners?

No matter the user's physical features, daily activities, and hygienic habits, a breathable prosthetic liner will eventually degrade, leading to skin irritation and discomfort. It's common for very active amputees to replace their liners twice a year.

Signs that it is time to buy a new prosthetic liner include discoloration, hardening, and a separation between the outer and inner layers of fabric. If unsure, you should consult your prosthetist to determine if a liner replacement is needed.

How Often Should I Wear My Liner Prosthesis?

If you are breaking in a new liner, your prosthetist will provide specific instructions for you to follow. If you experience any skin irritation after putting the liner on, please stop using it and contact your prosthetist immediately.

Below is a general guideline for breaking in a new liner:

• Day one: Wear your liner for one hour in the morning and one hour in the afternoon.
• Day two: Wear your liner for two hours in the morning and two hours in the evening.
• Day three: Wear your liner for three hours in the morning and another three hours in the evening.
• Day four: Follow the same step above, but extend the duration to four hours.
• Day five: Wear your liner the whole day.

If at any point during the process, your skin becomes irritated, then proceed to the next step once you've spoken to your prosthetist, primarily if blistering or prolonged redness occurs.

Please note: it is normal to experience some redness as your residual limb adjusts to the liner. However, this should subside within 15 minutes of removing the liner.

Prosthetic Liner Care

Follow these tips to prolong the life of your prosthetic liner and learn how to clean a prosthetic leg liner:

• Wash the liner inside out with mild, non-allergenic, fragrance-free soap and warm water. Gently blot dry with a towel, turn right-side out, and leave on the drying stand overnight.
• If the liner is fabric covered, take care not to soak the fabric, as this can weaken its structural integrity.
• Check the liner for signs of damage, both inside and out; schedule an appointment with your prosthetist if there's significant wear and tear.
• Always ensure the liner is clean, dry, and has no debris stuck inside before rolling it on your leg.
• When putting it on, ensure it is inverted and covers the end of the limb; air pockets can lead to unintended suction resulting in water blisters.

How Much Does a Prosthetic Liner Cost in Albuquerque?

A prosthetic liner price can range from $350 to $625 depending on several factors, such as the liner's type and complexity, the materials used, the manufacturing process, additional features, and the product brand.

Advancing Prosthetic Liner Technologies

Pin-locking prosthetic liners have revolutionized prosthetics by streamlining the process of securely attaching a prosthesis to the residual limb.

A prosthetic locking liner uses small removable pins to quickly and securely "lock" into the prosthesis. The pins fit into the socket in various patterns to accommodate individual activities and specific needs.

This customization reduces shear and friction between the limb and the prosthetic socket, yielding a better grip, higher comfort level, and improved control over prosthesis movement.

Not only that but a pin-locking prosthesis and liner enhances the suspension of prosthetic limbs due to their secure and stable fit and even distribution of pressure across the residual limb.

Furthermore, new and innovative prosthetic socket designs are being created to cater to individual anatomy and offer more creative materials such as 3D printed and carbon fiber-based sockets. Through customization, these designs achieve better comfort and fit for the individual based on their anatomy.

Also, these materials are lighter yet more robust, allowing wearers to be more agile and move quickly.

Which Prosthetic Liner Is Right for Me?

When selecting the best amputee liner for you, there isn't a "one-size-fits-all" approach.

At PrimeCare, we start by reviewing your level of comfort and mobility regardless of whether you already have a prosthetic or are a new amputee.

Then we consider your limb's residual shape, suspension technology, and other factors like skin compatibility, comfort, durability, and security.

In other words, your prosthetic liner must accommodate a wide range of daily volume fluctuations, be durable, and maintain a close fit to minimize movement within the socket - this is paramount for maintaining healthy and active lifestyles.

Empowering Lives with Prosthetic Leg Liners

It's essential to talk to your prosthetist when selecting a prosthetic liner. They will discuss the various types in detail, as well as which is ideal for your individual needs and preferences, including comfortability, durability, and cost-effectiveness. As time passes, your body's needs will change, and switching to your prosthetic liner is expected.

At PrimeCare, we always aim to provide liners made from the highest-quality materials that improve mobility and quality of life. We offer a range of direct sockets and above and below-the-knee prosthetic liners from an industry-leading manufacturer, Össur.

Don't hesitate to contact us for more information.

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