Losing a limb and wearing a prosthesis is a unique experience and one which can often leave you scrambling to find answers to some of the most basic questions. Below are some common questions and the answers we hope you’ll find helpful as you or your loved ones dive into this new chapter of life.
Q: How should I care for my residual limb?
A: You should get into a routine of cleaning and inspecting your residual limb each day after removing your prosthesis. Use regular body soap to clean your limb. Use a mirror if necessary to look at all aspects of your limb including the very end and back behind your knee. You are looking for signs of high pressure or abrasion such as: blisters, breaks in your skin, rashes, etc. Skin redness that goes away within about 10 minutes of removing your prosthesis is typically okay, however if it persists for longer periods, it could be an indicator of a high pressure point that your prosthetist needs to address. If you have questions about something you see on your residual limb that concerns you, contact your prosthetist.
Q: How will my residual limb change after amputation?
A: Typically, over time, it will get smaller circumferentially and a little shorter as muscles in your residual limb will atrophy (shrink) due to the fact they are no longer performing all of their intended functions. There are two types of changes your residual limb will go through after amputation: daily and long-term. On a daily basis, your limb will typically be its largest in the morning after you’ve been asleep and inactive. Then as you wear your prosthesis during the day, the pressure experienced by your limb in the socket will cause some fluids to cycle out of your limb causing it to get slightly smaller. On a long-term basis – weeks and months after amputation surgery – your residual limb will typically change shape and size getting smaller and more pointy with time. Some of your bones in your residual limb will become more prominent (distal tibia and fibula head) requiring adjustments to be made by your prosthetist to your socket to maintain comfort.
Q: What should be my wear schedule for my stump shrinker?
A: Following your amputation and typically after your residual limb is close to being healed, your PCP might want you to be fit with a “stump shrinker.” This device is similar to an elastic sock that is pulled over your residual limb. You will typically wear it “24/7”, except when bathing. A shrinker is meant to help shape your residual limb and prepare it for prosthetic fitting. It also helps the process of desensitizing your limb and preparing it for when you start rolling on a liner before you are initially fit with your first prosthesis.
Q: As a new amputee using a prosthesis, will I be able to do everything I used to do before my amputation?
A: This will depend on your age, your overall physical condition and your desire. A good rule of thumb is that with a prosthesis, you will be able to do most of the things your did prior to your amputation, but they might take a little longer and you might have to do them differently. Many amputees are able, after rehab (physical therapy) and some time, to get back to their old way of life with few limitations. If you work hard at it you will typically do well.
Q: As a new amputee, should I get physical therapy after being fit with my first prosthesis?
A: Typically yes! Depending on your overall physical condition following your amputation and fitting with a prosthesis, you have typically lost some strength and your P.T. will help you try to gain that back. Also, there are some basic things that you need to do when ambulating with a prosthesis that might not be obvious and your P.T. will help you learn them. As a new amputee, you will also typically need to use some type of assistive device immediately after being fit with your first prosthesis. Your P.T. will provide instructions and training in their use. A walker is the normal starting point which can progress to a Rollator, then a cane and hopefully to no assistive device at all after time and practice. The harder you work at therapy and at home, the quicker your recovery will be and the more independent you will become.
Q: What’s the difference between in-patient and out-patient physical therapy?
A: When you stay in a hospital for 5 – 10 days while receiving your physical therapy, that is referred to as in-patient P.T. or rehab. When you travel to a facility to attend your therapy session and then return home afterward, that is out-patient P.T. The benefit of in-patient P.T. is that you receive much more therapy in a shorter timeframe than you would as an out-patient. However, as an in-patient, you will have to go through a more involved insurance approval process. Normally, outpatient P.T. will be scheduled for 2 to 3 one-hour sessions per week. During in-patient rehab, you will typically receive 3 hours of P.T. each day that you are in the hospital, so your rehab is much more intense. Your P.T. sessions will last either until you aren’t benefiting from them any more or you have exhausted the annual reimbursement expenditure limit set by your insurance provider.
Q: Will I be able to jog or run in my prosthesis?
A: Normally not so much. Most prosthetic feet are made for standing and walking, either at a slow or even a brisk pace. But typically if you are a jogger or runner, you will need a prosthesis that includes a foot specifically made for such a purpose. Getting a prosthesis with a running foot is not always an easy proposition as your medical insurance provider will require that your PCP deems such a “specialty purpose” prosthesis as being “medically necessary.” Typically such prosthetic devices such as a running leg need to be pre-approved by your insurer and your physician needs to document that it is medically necessary, which is helped if you can you’re your physician document that your were a regular jogger or runner prior to your amputation and by continuing such activities, you will be better able to maintain your overall health and well-being.
Q: Why is it important to regularly see my primary care physician (PCP) as an amputee?
A: As an amputee using a prosthesis, you should see your PCP at least every 6-months and more frequently if you are having medical issues. When you see your PCP, you should make a point of discussing any issues you might be having with your residual limb or your prosthesis. When you do this, your physician should document these conversations and his/her observations in your medical chart so that their notes can be used to support any prosthetic activities executed by your prosthetist that result in billing to your medical insurance provider for reimbursement. If you are having a major prosthetic issue, you might even ask your prosthetist to attend a physician’s appointment to support you.
Q: When should I contact my prosthetist?
A: Whenever you have a question about something going on with your residual limb or with the fit or function of your prosthesis, you should contact your prosthetist and ask questions. Depending on the specific issue, you might need to make an appointment to go in and see your prosthetist. Always err on the side of caution. Many prosthetic questions can be addressed over the phone, but if not, make an appointment.
Q: How much should I wear my prosthesis each day?
A: As a brand new amputee, you’ll want to gradually increase your wear time as the days and weeks go by, maybe starting at and hour or two each morning and a couple of hours in the afternoon. As time passes, keeping increasing your wear time, assuming your skin is intact and you have no sores or blisters and your socket is comfortable. As soon as you can, you should try to wear your prosthesis all day and every day. After all, if you don’t wear it, you won’t be as likely to use it.
Q: How should I clean my liners?
A: At the end of each day when you remove the liner you’ve been wearing, you want to roll it inside out and with one hand positioned inside the liner, hold it under a faucet running warm water and with your other hand rub normal body soap around the surface of the gel to remove any perspiration or dry skin that has stuck to the gel. Then rinse the gel surface and pat the gel dry with a towel. Then roll the liner back to its normal “fabric out position” and set it aside until the next time you wear it. If you have two liners, it is a good practice to alternate their use from day-to-day so they wear evenly. Every week or two you might want to apply some rubbing alcohol to the inside of the liner to kill any bacteria that might be present. Rinse the gel off after doing this. If the liner does not smell, you are typically doing a good job cleaning it.
Q. How long do liners last before needing to be replaced?
A: Typically liners are provided in pairs, two at a time. Also, their manufacturers typically provide a 12-month warranty when two liners are issued together. A liner’s lifespan is related to how much they are used, the shape of your residual limb and how good your socket fit is. The more you wear your liners, the faster they will wear our. The better your socket fit, typically the longer your liners will last. When the gel on the inside of your liners starts to crack or wear thin, it is time to look into getting them replaced. A prescription from your PCP will be required and insurance reimbursement should always needs to be considered when looking to replace worn liners.
Q.What is a sock-ply?
A: Stump socks are made in different thicknesses called “plies.” They start at 1-ply which is a very thin sock and typically go up to 5 or 6-plies. The higher the ply number, the thicker the sock. The looser the socket, the more sock-plies you need to add. Typically the thickness of each sock is printed on it and stitching at the top of the sock is color coded for each different sock-ply.
Q: Why do I have to wear stump socks?
A: Stump socks are provided to help you manage changes in the volume of your residual limb. These changes can occur each day from morning to night and they can also occur over weeks and months following your amputation. As your residual limb shrinks, you will want to add volume loss socks typically over your liner to try to re-establish a snug socket fit which will help to prevent injury to your residual limb.
Q: How do I know how many sock-plies to wear?
A: This is a difficult question to answer and it is something you will learn as you gain experience wearing your prosthesis. You typically will want to add a sock or multiple socks when you start to feel pressure at the very end of your residual limb when you put weight into your prosthesis (while standing or walking). Pressure on the end of your limb indicates that the socket is not providing sufficient vertical support to your residual limb. Adding one or more socks over your liner can often help to re-establish an intimate socket fit. Prosthetic socks can be layered on top of each other and should typically be worn over the outside of your liner. Over time, you will get used to adding and removing socks depending on what you are feeling in your socket. Note, whenever you leave home for the day as a prosthetic user, you should take some socks with you in the event you need to add them.
Q: What does “medical necessity” mean and why should this term be important to me?
A: This is a term that all medical insurance providers lean on when determining if they will reimburse your prosthetist for certain things they do for you. For example, if you think you need a new socket, because your old one no longer fits your residual limb properly, you will have to visit your PCP and have him/her document in your medical chart that there is a medical necessity for this socket replacement. Medical necessity could include: your residual limb has shrunk significantly since you were fit with your current prosthesis causing you to have to wear a significant amount of stump socks which is compromising your socket fit and stability. Note that your prosthetist cannot establish medical necessity for anything they do for you. This has to originate from your PCP.
Q: What do I need a prescription (Rx) for when it involves my prosthesis?
A: Basically, you will need an Rx for anything involving your prosthesis, except for “minor repairs” that can be made by your prosthetist without an Rx. Your prosthetist cannot create an Rx as he/she is not a medical doctor (MD). Examples of things that you will need an Rx from your PCP for before your prosthetist can help you include: stump shrinker; replacement of consumable items such as: socks, liners or sleeves; replacement of a broken or worn out prosthetic component such as a foot or knee; a socket replacement; or a new every day or specialty purpose prosthesis. Whenever you need an Rx to address a prosthetic need, you should schedule an appointment with your PCP to meet in person and so your encounter can be entered into your medical record.
Q: What is meant by “K-Levels?”
A: In the mid-90’s, Medicare developed a list of five functional levels that were to be applied to amputees using prostheses. They range from K-0 to K-4. These standards are used by all insurance providers. The higher the K-Level, the more active the amputee is expected to be and the more dynamic their prosthetic componentry (feet & knees) should be. Medicare requires that an amputee’s potential functional level be determined by either a physician or a physical therapist. The functional level determines only one thing, what kind of foot and/or knee your prosthetist can put onto your prosthesis.
K-0: amputee would not be able to use a prosthesis
K-1: household ambulator – one speed
K-2: community ambulator – one speed
K-3: community ambulator – varied speed
K-4: very active adult or child or someone putting high stress on prosthesis due to vocation
Q: What is a “specialty purpose” prosthesis?
A: The prosthesis you wear every day to assist you with completing you activities of daily living (ADL’s), is typically referred to as your “every day leg.” If you require a prosthesis to help you accomplish activities other than your ADL’s, such as: jogging, running, skiing, snowboarding, skating, fishing, swimming, showering, etc.; this would be referred to as a “special activity leg.” Special prosthetic componentry exists for such activities. You would have to get your PCP to document the medical necessity of such a device and your insurance provider would have to authorize it for reimbursement.