[3.2] LOWER EXTREMITY PROSTHESIS (unfinished)

Not all are included especially the tables, pls review transes (too lazy sorry)

• Generally, the removal of areas of the foot

• Differentiated by the level of amputation

PARTIAL FOOT AMPUTATION

Type of partial foot amputation

just involves distal, middle, or proximal phalanx

TOE AMPUTATION

Type of partial foot amputation

• Can be performed on some or all of the toes

• Can give a lot of pressure on metatarsal heads => they are rounded in surgery to lessen the pressure

TOE AMPUTATION

Type of partial foot amputation
entire phalanx and metatarsal

RAY AMPUTATION

Type of partial foot amputation

All metatarsals are removed

RAY AMPUTATION

FILL IN THE BLANKS — Ray amputation

\Can cause significant impact if ________ rays are removed

1st or 5th

FILL IN THE BLANKS — Ray amputation

in gait with a normal foot it starts at _______ of the foot of heel towards the big toe

Lateral border

IDENTIFY — Ray amputation

1. ______________= push off would be removed creating imbalances in gait

2. ______________ = mediolateral support would be affected because of disability affecting the pts balance

1. 1ST RAY AMPUTATION

2. 5TH RAY AMPUTATION

Type of partial foot amputation

• Performed by dividing the metatarsal bones, either distally or proximally

• May remove all but there are cases where only some are removed

TRANSMETATARSAL AMPUTATION

Also known as tarsometatarsal amputation

LISFRANC

Type of partial foot amputation

Performed between the distal edge of the cuneiform and cuboid bones and the bases of the five metatarsal bones

LISFRANC

What is left when Lisfranc amputation is done?

Cuboid and 2 cuneiforms

The Lisfranc amputation is named after ______(what year)

 Jacques Lisfranc (1790-1847)

Divided between the navicular and cuneiform bones (medial side) and cuboid bone (lateral side)

BONA-JÄGER AMPUTATION

Allows the main functional advantages of the Lisfranc amputation over to the more proximal to be retained

BONA-JÄGER AMPUTATION

Type of partial foot amputation

Remains only the talus and calcaneus

CHOPART

Type of partial foot amputation

Chopart amputation is named after who?

Francois Choport

Type of partial foot amputation

Remains talus and calcaneus but involves arthrodesis

BOYD

What does arthrodesis do in BOYD amputation?

fusing the distal tibia, fibula, and talus

• Distal tibia and fibula are partially removed and fused

• Gives better weight bearing and better use of heel pad remaining

Type of partial foot amputation

Only parts of the calcaneus remains and is being fused to the distal tibia and fibula

PIROGOFF

*Just like Boyd but without the talus

Who invented the Pirogoff amputation and what year?

Nicolás Pirogoff in 1864

Also called Symes Amputation

ANKLE DISARTICULATION

it was discovered by James Syme in 1843 — Scottish surgeon

ANKLE DISARTICULATION

• Surgical removal through ankle joint

• Heel pad still remains as a cushion and is weight bearing

ANKLE DISARTICULATION

Also known as Below Knee Amputation (BKA)

TRANSTIBIAL AMPUTATION

• Amputation through the tibia and fibula

• May be long, mid, and short in length

TRANSTIBIAL AMPUTATION

Transtibial amputation

• SHORT STUMP = _______

• MEDIUM STUMP = _______

• LONG STUMP = _________

• proximal third

• middle third

• distal third

Also called through-knee amputation

KNEE DISARTICULATION

Carried out on the joint line itself where femoral condyles are then used as the weight bearing surface

KNEE DISARTICULATION

Also known as Above Knee Amputation (AKA)

[aka AKA haha lol]

TRANSFEMORAL AMPUTATION

• Amputation through the femur

• May be long, mid, and short stumps

TRANSFEMORAL AMPUTATION

Amputation through the hip joint

HIP DISARTICULATION

• Only hip bones remain

  • In some cases, head and neck of femur are still attached

HIP DISARTICULATION

Also known as trans-pelvic amputation

HEMIPELVECTOMY

• Performed more rarely

• Even more extensive than hip disarticulation as parts of the pelvis are also removed

• Only a few % of pts who undergo this amputation survive

HEMIPELVECTOMY

Type of HEMIPELVECTOMY

• Very rare case of amputation

• Parts of the pelvis and the whole lower limb are taken out

HINDQUARTER

Type of HEMIPELVECTOMY

• A much more rare amputation than hindquarter

• Complete removal of the pelvis bones

COMPLETE

What are the different general components of prosthesis?

1. Socket

2. Shank

3. Foot Suspension

T/F

Components of each prosthesis does not depends per level

False — it does depend per level

T/F

Materials per component (stainless steel, aluminum, titanium, carbon fiber, silicon, etc.) would depend on the examiner and pts ability to walk in the device or K-level of the pt

False -assessment & pay for the device

• Materials per component (stainless steel, aluminum, titanium, carbon fiber, silicon, etc.) would depend on the assessment and pts ability to pay for the device or K-level of the pt

Considerations for the type of prothesis

1. Level of amputation

2. Materials

3. Components

4. Thorough assessment (ROM, MMT K-Level)

What types of amputation involves a socket?

1. Ankle disarticulation

2. transtibial amputation

3. transfemoral amputation

4. knee disarticulation

5. hemipelvectomy

What types of amputation involves a foot?

1. Ankle disarticulation

2. transtibial amputation

3. transfemoral amputation ***

4. knee disarticulation

5. hemipelvectomy

*1,2,4,5 are based on the list, but all of them have the foot component

What types of amputation involves a shank?

1. transtibial amputation

2. transfemoral amputation

3. knee disarticulation

What types of amputation involves a suspension?

1. transtibial amputation

2. transfemoral amputation

3. knee disarticulation

4. hemipelvectomy

What types of amputation involves a interface?

1. transtibial amputation

What types of amputation involves a hip joint?

1. hemipelvectomy

What types of amputation involves a knee joint?

1. transfemoral amputation

2. knee disarticulation

3. hemipelvectomy

What 2 components do the toe/ray amputation?

• Insole with toe fillers

• Silicon

  • Special glue is used for attach the device to the foot

T/F

Boot type in a partial foot amputation would depend on the level of amputation of the partial foot

TRUE

Types of prothesis

AFO with toe filler attached

ANTERIOR OPENING & POSTERIOR OPENING

This type of prosthesis is for Lisfranc and Bona-Jäger amputation pts

ANTERIOR OPENING & POSTERIOR OPENING

Types of prothesis

Allows easier donning than anterior opening partial foot device

POSTERIOR OPENING

This type of prosthesis is for pts who need more ankle movement

JOINTED

Types of prothesis

OTHER PARTIAL FOOT PROSTHESIS

1. Modified shoes with toe fillers inside

2. Panel opening type of socket

3. Push-fit → has an interface made of EVA foam Polyethylene or Polyurethane build depending on the brand or clinic that offers it

® picture: Posterior opening → higher end with lighter materials but same model (posterior opening with straps available)

Primary gait deviations

• Pain

• Prosthetic alignment

• Muscle imbalance

• Habit

• Contracture

[Primary Pain Causing Man to Hop]

Secondary gait deviations

Another deviation to compensate the primary deviation

What are the gait deviations during transtibial amputation?

1. Lateral Thrust of the Knee

2. Medial Thrust of the Knee

3. Too much knee flexion

4. Too much knee extension

5. Drop off

6. Uneven Arm Swing/ Timing/ Step Length

STUDY THE SPECIFICS ITS NOT IN THE CARD SET

what are the gait deviations during transfemoral amputation

1. Lateral/Anterior/Posterior Trunk Bending

2. Circumduction

3. Vaulting

4. Hip Hiking

5. Steppage

6. Instability of the Prosthetic Knee

7. Abducted Gait

8. Terminal Swing Impact

9. Rotation of Heel during Initial Contact

10. Uneven Heel Rise

STUDY THE SPECIFICS ITS NOT IN THE CARD SET

three types of exercise programs for LE prosthesis

1. Pre-prosthetic management

2. Prosthetic intervention

3. Prosthetic rehabilitation

What are the aims of pre-prosthetic training

• Prepare pt for casting and fitting

• Lifelong prosthetic use

• Gait training

• We have to prepare the pt since he is already an amputee, he would be using prosthesis for a long time (if he chooses to)

[Please Let Gail Wait]

What to prepare during pre-prosthetic training

• Global body conditioning and core stability

• Psychology/Motivation

• Cardiovascular system

• Understanding/Expectations

• ROM and MMT

• Limb shape and volume

• Skin integrity

• Scar mobility

[Getting Pretty CURLSS]

Acute post surgical interventions

1. Avoid/Minimize contracture

• Contracture has a big impact in gait deviations

• Better if there is little to no contracture for the gait to be smooth

2. Swelling reduction and stump shaping

• By stretching, positioning, compression therapy

3. Stump Boards

• Elevation for the residual limb during sitting

• We can’t let the pt have a pillow underneath the knee

4. Strengthening Exercises

• Have to strengthen the knee extensors, hip extensors, hip abductors, and hip adductors (important muscle groups in the gait cycle)

5. Promote functional independence

• Bed mobilities, sitting balance, transfers in and out of bed, personal care, hygiene, usage of wheelchairs or crutches during walking

6. Rehabilitate and maintain general body conditioning and cardiovascular fitness

• Restore the pt from the deconditioned state

• Sound limb and strength conditions → we need to preserve what the pt has

• Check for flexibility and strength throughout the kinetic chain

T/F — Acute post surgical intervention

1. Contracture has a does not have an impact in gait deviations

2. Better if there is little to no contracture for the gait to be smooth

1. False - has a big impact

2. True

What are the pre-prosthetic interventions?

1. Continue w/ specific and global strength and conditioning

2. Continue to avoid or reduce contracture formation

3. Continue w/ stump shaping and size reduction

4. Avoid or reduce scar adhesions

5. Desensitize residual limb

6. Improve CV fitness, general conditioning and core control

7. Balance skills

8. Prepare the patient for the upcoming prosthetic rehabilitation

9. Early Walking Aids (PPAMaid, AMA, Femurette)

10. PPAMaid (Pneumatic Post Amputation Mobility Aid)

Type of socket for ankle disarticulation

• Full socket with a liner interface

Push fit

Type of socket for ankle disarticulation

• With_________ portion for easier donning

• Straps are attached so it would stay in place when stump is inside

Panel opening

Types of socket for ankle disarticulation

Push fit

panel opening

PTB socket

Type of socket for transtibial amputation

With a calf suspension since it does NOT have a suspension

Patellar tendon bearing socket (PTB)

Type of socket for transtibial amputation

• Most common

• Supracondylar design

• Takes more weight on the patellar tendon

Patellar tendon bearing – supracondylar socket (PTB-SC)

Type of socket for transtibial amputation

Why is PTB-SC diff from PTB

• it is a self suspending socket

  • Suspends on the supracondylar area; trimlines goes up to supracondylar area

Type of socket for transtibial amputation

Self suspending socket since it encompasses the supracondylar and suprapatellar areas → giving better suspension on the front

Patellar tendon bearing – supracondylar suprapatellar socket (PTB-SCSP)

Types of socket for transtibial amputation

1. PTB

2. PTB-SC

3. PTB-SCSP

4. Total surface bearing

5. Hydrostatic socket

6. CAD system (computed aided design)

Types of socket for transfemoral amputation

• Most common

WB area is the ischial tuberosity

Quadrilateral (QL)

Types of socket for transfemoral amputation

• Encompass some parts of the ramus that would have a bone lock

• Better WB system than the QL

• Slightly more difficult to cast than QL (need 2 people)

Ischial ramus containment (IRC)

Types of socket for transfemoral amputation

• Adaptation or modification for IRC

(both)

Marlo anatomical socket & Subischial socket

Types of socket for transfemoral amputation

Types of socket for transfemoral amputation