Frequently Asked Questions

Prosthetics

What is a Prosthesis?

A prosthesis is an externally applied device designed to replace a missing part of the body or to make a part of the body work better. A prosthesis is also known as an artificial limb.

How do I get a Prosthesis?

As a new amputee, you will begin the fitting process following a series of rigid casts and application of a compression sock “shrinker” which will help shape your limb in preparation for a prosthesis. This takes an average of 6-8 weeks following surgery, in most cases. Your doctor will be the determining factor regarding timing. Once your surgeon has given the approval, we will proceed with crafting your customized limb.

In some cases, rather than the rigid casting process, your prosthetist will use digital scanning to capture the shape of your residual limb. The scan will be used in designing your socket using computer-aided design technology.

You will then see one of our practitioners, known as prosthetists, who are professionally trained to fit, adjust, recommend and modify a prosthetic device. Several visits to your prosthetist are required and involve casting, or scanning, measuring, diagnostic fittings and training in how to use and care for your prosthesis.

If you are a new prosthetic wearer, you will most likely visit a physical therapist upon delivery of your prosthesis. We can assist in finding a therapist that is best for your situation: in-home, outpatient or a combination. The therapist will train you on the functions of the newly acquired device as well as how to obtain good performance and maximum comfort in everyday life while using the device.

The time from casting to delivery typically takes three visits over the course of about four to five weeks. Thanks to our on-site fabrication lab, if your doctor or therapist recommends a shorter time line for delivery, we can accommodate that.

What if the prosthesis doesn’t fit right?

Follow-up is as important as the initial fitting. You will need to make several visits for adjustments with the prosthetist as well as training with a therapist. They can help you ease pressure areas, adjust alignment, work out any problems, and regain the skills you need to adapt to life after limb loss. Tell your prosthetist if the prosthesis is uncomfortable, too loose or too tight, or causing any skin issues such as blisters. Ask questions about things you need or want to do. Communicate honestly about your needs. The more you communicate with your prosthetist and therapist, the better you will be able to succeed with a prosthesis.

How much does an artificial leg weigh?

The weight of your artificial limb will depend on the type of limb and the components, but on average a below knee prosthetic weighs 4 pounds and an above knee prosthetic weighs 8 pounds. A natural leg is approximately 1/6 of your bodyweight.

How long will it last?

Depending on your age, activity level and growth, the prosthesis can last anywhere from several months to several years. In the early stages after limb loss, many changes occur in the residual limb that can lead to shrinking of the limb. The greatest amount of volume loss occurs within the first six months following amputation. This may require socket changes, the addition of socks, or changes in the alignment and/or replacement of the socket. Later on, increased activity level and desire for additional function can necessitate a change in the prosthesis or its parts. Once the prosthesis is comfortably adjusted and you are functioning at the desired level of activity, the prosthesis needs only minor repairs or maintenance and can last for up to three years. There are several factors that can make this lifespan of your prosthesis shorter or longer.

What is phantom pain?

Phantom pain is the term used to describe sensations felt by amputees, which may include cramping, tingling, itching, pins-and-needles, stabbing pains, pressure, a sense of fullness (as if the limb was still there, but slightly swollen). The majority of amputees experience these sensations, however the degree to which it is felt will vary. The phantom sensations are intermittent and come and go, unpredictably. New amputees tend to have frequent and intense sensations several times every day, often continuously for a few hours at a time. As the years pass after an amputation, the sensations will generally become less frequent, and less intense, and bouts of pain last for a shorter amount of time. Talk to your prosthetist about the different options for helping to reduce the pain which may include a special sock made with a metallic material, massage, mirror therapy or medications. (http://www.webmd.com/pain-management/guide/phantom-limb-pain#1)

Can my prosthesis get wet?

We strongly encourage that you keep your prosthesis as dry as possible. Certain componentry will rust and is not meant to get wet. There are however, covers that go over your prosthesis that help prevent water from entering. We are also able to fabricate a special prosthesis designed for water activities including swimming, fishing and showering.

How do I determine the amount of prosthetic socks I should wear?

Many amputees wear prosthetic socks over their residual limb. These prosthetic socks come in a variety of thicknesses and materials. There are many benefits and uses for these socks. They provide cushion, reduce and absorb friction, protect the skin, absorb perspiration and compensate for shrinkage and/or swelling of the residual limb. As the residual limb matures, it will begin to change size and shape. To maintain an appropriate fit of the prosthesis, different thicknesses of socks are added to compensate volumetrically for any loss or gain that has occurred. For information about prosthetic socks, you can visit: http://comfortoandp.com/?page_id=77l

A prosthetic sock thickness and weight is represented with the term “Ply”. As you increase in ply, you increase in thickness.

You will receive several socks with your prosthesis. With this supply of socks, you will be able to better manage your fit. Every time you put on the prosthesis, it is important that you are aware of how many ply you have on. If the socket is loose and your limb slides in too easily, you need to add a sock; if the socket is feeling tight then reduce your fit by a ply. This process may need to be repeated throughout the day as your limb will change in volume. It is ideal to have the best fit possible with the least amount of socks. For example, it is preferable to have on one 5-ply sock rather than one 3-ply sock with two 1-ply’s. Understanding prosthetic sock management is key to avoiding skin breakdown and irritation. With the proper fit and follow-up the chances of having a healthier residuum will increase.

Sheaths are also available for the prosthetic wearer. They are used to reduce friction caused by excessive rubbing and help wick away perspiration. Link to care section, prosthetics)

Can I expect to drive as before or will I need special equipment?

Although a few right side below knee amputees can effectively drive using their prosthesis, in most cases, an easily operated left-foot gas pedal can be installed. These are inexpensive and fold out of the way for general use. In some cases, hand-controls may be a more realistic option.

Can I speak to someone in my situation?

Yes, definitely. We often arrange for new amputees to speak with others who have been though a similar process. And, we have amputees on staff that can assist and peer- counsel you through the process.

Orthotics

What is an Orthosis?

An orthosis is a custom made or custom fit device which is used to support a weakened limb, improve movement or prevent deformity. An orthosis can be made for any part of the body, from simple foot orthotics to spinal bracing or cranial helmets. It can be made of a variety of materials including plastic, carbon fiber, metal or fabric.

How do I get an Orthosis?

If you do not have an orthosis, but feel you might benefit from one, you will want to discuss this with your physician at your next appointment. They may write you a prescription for an orthosis. Alternatively, you can come in for a free consultation at RHS with one of our certified orthotists and we will provide you with our recommendations to discuss with your doctor.

If you already have an orthosis, but you feel it may require replacement due to wear and deterioration, or if your needs have changed, you can do one of two things:

  1. Schedule an appointment with your orthotist so they can either refurbish the current orthosis or verify that you need a new orthosis. If it needs to be replaced, and you haven’t seen your physician recently, you will need to contact your physician in order to get a prescription.
  2. See your physician and request a new prescription. Then call your orthotist and schedule an appointment.

Once you have a prescription for an orthosis you can call one of our offices, whichever is most convenient for you, and schedule an appointment.

What should I expect when I show up for my appointment?

If you are a new patient, there will be some paperwork for you to fill out before your appointment. Or you can download the forms and fill them out and bring them with you.

Once all of the paper work is done, one of our orthotists will perform an evaluation and discuss orthotic options available. After a treatment plan is agreed upon, the part of the body requiring an orthosis may be molded by the orthotist and/or measured. If you are coming in for an orthosis involving your knee, bring shorts so that a mold or measurement may be taken higher on the thigh.

If a custom fit device is decided on as the treatment, you will either be measured (if we don’t stock the item) or fit (if we do) with the device at the first appointment. RHS does not charge patients for their initial consultation.

How long after my first appointment until I get the orthosis?

This varies depending on the type of device you will be getting and your insurance requirements. There are many varieties of braces and all are unique. Typically, we require two weeks for custom devices including foot orthoses, ankle foot orthoses. If it requires less or more time than this the orthotist will tell you this at the initial appointment.

In the case of an emergency, we can turn around your orthosis more quickly, thanks to our on-site fabrication lab.

Will it fit into my shoe?

This depends on the type of orthosis you receive and the type of shoes you wear. For foot orthoses, ankle foot orthoses, or knee ankle foot orthoses we recommend a sturdy shoe preferably with a tongue and means of loosening/tightening. They should not be open back shoes. If you have concerns with shoe wear discuss this with your orthotist.

What if I have an area that is uncomfortable?

We encourage you to make a routine two week follow-up after delivery. Most problems can be rectified at this time. If there is discomfort after this point, call your orthotist and schedule an appointment for adjustment. Many times it is a quick adjustment to make the orthosis more comfortable for you.

How often should I see my orthotist?

The typical timelines for appointments include the initial evaluation appointment, two weeks later a delivery appointment, and a two week follow-up appointment. If there are concerns with fit/function, we may schedule additional follow-up appointments. Of course, you can call at any time if you need to see your orthotist for adjustments or follow up questions. You should schedule routine follow up appointments with your orthotist every six months so the condition of your orthosis can be assessed and repaired if need be.

I have drop foot, could an orthosis help me?

There are various orthotic treatments for drop foot. Depending on the condition of your other muscle groups and joints, you may benefit from a simple low profile ankle foot orthosis which will assist with your toe clearance during the swing phase of gait, but is still flexible enough so that it does not effect the rest of your gait. Talk to your physician to determine if an orthosis is right for you.

For more information about drop foot and its causes and treatment, follow this link: http://www.webmd.com/a-to-z-guides/foot-drop-causes-symptoms-treatments

My child has scoliosis, what should we expect?

Scoliosis is not an uncommon diagnosis in adolescents and pre-teens (http://www.webmd.com/back-pain/tc/scoliosis-treatment-overview). There are various orthotic treatments we use for idiopathic scoliosis. We will discuss these options and evaluate your child to determine which option would be most effective for their curve type.

When you are coming in for an initial evaluation, make sure you bring your child’s prescription and most recent X-ray. If your child is female bring either a sports bra or bikini top and a snug fitting pair of shorts or bottoms to a swimsuit. After a treatment plan is formed and necessary measurements are taken, we will schedule a delivery appointment. We will also coordinate an appointment with the physician for in-brace X-rays. This may be coordinated with the delivery or follow-up appointment. We will see your child frequently for follow up and adjustments. Your doctor will determine when additional x-rays are needed.