Fitting and Care Instructions

Above Knee Prosthetic | Below Knee Prosthetic | Ankle Foot Orthosis | Custom Plastic Spinal Orthosis

Fitting and Care Instructions for Above Knee Prosthetic Patients

New prostheses wearers: Your body will need time to adjust to your prosthesis.  Take your time and do not do excessive exercise or walking for the first several weeks. Do not walk more than 15 minutes at a time for the first few days. Check your residual limb several times a day for the first two weeks and check for unusual skin conditions. This will exhibit itself as blisters, bruising or any skin discolorations that do not return to its natural tone in 10-15 minutes. Call your practitioner immediately if you notice skin complications or related issues.

The following is a general list of instructions and your particular case may differ. Be sure to follow the specific instructions your practitioner gave you at your appointments.

Belt Suspension Prosthesis

  1. If you wear a gel liner, this is always applied to your residual limb first. Only one liner is applied and make sure it is wrinkle free.
  2. Apply the correct ply of prosthetic sock to the residual limb, over the liner or against the skin if no liner is used. Socks come in different ply, so make sure the proper sock is used.
  3. Apply the prosthesis over the socks. The prosthesis should be applied onto the residual limb as far as it will go while in a seated position.
  4. Before standing, apply the suspension belt securely around your waist.
  5. Now stand. Once you are standing make sure the prosthesis is “rotated” correctly and the knee is fully extended (straightened).
    1. The ischial tuberosity (pointy bone located in your gluteal or buttocks area) should be placed on the back shelf of the prosthetic socket. If this is not positioned properly, you cannot determine if the ply or sock applied is correct.
  6. Sock Management:
    1. If the ischial tuberosity is slipping and you are “wedging” into the socket, you need to increase the ply of sock applied to the residual limb. This may occur at any point during the day.
    2. If you receive excessive pressure on a bone in the groin area, check the position of the socket on the residual limb. The prosthesis may be rotated too far in either direction. If the position is correct, you may need to increase the ply of sock. Make sure that the sock is not bunched up at this area, but that it is folded over the top of the brim and laid flat.
    3. If you are receiving excessive pressure distally (on the bottom of your residual limb) you may need to increase the ply of sock.
    4. If the ischial tuberosity does not sit on the posterior shelf, you need to reduce the ply of sock applied to the residual limb. This may occur at any point during the day.
    5. If the sides of the residual limb towards the bottom of the socket feel as though they are being “stretched” you may need to decrease the ply of sock.
    6. All adjustments should be made one ply at a time. Patients do not shrink at 3 and 5 ply increments
  7. Once you are sure the fit is correct, tighten the suspension belt to its proper level before walking.
  8. You will probably receive “uncomfortable” pressure applied to the buttocks at first. This is common. The area should “toughen” over time.
  9. When seated, the prosthesis will more than likely slide slightly distally (down) on the residual limb, this is normal.

Proper Application of Suspension Component and Care: Waist Belt

  1. Apply the belt above your hip(s) and tighten the closure. If you have a pelvic band and hip joint, the band should be placed just below the waistline on the prosthetic side.
  2. DO NOT pull one side of the belt harder than the other as this will rotate the prosthesis incorrectly

 Locking Liner Suspension Prosthesis (Pin or Strap)

  1. Invert the gel liner as far as possible without tearing the liner at the bottom. The object is to achieve no “air pocket” between the bottom of your limb and the liner.
  2. Apply the liner to the residual limb. There should be no interface between your skin and the liner, unless otherwise directed by your prosthetist. Check to make sure there is no space between the bottom of the limb and the bottom of the liner.
  3. Slide the liner completely onto the limb with no pulling on the liner. There should be no wrinkles in the liner. Your care provider may instruct if there is a front or not, and you may use a lubricant on your skin. Be sure to discuss with your prosthetist how much lubricant is advisable. Too much and your liner will tend to slip and slide.
  4. Once the liner is donned, check to make sure the pin/strap receivers are positioned correctly. The receiver should be in line with your residual limb and not canted to a side, front or back. Also check and make sure the pin or suspension screw is attached to the receiver completely and is secure. Apply the correct ply of prosthetic sock to the residual limb. Socks come in different ply so make sure the proper sock is used.
  5. Apply the limb with sock(s) and liner into the prosthesis. If you have a lanyard strap, feed the strap through the “locking” mechanism located in the bottom of the socket and secure the strap through the buckle on the front top of the socket.
  6. Now stand. Once you are standing, make sure the prosthesis is “rotated” correctly and the knee is fully extended (straightened).
  7. Sock management:
    1. If the ischial tuberosity is slipping and you are “wedging” into the socket, you need to increase the ply of sock applied to the residual limb. This may occur at any point during the day.
    2. If you receive excessive pressure on a bone in the groin area, check the position of the socket on the residual limb. The prosthesis may be rotated too far in either direction. If the position is correct, you may need to increase the ply of sock.
    3. If you are receiving excessive pressure distally (on the bottom of your residual limb) you may need to increase the ply of sock.
    4. If the ischial tuberosity does not sit on the posterior shelf, you need to reduce the ply of sock applied to the residual limb. This may occur at any point during the day.
    5. If the sides of the residual limb towards the bottom of the socket feel as though they are being “stretched” you may need to decrease the ply of sock. All adjustments should be made one ply at a time. Patients do not shrink at 3 and 5 ply increments
  8. Once positioned correctly, the pin should be engaged in the lock or strap fastened securely through the buckle.

Suction Socket Prosthesis: Skin Fit, No Liner

  1. Remove the valve from the valve seat.
  2. Apply a “pull” sock over the residual limb encompassing most  of the top of residual limb. If your practitioner has instructed you to use the prosthetic liquid powder, apply a liberal amount over the top of the residual limb. Also, apply lotion to the brim (top) of the prosthetic socket.
  3. Apply the prosthesis to the residual limb and put the end of the pull sock through the valve seat. Make sure the prosthesis is rotated and positioned correctly.
    1. The ischial tuberosity (pointy bone located in your buttocks area) should be placed on the back shelf of the prosthetic socket. If this is not positioned properly you do not have the prosthesis positioned correctly.
  4. Carefully stand with the prosthesis on the residual limb as far as possible. Use an assistive device while standing to reduce the chance of falling. Using one hand, grab the pull sock and begin pulling the sock through the valve seat. “Pump” your residual limb while pulling the sock down and off. The purpose is to pull soft tissue into the socket, not just pull the sock off.
  5. Once the sock is pulled through the valve seat, check to make sure your residual limb in “filling” the bottom of the socket. This is achieved by simply pushing a finger through the valve opening and feeling for soft tissue placement.
  6. Apply the valve to the seat and screw it in snugly.
  7. After sitting, air may need to be removed once you are standing again. This is achieved by using the valve release mechanism.

Instructions Given for Care of the Prosthetic Socks and Nylons

Only use the prosthetic socks and sheaths provided by your care provider. Each type of sock has its own cleaning instructions. Follow the instructions provided to you by your prosthetist. Every person is unique. Your prosthetist will give you specific instructions for your case.

Routine checks on your prosthesis should be completed by your prosthetist in two weeks, then in three months, and followed up with an appointment six months after initial delivery.

Fitting and Care for Below Knee Prosthetic Patients

New prostheses wearers: Your body will need time to adjust to your prosthesis.  Take your time and do not do excessive exercise or walking for the first several weeks. Do not walk more than 15 minutes at a time for the first few days. Check your residual limb several times a day for the first two weeks and check for unusual skin conditions. This will exhibit itself as blisters, bruising or any skin discolorations that do not return to its natural tone in 10-15 minutes. Call your practitioner immediately if you notice skin complications or related issues.

Proper Donning and Wearing of Your Prosthesis: No Gel Liner Socket

  1. If you wear a silicone sheath, this is always applied to your residual limb first. Only one sheath is applied and make sure it is free of wrinkles.
  2. Apply the correct ply of prosthetic sock to the residual limb. Socks come in different thicknesses called “ply”. It is important that the proper ply of sock is used.
  3. If your prosthesis has a one, remove the soft liner from the prosthesis and apply it to your limb. Approach the limb with the liner from the back of the limb and apply onto the limb until the patella tendon bar is in the proper location.
    1. The indention towards the top front of the liner/socket is known as the patella tendon bar. This “bar” should be positioned at mid-patella tendon level. The mid-patella tendon level is the mid-point between the bottom of the patella (kneecap) and top of the tibia (shin).
  4. Place your residual limb, and if you have one, the liner into the prosthesis. The socket should line up correctly with the patella tendon bars matching.
  5. When standing, pressure should be applied by the patella tendon bar at mid-tendon level (see 3a). No adjustments need to be made to the ply of sock as this is a proper fit.
  6. Sock Management:
    1. If the bar applies pressure to the bottom of the patella or excessive pressure to the bottom of your residual limb while standing, you need to increase the ply of sock applied to the residual limb. This may occur at any point during the day.
    2. If the bar hits the tibia (top of the shin) while standing, you need to reduce the ply of sock applied to the residual limb.
    3. All adjustments should be made one ply at a time. Generally, patients do not shrink in 3 and 5 ply increments.

Gel Liner With Patella Tendon Bar Socket

  1. Invert the gel liner as far as possible without tearing the liner at the bottom. The object is to achieve no “air pocket” between the bottom of the limb and the liner.
  2. Apply the liner to the residual limb. There should be no interface between your skin and the liner, unless otherwise directed by your prosthetist.
  3. Slide the liner completely onto the limb with no pulling by you on the liner. There should be no wrinkles in the liner. Your practitioner will have instructed you if there is a front or not and if you may use a lubricant on your skin.
    1. The indention towards the top front of the liner/socket is known as the patella tendon bar. This “bar” should be positioned at mid-patella tendon level. The mid-patella tendon level is the mid-point between the bottom of the patella (kneecap) and top of the tibia (shin).
    2. If your liner has a pin locking system: Once the liner is donned, check to make sure the pin is positioned correctly. The pin should be in line with your residual limb. This means that the pin is not canted in one direction more than another. Also, check and make sure the pin is screwed in the receiver completely and is secure.
  4. Apply correct ply of prosthetic sock to the residual limb. Socks come in different ply so make sure the proper sock is used. If you do not wear a soft-liner, skip to #7.
  5. Take the liner out of the socket and apply it to your limb. Apply the liner on to the limb until the patella tendon bar is in its proper location.
    1. The indentation towards the top front of the liner/socket is known as the patella tendon bar. This “bar” should be positioned at mid-patella tendon level. The mid-patella tendon level is the mid-point between the bottom of the patella (kneecap) and the top of the tibia (shin).
  6. Apply limb with socks and liner(s) into prosthesis.
  7. When standing, pressure should be applied by the patella tendon bar at mid-tendon level (see 3a). No adjustments should be made to the ply of sock, as this is a proper fit.
  8. Sock Management:
    1. If the bar applied pressure to the bottom of the patella while standing, increase the ply of sock applied to the residual limb. This may occur at any point during the day.
    2. If the bar hits the tibia (top of shin) while standing, reduce the ply of sock.
    3. All adjustments should be made one ply at a time. Changes do not occur in 3-5 ply increments.
    4. You may need to adjust the ply during the course of the day.

Gel Liner with Total Surface Bearing Socket

  1.  Invert the gel liner as far as possible without tearing the liner at the bottom. The object is to achieve no “air pocket” between the bottom of the limb and the liner.
  2. Apply it to the residual limb.
  3. Slide the liner completely onto the limb with no pulling on the liner. There should be no wrinkles in the liner. Your practitioner may instruct if there is a front or not and if you may use a lubricant on your skin.
    1. If your liner has a pin locking system: Once the liner is donned, check to make sure the pin is positioned correctly. The pin should be in line with your residual limb. This means that the pin is not canted in one direction more than another. Also check and make sure the pin is screwed in the receiver completely and is secure.
  4. Apply the correct ply of sock to the residual limb. Socks come in different ply so make sure the proper sock is used.
  5. Apply limb with socks and liner into prosthesis.
    1. If there is excessive pressure being applied “upward” onto the bottom of the residual limb, then increase ply of sock.
    2. If the is excessive “pull” on the residual limb while standing, then decrease ply of sock.
    3. All adjustments should be made one ply at a time. Changes do not occur in 3 and 5 ply increments.
    4. You may need to adjust the ply during the course of the day.

Proper Application of Suspension Component and Care

Waist Belt

  1. Adjust waist belt for snug fit over the hips.
    1. The belt should be over a shirt or pants to prevent skin irritation.
    2. The belt should not cause difficulty in breathing.
    3. If the elastic pick-up strap creates a “V” in the belt with tension applied, the belt is not tight enough around the waist.
  2. Put the billet through the buckle and fasten it in its proper hole. When standing, there should be slight tension applied to the elastic pick-up.
    1. Too much tension will put excessive pressure “upward” on the residual limb. It will also put excessive strain on the lower back and hips.
    2. No tension will cause the prosthesis to “piston” or “drop” on the limb while walking.
  3. Apply the Velcro strap above the knee snugly, but not too tight. Minimum to moderate pressure is applied to the skin.

Care: Wash the waist belt by hand in cool or warm water and allow it to air dry. Do Not use bleach, only mild detergents.

Suspension Sleeve

  1. Pull or roll the suspension sleeve up onto the thigh. This will need to be discussed with your prosthetist to determine which technique to use. Half of the sleeve should be above the prosthesis and half on the prosthesis.
  2. Make sure that the sleeve is wrinkle free. The prosthesis will be allowed to  “piston” or move on the residual limb for each wrinkle.
  3. Once the sleeve is applied wrinkle free, fold the top half in half and lightly pull upward at the fold.
  4. Depending upon the type of material used, which your prosthetist can deatail for you, fold or pull, the remaining portion back up on onto the thigh. If the sleeve is pulled onto the thigh it will “push” the residual limb into the socket. Also, excessive tension will be applied to the skin if the sleeve is pulled. This may cause skin rash, itching and/or sores/ulcers.
  5. The suspension will work better with the surface of the sleeve on the skin or the gel liner. Your prosthetist will check for proper length of prosthetic sock for this suspension.

Care of Sleeve

  • At night, allow the sleeve to stay “up” not left rolled down on the prostheisis. This will prevent premature stretching of the sleeve.
  • If you have two sleeves, swap them once a week. This will prevent premature stretching of the sleeves.

Care of Liners

  • Follow the instruction booklet given to you by your prosthetist. Clean the liner after each usage with soap and water.
  • Clean the inside of the liner once a week with alcohol. Switch the liners daily. This allows the liners to dry and prevent premature stretching.

Instructions Given for Care of the Prosthetic Socks and Nylons

  • Only use the prosthetic socks and sheaths provided by your care provider. Each type of sock has its own cleaning instructions. Follow the instructions provided to you by your prosthetist. Every person is unique. Your prosthetist will give you specific instructions for your case.
  • Routine checks on your prosthesis should be completed by your prosthetist in two weeks, then in three months, and followed up with an appointment six months after initial delivery.

Fitting and Care Instructions for Ankle Foot Orthosis Patients

Thermoplastic  AFO

In general, an Ankle Foot Orthosis (AFO) consists of a lower leg shell with a strap attached to it and may, or may not have a separate foot plate, possibly with an ankle joint.

  1. Apply a cotton sock over your leg. The top of the sock should be as high or higher than the height of the tibial shell.
  2. Apply orthosis onto your leg.
    1. It may be easier to slide your heel into the largest part of the tibial shell section, allowing the orthosis to slide up into position.
  3. Make sure that your foot is in total contact with the footplate portion of your orthosis. Your heel should be encompassed by the back part of the footplate.
  4. Secure all straps and tighten them. The fit should be snug, without restricting blood circulation, but preventing any leg movements within the orthosis.
  5. Apply your shoe over the orthosis, the type of shoe should have been approved by your orthotist. It should have the correct heel height for your orthosis and appropriate closures. A shoehorn may be helpful for applying the shoe.
  6. Once the shoe is applied, set your foot firmly on the ground. Make sure that your leg is still properly positioned in the orthosis and both are properly positioned in the shoe. Secure orthosis on your leg with the strap(s).
  7. Before standing and walking, make a final check to assure that everything is positioned and fastened properly. If you have poor tactile sensation, pay specific attention to donning procedures and making routine checks on proper wearing and skin condition.
  8. General wearing timetable should be consulted by the patient with attending physician, physical therapist and orthotist.

Conventional AFO (Metal Uprights Attached to the Shoe)

  1. Apply a cotton sock over your leg. The top of the sock should be as high or higher than the calf band.
  2. The closure on the calf band should be open. Place your foot into the shoe. A shoehorn may be helpful for applying the shoe.
  3. Make sure that your foot is completely down in the shoe and the back of your heel is fitting snugly into the back of the shoe.
  4. Secure all straps and tighten them. The fit should be snug without restricting blood circulation, but preventing leg movements within the orthosis.
  5. If you have a T-Strap attached to the shoe: Position your shoe on the ground, with your shin/calf section perpendicular to the floor (if possible). Wrap the long part of the strap closure around the outside of the metal upright on the opposite side from where it is attached to the shoe. Tighten the strap while sitting.
  6. Secure the calf band closure around your calf with the leather band fitting snugly against your calf. It must be snug, but not compromising your blood circulation. There should be minimal sliding of the band on the leg when walking.
  7. General wearing timetable should be consulted by the patient with attending physician, physical therapist and orthotist.

Proper Care of Your Orthosis

  • Check your skin several times a day for areas of excessive pressure. Usually this presents itself as an area of reddened or whitened skin, not returning to its natural tone in about 15-20 minutes. These areas can cause skin breakdown and should be checked by your orthotist.
  • Wash your orthosis two-three times a week. Use a mild antibacterial soap that does not cause skin irritation. Use a soft cloth for cleansing. Avoid water and dirt in any joint.
  • Once a week, clean the orthosis with alcohol swabs.
  • Never submerge your orthosis in water or leave it exposed to very high or low temperatures.
  • Routine checks on your orthosis should be completed by your orthotist in two weeks, then in three months, and followed up with an appointment six months after initial delivery.

Fitting and Care Instructions for Custom Plastic Spinal Orthosis Patients

Successful brace wearing requires you to:

  • Wear your brace 18-20 hours daily within 2-3 weeks, unless otherwise specified by your doctor.
  • Take care of your skin daily.
  • Wear an undershirt at all times under your brace. For girls, bras are worn under the undershirt.
  • Apply the brace properly to your body.
  • Clean your brace daily.
  • Do your exercise program daily, if your doctor or physical therapist has provided you with one.
  • Gradually increase your brace wearing time every 2-3 days.

Putting Your Brace On

Proper placement of the brace to your body will be demonstrated by your orthotist. There are several methods of applications. At first, you may need help, but eventually, you will learn to do it yourself. The easiest method is described below.

For a single piece, plastic front opening device:

  1. Place brace around your body by holding each side and spreading the brace so you can slip into it. If the brace is stiff, you might need help.
  2. Make sure all straps are outside the brace.
  3. The opening of the brace should be in the middle of the front.
  4. Push the brace down by placing hands on your hips; the crescent shaped pads on the inside of the brace should rest just above your hip and below your ribs.
  5. Secure the bottom strap first then, then straighten up, tightening each strap as you go. As you pull each strap, you should get into a better posture.
  6. If you have a 2-piece orthosis, apply the front over the back and follow step #4.

How to Apply and Tighten the Brace Yourself

Proper brace application can be achieved by lying face up in bed or leaning against the wall to hold the back in place while you position the straps. This frees up your hands helping you keep the brace in the correct position.

Helpful Hints

  1. Make sure your spine and gluteal crease is centered in the brace.
  2. The crescent pads or waist pads are above your hips and below your lowest rib.

It is very important to PREVENT SKIN BREAKDOWN—that is skin that becomes sore, red or raw. The skin under the brace needs to be toughened up, especially where the brace presses the hardest.

  1. To Protect the Skin
    1. Bathe or shower daily.
    2. Special attention is necessary to pink areas of the skin where the brace presses the most.
    3. Always wear underpants beneath the brace.
    4. Wear brace as tightly as possible, a loose brace will cause skin problems by rubbing.
    5. The use of cornstarch is often helpful in hot weather, or to skin sensitive to alcohol. (Initially do not use creams, lotions or powder under the brace. These soften the skin).
  2. If there is skin breakdown (sore, red, raw skin) the brace must not be reapplied until the skin heals (one day or more). If this happens, call your orthotist. The problem may be solved over the phone.
  3. Sometimes the skin over the waist and hips get darker. This is common and not a problem. When the brace treatment is over, this color will go away.

Breaking In Your Brace (Unless your physician provides different instructions)

The following program is designed to help your skin and muscles adjust to having the brace on.

Stage 1:

  • Wear brace 6 hours a day
  • Best accomplished after school or work and up to bedtime
  • Apply brace for 2 hours
  • Remove brace, check skin
  • If your skin is just pink, reapply brace for 2 more hours and repeat up to 6 hours, total
  • If you skin is sore and red, wait 30 minutes then rub with alcohol and wear for 2 more hours, up to 6 hours total

Stage 2

  • Wear brace 10 hours daily
  • Best done over a weekend
  • Put brace on for 4 hours
  • Remove brace, check skin
  • Reapply brace for 3 hours
  • Reapply up to 10 hours total
  • One weekend for Stage 2 is all that is necessary

Stage 3

  • Wear brace 18 hours daily
  • Put brace on before school or work
  • At lunchtime (or 4 hours later) take brace off and check skin
  • Put brace back on until after school
  • After school or work remove brace for 6 hours
  • Reapply at bedtime and sleep in brace, if your doctor recommends sleeping in your brace

Once you are able to sleep in your brace, or wear it all day, you have achieved your brace-wearing goal! Remember to ask about total number of hours necessary for your treatment plan.  Also, don’t neglect your physical therapy plan, if you were provided one by your doctor.

Routine checks on your orthosis should be completed by your orthotist in two weeks, then in three months, and followed up with an appointment six months after initial delivery.