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Heather Mills - Amputee Forum
Kaz

'cushioning' under the bone

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OK, this could either turn out to be a tip and/or a trick :D ??!!!

As some of you may know, i lost my foot in a car accident in Greece.

The medical facilities in Greece were (are still!!) quite....

:(

Many things went wrong in the operations following this accident. One thing was they didn't cut the bone back enough. As i was only 10 years old ...ofcourse the bone was still growing. By the time i was 20 the bone was actually forcing itself through the skin. I had an open wound there for about 2 years not really wanting to accept i had to go under the knife again. So i never told anyone till it just started to get septic and did not stop bleeding. The pain started becoming unbearable too. Anyway, to make a long story short....40 - 50 tubes of anticeptic cream later , i had a revision where they cut the bone back and pulled the muscle over the bone which acts like a sort of cushion. Since then i have not had a single prob with the skin in that area. It's actually extremely comfortable walking now. It would interest me : Is this method the norm ?? Do any of you have the same ? It would certainly be the answer for anyone that has probs with comfort. Hmmm.

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Hi Kaz,

I have about an inch of muscle/tissue below my bone. This was how the surgeon finished my stump off, after amputating my right leg (AK).

So I have always had 'that' cushion, and it is comfortable. But I have an inch gap between the end of my stump and the base of the socket. IMO because of these things, I've never had any serious problems and walk comfortably.

The only problem I've had was when my socket went out of alignment and caused severe bruising. This took about 6 weeks to 'clear' up.

I don't know if it was standard surgical procedure for AK's to be left with a cushion?

Best as ever

Steve

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Hey Kaz I had a revision just like yours when I was 11. The bone was still growing and had to be "shaved" a bit. I have a pad under my stump as well, although it's quite sensitive and, as I weight bear a lot, any irregularity in the liner effects me a great deal. This is my problem at the moment the stitching in my new liner is like walking on glass after a few hours and I'm having to wear my old leg a bit.

Cat

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My muscle was used to cushion the end of the bone. My surgeon kept what is basically everything from the back of my leg and pulled it up over the end of the amputated area. If i touch the very end of my stump it feels like i am touching the back of my leg, it was really weird at first :blink: but i am used to it now :) . It certainly seems to make things very comfortable.

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Thanks guys,

it seems to be the 'standard' pulling the muscle and tissues over the bone. It would be interesting what the nerves do. I heard somewhere they continuously search for the foot, meaning they grow and grow. My surgeon took a pic of my leg during this OP (12 years after amp). The nerves had grown to an incredible length which was one of the reasons i had so much pain. I wonder, do they grow around the stump area or do they grow back up the leg (lets say, after 30-40 years ....??!!.hehe.)....Does the stump area become more sensitive with time ??? So many questions, such little time ... :rolleyes:

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Not sure what happens to the nerves Kaz but you got me thinking.

My stump is definitely more sensitive now than it used to be.

Once I could take any amount of pressure and could actually walk ( hobble) on my stump. Can't do that anymore.

Cat

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:o :o :o :o :o

You could walk on it ????? OOOUUUCCCCHHHHH!!!

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Nope was never ouch at all. I can still stand on it ( full body weight ) but can't move forward as the sensitive part is towards the front.

It's weird but when I was younger i just assumed that we all could do that.

Ok...I'm a freak :rolleyes:

Cat

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Hiyya Kaz , hmmmm , well , for me , ssince i have never had a pros. I guess i have no idea about what is the better way but , my residuqal leg is heavily covered with huge sacrs anyway and it is waaaay sensative to teh touch . Actuaally , it is always very sore , sort of like this burning feeling os something ( up to waaaaay over muy knee ) like that aand this is sort of like one huge thing that wworries me when i go in for my revision in jan of 05 . ( insert sound of brain being turn edd off .. not wanting to think abou this right now )

Cat , let me re-say what Kaz sadidied ... OOUUUCCCHHH ..... Sheeesh , i had no idea that you can actually put any weight on the end .

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MEEP at Cat-I could never do that on my stump it'd kill :o I too have the padding which is calf wrapped forward and stitched to shin as most others describe although the tissue didn't knit too well owing to a stupid nurse screwing the stitch removal up in a BIG way after a revision. First of all, tho' my scar was still covered in post surgery scabs, 'orders was orders' so she yanked them all off with the tweazer things to get at the obviously not ready to come out stitches. The revision was s'pposed to remove excess tissue and firm it all up, but the middle (doubled round twice) stitch was s'pposed to stay in longer instead of which she got hold of one end and pulled so hard it tore through my tissue as the loop just got tighter and cut in the harder she pulled 'cos she didn't even realise it had been doubled round :rolleyes: :( I screamed a lot as I recall and was not even surprised when another 2 weeks on at home things felt a bit funny and on closer inspection I noticed the thick BIATCH had actually left a stitch in so I carefully picked the knot undone and it came out painlessly like removing an earring or something. Only last week at rehab I spoke to two other patients who'd had the exact same thing happen, ie stitch left in only neither of them noticed 'til it needed surgery to get 'em out again so glad I noticed mine and removed it when I did.

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Ok.......been looking and found some stuff.

Cat

Surgical Neuromas in Amputation Surgery

by Richard Chambers, M.D.

Whenever a nerve is cut, regrowth of the nerve is attempted by the body. The nerve trunk still attached to the spine (proximal end) sends out nerve fibers in an attempt to repair the interruption. This normal physiologic response to injury produces a swelling at the end of each cut nerve left in the residual limb. These are called "neuromas."

Some of these neuromas become tender to touch. This is more likely if the neuroma forms in an area where it is frequently stimulated by the prosthesis (or other pressure also, Ed.) Symptomatic neuromas are one of the causes of pain in a residual limb after amputation. Other painful limbs are caused by inadequate circulation (claudication) and phantom limb pain. Neuroma pain can be distinguished from those other causes since neuroma pain can usually be reproduced by pressure over a small discrete skin area overlying the neuroma.

Treatment for a symptomatic neuroma includes desensitization, injection, and surgical resection (cutting them out, Ed.) To desensitize a neuroma, rapid and frequent pressure by tapping or rubbing the area may trigger the body to shut down reception of impulses from that nerve. Injection of the neuroma with a steroid preparation may also be helpful in decreasing the painful symptoms. Ultimately, if these methods are ineffective, the nerve should be re-cut and its end positioned to avoid trauma in the future.

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Ah, thanks Cat!

I am getting a sharp tingling sort of feeling more frequently now and it's becoming more unpleasant with time. As i am at work during the week there is no way of me taking my leg off, so i have to discretely ( :o ) bang my leg on the floor to stop it.

I hope this will disappear on it's own...! No more chop chop for me i hope.

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As i am at work during the week there is no way of me taking my leg off

Stuff that Kaz, if I need to take my leg off, it comes off. I do try to not offend the more squeamish of my workmates but my boss wouldn't dare try to stop me getting comfortable.

It's funny you should mention that banging your foot eases the pain as I found the same when the end of the bone starts getting a bit sore (usually time for a new sock). That usually makes people wince more than taking my leg off.

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Hey Guys,

I take my leg off in work sometimes. Usually lunchtime - but occasionally, under the table if I'm working with a group of people. They don't notice if I stay sat down - just look around when I click it back into the socket - looking for the noise!!

My friends and colleagues at work are used to me doing this - if the leg is a bit sore etc.

Went into one of our repair workshops the other day to ask our Engineer for a pair of pliers to tighten the screw on my new liner / pin. He just said take off your leg and I'll do it for you now - his trainees are used to me popping in for bits and pieces - but never for a leg tightening!!! Gave them a good laugh though! :D

Sue - Cardiff - UK

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Hi everyone :D

I have had my right leg amputed since I was 2 years old I am now forty......

I was informed when I was a child, that I would probably have to go into hospital to have the bone at the bottom of my stump shortned. This never happened, and I know now that this is the reason I have been having problems getting a leg to fit comfortably. My stump has always been thin and bones are showing in most areas. But the reason why I can't seem to get a leg to fit is because of the bone at the bottom of my stump. My doctor at DSC is in the process of getting me transferred to another DSC for a 2nd opionion this has now taken 3 months and I am still waiting. His idea was to amputate my stump by another 6" :blink:

I am absolutely petrified at that thought.

I was told by a specialist that saw me in May, that they can use laser treatment now to shorten the bone. Which I think I could stand but to amputate ahhhhh!!!

Surely in this day and age someone somwhere must have some idea that does'nt have to involve going under the knife :(

Take care all

Larry

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I'm with you Larry,

Apart from some very minor revision stuff since I was 5, I've never had anything major done and I'm absloutely terrified at the thought.

Hopefully this turns out ok for you and that someone here knows of new options other than suregery.

Good luck,

Cat

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This is what I was told by my surgeon about neuromas.

If there is a nerve left near the surface of the skin it will develop into a neuroma (as discribed above). He is that nerves should be tucked in towards the bone and muscle. In the unlikely event that I should get a neuroma, it would probably be within the first year.

June

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Hi Larry

I am in the same position as you, and at the moment have put any surgery on hold. One surgeon has suggested trimming the bone about 6 cms (I think) and bringing muscle/tissue from the back of the leg over the front. Apparently I have a neuroma and this would be buried. However another doctor has suggested having tissue/muscle taken from another part of my body and having it grafted over the stump, which would mean the stump wasn't shortened.

Would probably prefer to go for first option but have been advised that a shorter stump will make walking difficult. Got to admit none of it sounds very inviting.

Ann

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Ow OWW and Tripple OOWWWw

What great information and insigt you all have, it is so nice to actually find a place to read about other people's trial and tribulations.

I had trouble with Nueromas in My AKA for years. I lost my leg in a Morotrcycle accident At first my doctors told me that my persistent problems with nueormas were probably because of the traumatic nature of my amputation. Then they changed their tune and told me that it was becaseu of my age. Anyway they talked me into revising my nueromas( and bone spurss) surgically 6 times, and in between just so I could tolerate the pain and my prosthesis they gave me more than 32 nueroma injections over a span of 8 years. I also went through several sockets and soemtimes those adjustment helped sometimes they didn't.

Unfortuanately (or Fortunately) after the sixth time I changed doctors(again) and he baisically said "look these revisions are not helping you".

I stilll have nueormas( Once you cut a neve it will always try to grow back) and yes I can still stimulte them by touch and I still have "strange sensations of my former Instep and foot".

What helps me the most is a cream called Zostix H>P> or the generic cream Capsasin., hot baths,wearign my stumps shrinker, and soemtimes just touching the trigger spots

I think that revsing nueromas CAN help if ttere is a really specific nerve and if hte sureon can place that nerve somewere it will not be oberstimulated by the socket. But if you try it once, pleae think twice about doing it again.

Good Luck to you all,

As usuall it is great communicating with you

Unique no more

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