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Hi everyone.

My name is David and I am facing (like Austin) the option of a right BK amputation. On Feb 7 2006 I had a ladder slide out from under me at work. I had a severe low compound tib/fib fracture. My break was too severe for the doctors here at my local hospital to fix so after 2 surgeries they sent me out the door with an external fixator on and an appointment with a specialist orthopedic surgen in the bigger city down the road an hour away. My orthopedic surgen gave me 3 options -- 1) amputate 2)fuse the entire ankle or 3) put it back together and hope for the best. Being a work injury i opted for 3 -- put it back together and hope for the best. After 2 surgeries he managed to put everything back together but didn't have enough skin to close the wound so i was then shipped off to a specialty hospital in San Francisco for skin graft/flap. Long story short after 4 more surgeries and one failed graft i got to go home 5 weeks after being admited to that hospital. Fast-Forward though 3 months of elevated leg 2 months of PT(physical theropy) a week in the hospital for pulminary embolisims (both lungs full of blood clots) and another 5 months of PT, I am now "healed" and walking around on my own without assistance. I have 2 plates and 15 screws still in my leg and the bones are healed great BUT, my ankle is pretty much destroyed. I have some down flex very little side to side and zero up. I have mild to moderate pain all day long and i take 1-3 Vicodin 5/500 a day but some days i don't take any just depends on my activity level for the day.

The option to amputate is 100% mine at this point but due to recent workmans comp reform here in California i may have to speed up the process due to monitary reasons. I have been given a 45% dissability rating by the insurance company (work comp) but i have NOT been cleared to go back to my job as an electrician. Under the new laws here i receive a state maximum of $230 a week and I am somehow expected to support a family of 4 on this yet I am NOT cleared to go back to work. With the new laws the state will no longer retrain someone that can no longer perform their job due to a work injury. In my case i can receive a "voucher" for $8000 and i have to find a "state certified school" that will retrain me to do a job that may or may not get me actual employment.

I was given the "future option for BK amputation" via the agreed medical examiner so if i do decide to amputate it will be covered by the insurance company. So my 2 options right now are 1) deal with the pain i currently have and try to retrain in a new job and hope i get a job and a first pay check before we lose everything we own OR 2) amputate, recover, get a prosthetic and get my butt back to work to support my family.

I have been doing extensive research on this subject but i really need the insight and wisdom that other amputees have in order to help me. I KNOW that i will amputate ONLY IF workmans comp will pay me my 2/3 salery (what we were getting up till a month ago) while i have the surgery and durring my recovery time and if they cover all my prosthetic wants and needs for life.

I'm the kind of guy who likes to tinker with stuff and i like to try to know EVERYTHING I can about what i'm interested in. So far the feet i like are -- the collage park -- trustep and venture and the ossur proprio foot. But things like sockets -shocks- liners- ect ect i know NOTHING about.

Sorry for being so long winded hehe. :P and many thanks to JonnyV for letting me join this fine forum and I greatly admire all of you and the information that you share in order to help people out. :)

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Hi David & welcome,

Nearly 4 years ago I lost my right leg above the knee; but my left leg posed an even greater concern which is similar to yours. I broken my tib/fib in several places did what sounds like similar nerve damage to you and also had a muscle flap operation (my lat from my back was put in the place where my calf had once been), and multiple grafts. I was in an external fixature for 4 months to hold what bones were left together. Like you i have downward movement side to side but absolutely no upward movement at all. I wear an afo (assisted foot orthosis) brace on this leg to enable me to drive (as my right leg is missing) walk and do all else I am able. To this point I am very glad that they managed to save it. As I said it has been nearly 4 years and while what i affectionally call my "good leg" isn't great I'm exremely glad to still have it.

The decision of amputation is by no means an easy one and I wish you lots of luck. I'm not sure if you have spoken to a prosthesist but that may be the best course of action prior to having surgery. They will also be able to advise you on feet for high medium and or low activity; suction or pin liners and sockets; most of which are generally similar.

Good luck

Mel.

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You have a very big decision ahead of you. Read the replies to Austin and you will see how a few of us succeeded following amputation. It sounds like you're a take charge person who wants to get on with his life. That's what made me decide for amputation. My case was different from yours, but my major reason to go with amputation was to get on with my life, which I have done quite nicely.

Good luck,

Neal

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G'day David and welcome. Hope you can join in the fun that we have here :D

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You have a very big decision ahead of you. Read the replies to Austin and you will see how a few of us succeeded following amputation. It sounds like you're a take charge person who wants to get on with his life. That's what made me decide for amputation. My case was different from yours, but my major reason to go with amputation was to get on with my life, which I have done quite nicely.

Good luck,

Neal

Hi David, welcome to the forum. Neal has said it for me.

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Welcome to the forum, David. Lots of good people here with sound advice. Good luck to you.

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David, I think if we lived closer we could be great buds. I was an electrician for 12 years up until my accident. I went back to school, and I'm now about 4 months away from graduating with a bachelors in electrical engineering. Mama always said work smarter, not harder...

While I'm obviously in no position to give you any sort of advice about your decision, I will say that a big part of me wishes I would have opted for amputation back in 2003 when it was first recommended to me. I'm close to back where I started, but the choices are, I think, clearer this time.

I've met and talked to a few local amputees. One guy gave me an argument in favor of amputating sooner rather than later, which was that the sooner your junk limb comes off, the less severe your phantom pain will be. I hadn't really considered that aspect of it before.

This board is really the best source of info I've found. I found a couple other amputee forums, but none very active. I've been reading threads on here almost non-stop lately.

For me, I've pretty much decided to go ahead with the amputation. I think I'm still trying to find reasons to convince myself to keep my real foot, but it just seems like there's so much to be gained by trading it in for a working model. The Ossur Proprio foot you mentioned seems great. When I read the description of all the motion it has and then think about my own lump-of-rock ankle, it really makes me wish I'd already had the operation & was healed & able to use a foot like the Proprio right now.

I have been given a 45% dissability rating by the insurance company (work comp) but i have NOT been cleared to go back to my job as an electrician. Under the new laws here i receive a state maximum of $230 a week and I am somehow expected to support a family of 4 on this yet I am NOT cleared to go back to work. With the new laws the state will no longer retrain someone that can no longer perform their job due to a work injury. In my case i can receive a "voucher" for $8000 and i have to find a "state certified school" that will retrain me to do a job that may or may not get me actual employment.

Wow, what a bad situation. It doesn't really make sense for the state to say they won't retrain someone down from a work injury. It's California after all... Have you thought about what else you would want to do, or what you would want to retrain for? I'm not sure how far they expect $8k to go...

What kind of electrical work did you do?

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Hi David and welcome.

I had an elective amp in 1977 due to congenital deformities and for me it was absolutely the right decision BUT everybody is different. I am lucky in that I am fairly mobile and the pain that I do have generally comes from the abnormal remainder of my leg and not due to the amputation, I know others have had a different experience.

Good luck whatever you decide to do.

Sue

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Thank you everyone for greetings. :)

This board is really the best source of info I've found. I found a couple other amputee forums, but none very active. I've been reading threads on here almost non-stop lately

I'd have to fully agree. This board has anwsered just about every question I've had come to ponder over my time of contemplating this decision and giving me alot of information that didn't have and never thought to ask. :D Thank you everyone for the wisdom you share here B)

Austin --- I too have pretty much decided that amputation will be my best option, pending workmans comp agrees to pay for my prosthetic wants and needs for life (hehe that's what the lawyer is for though) :P I was lead electrician for a small electrical contractor we mostly did residential work with some commercial/industrial work. Right now my electrical carrer is OVER since it is stated in my workmans comp case that i can not "perform any prolonged standing, walking, squatting, kneeling, negotiating uneven surfaces, running, climbing, jumping or heavy liting-type activities." - hence anything other than sitting on my butt. and that is refering to the condition of my lower extremity. But with an amputation (and good fortune and healing) those limitations go away and i could actually return to my job as an electrician. If for some reason i end up keeping my foot as is, I've thought about becoming a building inspector for the county since county employees get excellent benifits and with a gimpy foot i'm gonna need good insurance. I have worked since 1989 as an electrician but have also worked a few years in the sheetmetal (heat and air) buisness so i have a good knowledge of construction and with the limited retraining funds i'm pretty sure i could become an inspector.

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Hi David,

Welcome to the group. I hope we all can help you the best way we know how! I know you have a tough decision to make, but know we all are here for you..

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Welcome to the forum.. You have a wealth of knowledge with all of the members here.

Anything you might want to know, just ask, I'm sure someone will be able to help. That's part of the reason that we are all here.... to support each other in whatever way we can..

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Hi David. Welcome to the forum. I have not been around a lot lately, but am in that same group of elective amputees. I chose mine three years ago and am so glad I did.

I had a foot that was twisted and non responsive, from a mild form of spina bifida. It kept getting sores and infections and I spent at least a month every year on crutches. Not a fun way to raise four active kids.

I actually had to convince my doc to do the operation. To him I had a healthy foot....twisted but healthy....but it held me back from the life I wanted.

I gave myself plenty of recovery time and plenty of rehab time but was thrilled when I got my first leg. After years of no response from my left side, while walking, I suddenly had energy return coming from my left 'foot'. Very exciting. I have the renegade foot by freedom...love it. It is esp good on slopes, has more side to side movement. I hope to get that mechanical ankle some day, so I can really do slopes and stairs well.

I have very little pain, and all of it is related to my socket not fitting right (fixable) not to phantom pain. I was on strong pain meds for three days before the surgery, to help block those pain signals, hoping it cut down on the phantom pains. I dont know if that did it, but I have never had phantom pains.

I wrote an article specifically for elective amputees. Johnny is going to post it on the thread entitled 'inMotion article'. I sent him the unedited, longer version today, to replace the shorter, edited version he got from the magazine.

If you need any more advice feel free to holler....I love encouraging others, since so many people encouraged me when I was considering this surgery.

Good luck, my friend.

Judy

LBK

NY

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Hi Tiger,

I am not really completely qualified to give you advice on your situation as I lost my leg in the tsunami nearly three years ago and so I never had to make any decisions as to amputation (I am now rbk by the way with a v short stump).

However, from reading your introduction it appears to me that your leg isn't completely irredemable in that you do have some flexion in your ankle. Tell me do you get around without crutches and ok?

All the replies so far have been very positive about having the amputation but can I just play devil's advocate for a minute? It takes a long time to get yourself to the stage where you can just "get up and go" without having to worry about it post amputation. I was only 27 and was fit and healthy before I got hit by the tsunami and it took me 18 months to even be able to walk without a walking stick. Also, it takes a lot of time to get your prosthetic to the stage where it is completely comfortable. Again, it took me about 18 months - and the comfortable socket that I finally managed to get made for myself took 6 months to get to that stage. Also, even with the best most flexible prosthesis, the ankle doesn't have anything like the same flexibility as a natural ankle. When I was reading your description of the flexibility you have in your ankle at present the first thing that came to my mind was that that is pretty much the same level of flexibility I have in my ankle - and that is from quite a high spec foot.

Also, if you don't have a well fitting socket - it can hurt. A lot. At the moment I am in between legs and there are times I find myself almost in tears walking down the road because my socket is just a milimetre out and my liner is "burning" my leg. Of course, other times it fits perfectly and so you don't bother to get the socket adjusted because you generally know that the pain will only last a few days or weeks.

And also, if you really do want the high spec stuff, it is expensive. I note that you mention the ossur propiro foot in your post. That costs a fortune and if you are just an average joe like most of us it really will take some convincing to persuade your insurance company to shell out for one. For example I started running again a few months ago and had to buy my own running leg. It cost a lot of money and I have actually had to stop using it due to the fact that the socket is hurting me too much.

If you elect to have an amputation you will have to face all of these things and you will have to deal with them day in day out for the rest of your life. It is not a barrell of laughs.

Having said that, I have discovered over the past few years that it really is possible to do anything with a prosthetic leg. I took up cycling a year or so ago and in November last year cycled 500km in 6 days from Saigon to Ang Kor Wat, even beating most of the able bodied people in my group. I have been hiking a good few times and have walked long distances, and as I mentioned above I have recently started running again. My next bike ride is going to be from Manchu Piccu in Peru to the Amazon Basin, and I am presently aiming to do a 10Krun soon.

I feel that my amputation has made me a better person and I feel more alive now and more willing to grab every opportunity that I am offered than I ever did before my amputation, and really I can honestly tell you that the feeling of achievement you get when you try new things and realise that you can actually do tham again is absolutely amazing.

In summary (because I have gone on about it long enough now) my advice to you has to be to do what is right for you. If you do choose amputation then you just have to be aware that it isn't a walk in the park, that is a difficult thing to get over physically, and that it is something that will be with you every day for the rest of your life. Also, there is a chance that your mobility will not improve much over the mobility you have at the moment.

However, amputation isn't all disastrous and certainly hasn't been for me, and what I have learned from it is that even in a true legless state, it is still possible to do pretty much anything you put your mind to.

Hope that helps,

Feel free to ask any questions.

Fiona

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Hi Tiger,

I am not really completely qualified to give you advice on your situation as I lost my leg in the tsunami nearly three years ago and so I never had to make any decisions as to amputation (I am now rbk by the way with a v short stump).

However, from reading your introduction it appears to me that your leg isn't completely irredemable in that you do have some flexion in your ankle. Tell me do you get around without crutches and ok?

All the replies so far have been very positive about having the amputation but can I just play devil's advocate for a minute? It takes a long time to get yourself to the stage where you can just "get up and go" without having to worry about it post amputation. I was only 27 and was fit and healthy before I got hit by the tsunami and it took me 18 months to even be able to walk without a walking stick. Also, it takes a lot of time to get your prosthetic to the stage where it is completely comfortable. Again, it took me about 18 months - and the comfortable socket that I finally managed to get made for myself took 6 months to get to that stage. Also, even with the best most flexible prosthesis, the ankle doesn't have anything like the same flexibility as a natural ankle. When I was reading your description of the flexibility you have in your ankle at present the first thing that came to my mind was that that is pretty much the same level of flexibility I have in my ankle - and that is from quite a high spec foot.

Also, if you don't have a well fitting socket - it can hurt. A lot. At the moment I am in between legs and there are times I find myself almost in tears walking down the road because my socket is just a milimetre out and my liner is "burning" my leg. Of course, other times it fits perfectly and so you don't bother to get the socket adjusted because you generally know that the pain will only last a few days or weeks.

And also, if you really do want the high spec stuff, it is expensive. I note that you mention the ossur propiro foot in your post. That costs a fortune and if you are just an average joe like most of us it really will take some convincing to persuade your insurance company to shell out for one. For example I started running again a few months ago and had to buy my own running leg. It cost a lot of money and I have actually had to stop using it due to the fact that the socket is hurting me too much.

If you elect to have an amputation you will have to face all of these things and you will have to deal with them day in day out for the rest of your life. It is not a barrell of laughs.

Having said that, I have discovered over the past few years that it really is possible to do anything with a prosthetic leg. I took up cycling a year or so ago and in November last year cycled 500km in 6 days from Saigon to Ang Kor Wat, even beating most of the able bodied people in my group. I have been hiking a good few times and have walked long distances, and as I mentioned above I have recently started running again. My next bike ride is going to be from Manchu Piccu in Peru to the Amazon Basin, and I am presently aiming to do a 10Krun soon.

I feel that my amputation has made me a better person and I feel more alive now and more willing to grab every opportunity that I am offered than I ever did before my amputation, and really I can honestly tell you that the feeling of achievement you get when you try new things and realise that you can actually do tham again is absolutely amazing.

In summary (because I have gone on about it long enough now) my advice to you has to be to do what is right for you. If you do choose amputation then you just have to be aware that it isn't a walk in the park, that is a difficult thing to get over physically, and that it is something that will be with you every day for the rest of your life. Also, there is a chance that your mobility will not improve much over the mobility you have at the moment.

However, amputation isn't all disastrous and certainly hasn't been for me, and what I have learned from it is that even in a true legless state, it is still possible to do pretty much anything you put your mind to.

Hope that helps,

Feel free to ask any questions.

Fiona

Fiona - I'm the one that quite often plays the roll of "Devils Advocate" so I love it when someone throws it my way :) As of right now I do get up and walk around on my own , I can do stairs without using a handrail, I can walk with ALMOST a normal looking gait if on flat ground. BUT -- I can NOT do any of these things for very long. 30 minutes to maybe an hour before I have to sit down and take a break. I can NOT -- Run, Crouch, Squat, Jump and the big one for me, negotiate uneven surfaces or hills. This is a HUGE factor since I live in the foothills of California and NOTHING here is flat. Parking lots at stores aren't flat and there is no such thing as a sidewalk where i live. Our home is on some acerage in a country setting so my ability to move around on hilly uneven surfaces is a MUST. As is my mobility is only good on FLAT ground and that is for a limited amount of time and with constant pain. In your own words you said your socket hurts you sometimes. Now imagine that pain constantly and your only option to get rid of that pain is to pump yourself full of narcotic pain killers. I am 36 and I have 2 younger children and I can NOT even run after them to play with them, this hurts my heart deeply. You (as devils advocate :P ) say your socket sometimes hurts to the point of tears and your liner burns, I'd gladly take a little pain and some liner burn just the be able to run after my children and play with them, to be able to run with them and play soccer with them on the lawn. TO ME that would be just fabulous :) I consider myself somewhat lucky. I know what it's like to have a good real foot and i know what it's like to have a painful half functioning club on the end of my leg so my decision to amputate is a pretty easy one. I NEVER have to wonder if it was the right thing to do because I KNOW what life is like with a painful club. Unlike soooo many amputees I'm lucky enough to have seen what life is like with( to quote Austin) "a junk foot", so I won't have the mental and psychological aftermath that tramatic amputees have. To me it's like a flat tire, yes your car still rolls with a flat tire but if you drive on it too long your going to destroy the rest of your car, so CHANGE the flat tire and get on with your life . :D

Since my accident happened at work the cost of things is not an issue. Everything is paid for no questions asked. And if my lawyer comes though on his word then "all my prosthetic wants and needs for life" will be paid for. And being an elective amputee I can ask for ERTL procedure right off the bat and hopefully avoid some of the ill effects and complications that occure from amputation. I will also have the time to walk into the offices of potential PC's before my amputation and again hopefully find one that I like and trust. So to me the decision of amputation is a fairly easy decision. My quest is now to make sure I find the right doctors to do the surgery , find a prosthetist that i like and trust and bottom line make sure I get the life time coverage to insure i get a proper fitting leg for life so that I can return to work and the active life style I had before the accident. :D

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As of right now I do get up and walk around on my own , I can do stairs without using a handrail, I can walk with ALMOST a normal looking gait if on flat ground. BUT -- I can NOT do any of these things for very long. 30 minutes to maybe an hour before I have to sit down and take a break. I can NOT -- Run, Crouch, Squat, Jump and the big one for me, negotiate uneven surfaces or hills.

David,

You've just described me to a T. I tried to run a couple weeks ago (I just jogged down my yard)... a mental image of the elephant man came to mind.

The uneven terrain bit is the worst. My back yard is huge and the ground is lumpy. It takes me about 2 to mow, which is why I only do it once a month - I know I won't be able to walk for an entire day afterward. That's a crap way to live. I'm constantly stepping on lumps with my fused ankle, which can easily toss me to the ground. At the very least it keeps throwing my knee out (and I'm pretty sure that's not good either).

I've been looking at the ERTL procedure alot also. There must be some drawback to it, or some reason why it's not done more. I still haven't found out what that is. I've seen people here recommend or caution against it also - still wondering why. Possibly because the weightbearing bridge is like two fusions, so there's a chance they may not take. I have no idea if that's why, but it makes sense.

How close are you to Sacramento? That's where Jan Ertl is listed (go to www.ertlreconstruction.com, click on 'ertl pages' then click on 'ertl surgeons'). Lucky you.

Lucky me, too - there are none listed in WA, but I read one of the amputee stories and he mentioned an ertl doc at the Hanson Foot and Ankle Clinic in Seattle. Very close to me.

Be sure to read all of the stories on the 'ertl amputees' page also. Good stuff there.

I love this picture of an ERTL amputee:

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Guys, I'm not an expert on the Ertl procedure, but those I know who have had it have been pleased with it... and if I were ever to need a revision, I'd at least look into it.

As with any procedure, there seem to be plusses and minuses. The "minuses" I've heard are that, as the bone bridge needs to be strong and well-fused in order for the procedure to work, healing time can take longer (simply because you're waiting for bone to heal, instead of just soft tissue). And Austin, I suppose that there would be some percentage of patients where the bone bridge doesn't form, which would mean revision surgery, so I'd have my bone health evaluated as one of my considerations. Also, I think it's wise to have the procedure done by an Ertl or someone they've personally trained. There are surgeons out there who have created "Ertl-like" procedures... they may be just fine and work well, but I'm just cautious enough that I'd want "the real thing" if I were going through the time and trouble. The people I know who have been operated on by real, live Ertls, say that they are excellent surgeons and have been pleased with the results.

Advantages: Well, you get a sturdier stump, better for weight bearing. There's less possibility of the bones shifting. And, most impressive to me, you retain muscle tone in the calf, which can translate to more strength, more endurance, and less stump shrinkage due to muscle atrophy.

I do gather that most of the information on the Ertl procedure is anecdotal. But I don't think that's a reason to discard it... just be aware that you're likely to hear reports from either the people who have done very well with the procedure or those who have had a serious problem... "It went okay and I'm okay with it" is not likely to make a point of telling the world. I'd add that I've not seen "complaints"... it might be interesting to search and see if there are any out there.

Now... just another bit of information for you fellows to mull over as you make your plans........

Your prosthesis will never feel like a "normal" leg. You may still have problems with activities that require endurance (and/or you may have to really, really work up to it). If you're intent on running, it can be done... but it will be more of a limited-distance jog (such as the annual 5K that is one of the activities at the ACA conference) than a long-distance race, unless you find the "ideal" components or (better) can afford a separate running leg.

Bending at the waist is easy... squatting can take some effort and imagination. Crouching is possible but, again, takes some thinking about until you get it down. Jumping can be problematic. Open ground is quite do-able, but it can take QUITE a while to get used to it. I'm only really starting to feel confident about it now, two-plus years after the fact... but there are amps out there who not only hike, they climb mountains. And the run-of-the-mill prosthesis, especially for a "beginner," is likely to be rather stiff in the ankle... do a LOT of talking and working with your prosthetist to make sure you get the best you can handle on that front.

Less pain and somewhat more flexibility than a fused ankle are real, live advantages and quite likely for you. It was the pain and the daily struggle to determine what my mobility level "for TODAY" was likely to be that tipped me in favor of amputation. I don't regret it... but I wish I'd been as well-educated about it as you two are trying to be!

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Thanks Cheryl.

Thanks for the heads up about "ertl-like" procedures. I've read a few stories about people getting those types of amputations, and my heart really goes out to them. Personally, I despise inept surgeons. I'm not bitter, but I lost two years of my life by going to an inept surgeon and having poorly executed surgeries. I wish I would've known then what I know now, which is to shop and shop and shop until you get the absolute best and most experienced person possible as a surgeon. My days of passive health care are over.

If you happen to come across any negative stories about real ertl reconstructions, I'd love for you to send me a link. So far I've only read positive things.

I think both David and I have forgotten what a normal (right) leg feels like. Even a leg which is "rather stiff" in the ankle would be a huge improvement. As the days are progressing I'm getting more and more impatient to get rid of my foot and get a working leg.

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Hey David and Austin,

OK it looks like you have made your decisions. I am not going to try to play devils advocate again in that case....

Just to say re: the hills and uneven ground thing - after a while you will get good on uneven ground. THe way you describe your fused ankle when you step on a boulder or something David is exactly what it is like with a fake foot. So many times I have been walking along not looking at the ground and suddenly taken a lurch forward or sideways or something like that and it has been because I have stepped on a boulder or a clump of ground sticking up or something and not realised it, but it is not the end of the world and you get used to it.

Re: the hills. London where I lived up until May didn't really have a hill issue because it is relatively flat, but I have now moved to Hong Kong which is built on a mountain. I had an idea that it was going to be a bit hilly before I came but hadn't appreciated just how hilly (yes I am stupid and hadn't even visited before I moved here....!). Anyway, it is very very hilly, and the hills are very very steep so I have really had the chance to put my leg to the hill test. Going up is generally easier than going down - I have managed to develop a way of doing it where I walk on the tiptoes of my foot and the energy return it gives helps propel me up. But you need to be able to control your knee well to do it and I don't know if that would have been possible for me until relatively recently. But going down is still difficult for me. It is not the technique which you just learn that I find difficult but the fact that it just seems to put big strains on all the places on my stump that are the weakest (and the soreest).

Just thought I would give you a heads up. As both of you will be able to pretty much pick your leg length and pick the way you get your surgery done you will be in a much better position than I am, and that should make a massive difference to all of the above.

And re: the ERTL procedure - from what I have read about it it sounds brilliant to me. Keeping the muscle on the stump will make a massive difference in the future as it will mean much less likelihood of needing surgery to "pad' it out again. Also the two places I get the most pain by far from on my leg are the end of the tibia and the fiblua head, and that won't be an issue for you either as they will be fused. That photo you posted Austin is amazing. If it is possible to do that on your stump as a result of the surgery you have then wow. I am getting shivers down my spine even considering trying to do that on my leg.

I would say go for it.

Anyway, good luck with everything and any questions please feel free to ask.

F

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Oh yes David - just one more thing - I am a solicitor and I would advise you to really push your lawyer on his promises re: the insurance paying for you for the rest of your life. Being cynical (and having dealt with insurance companies in my own leg case) it sounds too good to be true to me.

If I were you I would get my lawyer to confirm with the insurance company again and again that this is what they are going to do. Have absolutely all the points that you think may even be slightly relevant covered, even down to things like who will pay for your prosthetic socks, and get a concrete time limit from them. Ask him for advice on why he thinks that that is what is going to happen, and just make sure you have everything written down and all the points you want covered dealt with. And one other thing I would say is to read absolutely every document you are sent down to the last detail and question anything, even the smallest thing.

Sorry I will stop. Good luck,

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Hey David and Austin,

If it is possible to do that on your stump as a result of the surgery you have then wow. I am getting shivers down my spine even considering trying to do that on my leg.

F

I have to say that I am able to do that and it is a great advantage (as I think I have posted elsewhere) - the only problem is that I can't balance for long but that is a balance issue not a weight bearing issue. I must admit until I found this forum it hadn't even occured to me that some amps might not be able to take weight on their stump I just assumed that was normal.

David - I would just re-iterate Fiona's comments about making sure your lawyer gets everything absolutely watertight for the future. Here in the UK we don;t have to worry about cost of prosthesis when making such a decision but I know for you (in the US) it is a major issue and given the high cost of even moderate components (let alone high end ones) you need to be sure that they will always cover what will give you the best quality of life - to include comfort as well as performance. An amp with a good prosthesis and no other issues can do almost anything and that is where you want to be in a year or two. (Regarding running with your children it is fun but embarrassing when you realise that even a 7/8 year old can run faster than you can!!_

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Austin, most forms of amputation will allow a certain degree of weightbearing on the ends of the tibula and fibula once healing is complete, which takes something like a year. At one time, mostly before World War I, nearly all prosthetics bore the weight of the body directly on the bone ends. This was uncomfortable or downright painful for many in the long term, not to mention leading eventually to bone deterioration, and prosthetic design has stressed other suspension strategies ever since. Even the Symes amputation is intended to only provide weightbearing for very limited uses--like Sue says, getting to the bathroom at night. The Ertl bone bridge may indeed be better for weightbearing, but I don't know of any surgeons or prostheticists who would recommend much of this.

Why aren't more Ertl procedures performed? As I mentioned before, over the 80+ years it has been available, no one has really proven it's better. The majority of Ertls are done as revision surgery, with the intent of correcting specific problems caused by poor results from a primary amputation. You can't very well amputate both legs, one by Ertl and the other by another technique and compare the two! There's no easy way to objectively compare techniques. It may be that the problem is that studies performed to date compare results among all amputees, not just the more athletic ones. It might be that among that subgroup the procedure is really superior.

But the main reason you don't see more surgeons doing Ertl amputations, as the Ertls themselves have pointed out, is that many insurance companies do not pay extra for the procedure. It takes about twice as long to perform an Ertl amputation as other techniques, and is considerably more involved, yet the surgeon, staff, and hospital may not be reimbursed more.

Why won't the insurance companies pay more? Well, they say if you want truth seek neither religion nor science, but find a good set of insurance actuarial tables! Insurors have never been able to demonstrate superior results, for them, from the Ertl technique. This is the reason the Ertls are so anxious to get the results from the current comparitive study completed: it would provide justification for a higher level of reimbursement.

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Sue, are an ERTL or a symes, or is there some other procedure that'll allow weightbearing?

I'm a symes - albeit not a typical one due to remaining abnormalities.

Sue

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trwinship, thanks for the explanation. I've seen the prelim study results, i think. Something like 138 out of 143 ertl amputees got a 30/30 on the study's scale.

Sue - it's the abnormalities that keep people from being boring, right?

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I wish you both luck with your decisions and journeys. I was in a car accident in 1994 where my ankle was totally gone and underwent a number of fusions. I was in a lot of pain and not able to do much at all and underwent a RBK amputation in 2003. For me, it was the right decision. Even on my worst days, it is better than it ever was before. I just had my 2nd revision but this one was more so because of extra tissue due to weight loss and some muscle that was hanging down.

Nobody can make this decision for you and all experiences are different and very personal. I wish you both the best.

Take care.

caroln

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