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Jane K

Leg prosthetic options & being short! Input please.

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09/18/2010

Hi:

I'm a new through new amputee (8/13/10) and I'm short 5'1". My leg guy is suggesting a hydraulic knee may fit me better than a electronic "C" type knee. His concern is that the electronic knee would extend about two inches beyond my left - remaining leg. He does point out the hydraulic knee cost is about half the electronic counterpart.

I understand his aesthetic concern, and certainly would like the lesser cost, but I am more concerned about function than looks. I hope to be able to do the activities I once was able to do routinely. Walk, alpine ski, hike and maybe tennis or racket ball. Earning a living, getting groceries, dump runs are also in the desired, although not always as much fun, goals.

Prior to the actual surgery a "Plan A - through knee amputation" and a "Plan B - higher up on the femur amputation" were laid out as options. I understood the Plan A - through knee amputation - would allow me greater strength going forward and seemed the best outcome. I awoke from the surgery relieved that the through the knee option was able to be done. I'm feeling like I'm now being penalized for being short.

I realize that the "more expensive is better" concept may be clouding my view but I really do want the chance to live actively again. I've seen on this site other conversation on the pro and cons for the different equipment but I don't recall height issues being part of the equation. What is done for kids? Can anyone offer input?

Thanks,

Jane

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For me appearance is the last concern. For function I would go with a microprocessor knee. The control you will have over your leg combined with the response of the Micro knees will give the most natural gait possible. I plan on the Plie 2 by freedom innovations. With a standard pyramid adapter it is 9.25 inches high and with a threaded adapter it is 8.75 inches. As long as the build height of the leg can fit under you then I wouldn't worry about it sticking out a few inches beyond your other knee when you sit down. When I get my amp it will be a through knee as well so I know the issues you face for equipment fitting, not everyone makes a knee for disarticulation amps. Even with some of the headaches of the through knee I would take them because the benefits far outweigh the cons. For one your socket top edge can be lower so it doesn't get as "personal" with you as a regular AK socket would. You will have better control and strength over your leg so you will end up with a better gait and have an easier time walking. I would imagine your surgery was easier to recover from as well since no bone was cut. Also those time that you don't have your leg on you will have better mobility options since you can put more weight on the end of your leg. Good luck and let us know how it goes.

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Hi Jane,

Don't believe everything you are told about micro processor knees being the best and only option given the choice.

It's not that simple, each amputee may suit a different knee for all sorts of reasons.

I would say go with the hydraulic knee, the most active amputees don't in fact use micro processor knees, they use hydraulic units as a rule.

With the right hydraulic knee, you will be able to do as much as anyone with an electronic knee if not more, and it will look better.

It's not great sitting down and having one of your knees obviously sticking out much further than the other, and the amount it'll cost you, you just may regret it.

I'd say give the hydraulic knee a go, what have you got to lose?!

There are some very good 4 bar linkage knees that have an extrememly low build height that were designed specifically for through knee amputations. The effective centre of rotation on these devices is above the harware so you get a very natural feeling gait. With the knee too low, as in the case with a conventional single axis knee such as a plie or c-leg on a through knee amputee, the swing of the knee will not feel great, let alone what it looks like.

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Hi Jane,

Don't believe everything you are told about micro processor knees being the best and only option given the choice.

It's not that simple, each amputee may suit a different knee for all sorts of reasons.

I would say go with the hydraulic knee, the most active amputees don't in fact use micro processor knees, they use hydraulic units as a rule.

With the right hydraulic knee, you will be able to do as much as anyone with an electronic knee if not more, and it will look better.

It's not great sitting down and having one of your knees obviously sticking out much further than the other, and the amount it'll cost you, you just may regret it.

I'd say give the hydraulic knee a go, what have you got to lose?!

There are some very good 4 bar linkage knees that have an extrememly low build height that were designed specifically for through knee amputations. The effective centre of rotation on these devices is above the harware so you get a very natural feeling gait. With the knee too low, as in the case with a conventional single axis knee such as a plie or c-leg on a through knee amputee, the swing of the knee will not feel great, let alone what it looks like.

9/19/2010

Thanks very much for your input and help putting the options in perspective.

Especially your comment about what do I have to lose. I came into this world after six years of trying to just hold onto a mangled, painful, unstable knee that my surgeons strongly suggested amputating two years ago. Since the initial surgery mending I'm free of knee pain and I see how easy I've slipped into the mindset the closer I can get to normal the better. (Friends will say I've never been normal but that's another story.)

This site and the folks in it are amazing. Thanks to all.

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First off, I am a below knee amputee, not an ak, but, I am short... (Just ask those who know me. :biggrin: ) There are other ak's on the site that aren't tall either.. Hopefully, they will check in..

The one thing that came to mind for me when reading about your situation is, how familiar is your prosthetist with legs? Some tend to specialize in legs, some in arms/hands. If you ever have any doubts, you can always talk to another prothetist. I questioned my guy many times, until I was satisfied that what he is doing for me is the best for me. I'm not the easiest to find parts that will fit under me, but we ususally find something that will do what I am satisfied with. I haven't been lucky enough to find all the components that I wish for in one foot, but I have a foot for each situation.. i.e. work, the farm, and water. For me, that works...

As time goes on, and you get much more familiar with your leg, you will find that you regain many parts of your life that you thought you may have lost.. Sometimes, it's just getting familiar with your life as it is now. The more time went on, the more I realized, I had gotten back what I thought I had lost. It is differently done, but I do it.. The day that I found myself up on top of a stack of hay at the roof, in our barn, I definetly realized, that I didn't have to worry about if I could get it down to the floor, I just had to plan and implement a little differently...

Talk with him, ask many questions, and look at some of the websites for the knees...you many find many answers there too. Especially what they call "build height". That might help you...

Good luck, and welcome to the forum Jane..

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Hi Jane,

Not wanting to jump on what’s the best knee argument, I just thought that I would share some of my views on the subject.

When I got my first proper leg I was fortunate enough to get the adaptive 2 micro leg made by Endolight, I was over the moon with it, I loved it.

It took me every where, and I did every thing with it no complaints what’s so ever, the only down side was its not waterproof. I went hiking up the mountains with it, shopping, went back to work ECT ECT, basically I got on with my life.

Later on I took part in the testing of the new improved smart adaptive knee, again fantastic no complaints about it performance. Except it wasn’t robust enough for me when I went out into the hills.

A couple of years ago I got a second leg made, this time I was offered the kx06 knee (hydraulic) from the moment I put it on and walked a couple of steps I knew that I was going to do great things with it.

I go walking still up in the hills (there are some post on here, should really try to get some more posted) and get on with my day to day life, the only difference is this knee makes it much more easer.

I had both a brand new smart adaptive and a new kx06 knee for a year and I kept a written record of how each one preformed and how I felt for a year even though I preferred the hydraulic.

I would do the same hike in both knees and despite all the micro knee hype I honestly found that the kx06 was far better (for me).

Last year (at my limb centre) I swapped my micro knee for a kx06 knee that’s how good I feel it is.

On paper the micro knee cost 4 times? As much so it’s not about the more money it cost the better the knee.

So basically what this post is about we are all different and there is no one magic knee that fits all.

Take care ……………..Mick

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Hi, there

I agree with what OBL said about the hydraulic knees. There are some very good ones out there, and with a through-knee amputation (also called a knee disarticulation) you will have more control of your prosthesis than someone with a shorter femur length. I can't tell you much about the four-bar knees except that they do fold up nicely underneath when sitting, but I don't know of anyone who uses one for running. Endolite, Otto Bock and Ossur all make some excellent hydraulic knees that I'm sure you'd do great with. That being said, both the C-leg by Otto Bock and the Plie 2 by Freedom Innovations are available with a special, shorter attachment for knee disarticulates. I'm also on the "short" side, 5'4", but that has not limited my choice of knees. If that is an issue for you and you really want a microprocessor knee, I believe there is an Asian company making one for shorter people....you might ask your prosthetist if he familiar with them.

I've been an AK amputee since age 13 and have worn hydraulic knees for most of life, switching to a C-Leg after my daughter was born (10 years ago) because it offered greater safety/stability when carrying her across the lawn, on inclines, etc., but I always found it to be too controlling for me. Three years ago I switched to a Plie knee which is less controlling but still offers more stability than a standard hydrualic knee. If I were doing any running, I'd probably have a separate leg with hydraulic knee for that and any other higher impact activities as they tend to perform and hold up the best under those circumstances.

If there is any way for you to try a few knees in your prosthetist's office, I'd urge you to do that. Some of the product reps will be happy to bring in demo units. Having never worn a prosthetic leg before, there is no way you can know what is best for your situation, which is where the advice of a good prosthetist comes in. Make sure yours knows you are more concerned with function than looks, and what activities you want to be able to do. PM me if you have any questions you'd like to ask me about my experience with different knees.

Karen :-)

AK

Orlando, FL

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Hi Jane,

My original amputation was a disarticulation but infection caused an AK later about 3.5 inches above the knee. Sitting down with my C-Leg it sticks out about half an inch more than my real knee. There is about that much space that could be taken up inside where the socket meets the bottom of the frame. If I still had a disarticulation the knee would stick out several inches more with the C-Leg. Below is a video of a woman with a disarticulation using an Otto Bock 3R21 knee.

http://www.youtube.com/watch?v=uJk5NO_yc7E

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You know what guys........I didn't know anything about amputations before it actually happened to me. In fact I had never seen an amputee. This is so good for those going through the surgery, etc. I am so proud of the people on this forum for helping others. :smile:

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Hi Jane,

Welcome to the forum! I have a similiar problem and I wish I knew what to say. I am a left hip disarticulation amputee (as of Feb '09) and I am even shorter (4'10)! I have only had my prosthetic since last Dec and have a Otto Bock Helix Hip and C-leg knee setup. With my short stature, they were barely able to fit the hip and knee in the prosthetic and we couldn't use the usual metal piece that would normally go in between the hip and knee to off-set the knee back in line with the rest of the leg. All Otto Bock was able to do was to place a rather wide flat metal plate between the hip and knee instead. The aesthetic problem this caused is that the knee juts out a few inches past the actual prosthetic, which makes it look rather strange, especialy when I have pants on. It looks like I have a mechanical claw for a leg! My prosthetist tried experimenting with moving the knee father back a bit on the metal plate so it wouldn't stick out as much. However, this completely threw off the C-leg's weight alignment and stability and I was falling constantly so we had to move it back where it was.

Of course, this is just a aesthetic issue and function is most important, but it really bugs me!!!! I completely understand how you feel. I am faced with a similiar situation with the possibility of giving up my new Helix Hip that I was so fortunate to be able to have and going back to the conventional, traditional hydraulic hip, which would give me a more streamline prosthetic but I would loss the functionality benefits that the new Helix Hip provides, which is a much smoother and more natural gait with much less "hip hiking". Yes, I also feel like I am being penalized for being short! I eventualy would like to have a cosmesis made for my leg, but that isn't going to be impossibe the way my leg is now with the wide metal plate. I am in the process of having a new socket made right now and my prosthetist is going to try working with Otto Bock to come up with some way to redesign my leg so it is a more natural shape but they are not sure there is much they can do. The Helix Hip is very new and Otto Bock has never faced this situation with someone as short as I am. Best of luck and keep us posted!

-Chrissy

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09/21/10

Thank you all for your responses. As you all stated no one answer fits everyone but you all have given me good ideas to work going forward. I feel a bit less overwhelmed understanding the technology and this new life.

I think I've said it before, and at the risk of repeating myself, this site is amazing! The willingness individuals have shown to lend support, suggestions or a shoulder to lean on is something I've never experienced before. The good nature of people shines here!

Take care all,

Jane

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11/7/2010

11/7/2010

Hi Everyone!

My odyssey in experiencing different knee options continues as do my questions.

For about two weeks I have been using a Otto Bock EBS Pro 3R60. It felt wonderful to be able to stand up on two feet again but I didn't like the fact that once the knee is bent, and weighted, there is no resistance to stop a fall. I tested this point when I tripped in my office and managed to connect with a very solid iron support column that jumped up in my path. A bit more than my pride was bruised but fortunately no bones were broken per the kind folks at our local medical facility.

I realize falling is certainly part of the learning curve and I know more falls will be part on any life but I'm hoping other knee options can work for me.

My leg man did arrange for me to try a Rheo Knee this past Friday but we had no luck. Despite numerous tinkering being short and a through knee amputee combination made this equipment unworkable. The equipment rep. couldn't get enough clearance to stop a toe drag when I walked.

My leg guy had been willing to try this knee because the "build height" noted in the Rheo's literature, (9 1/4) while tight, looked like it should be workable. Unfortunately the "knee center" amount was not. The rep only brought up this "knee center" reference at the end of several hours trying to make the equipment workable. He said this knee center measurement needed 17 or so inches to make the knee workable and I have only 14 +/- inches for spacing. This term is no where I can see in any company info. My leg guy said had not seen this term in the literature either. To hear this requirement at the end of this time was frustrating.

However the afternoon was productive in that I could see how much this knee stuck out beyond my own left knee. I didn't measure it but it was huge and would have to be really considered even if a microprocessor knee came along in the future. As it is my current Otto Bock knee extends about a 1 1/2 beyond my own knee.

I will be talking further tomorrow with my leg guy but I wanted to ask today if my hope to find a hydraulic knee that can allow me to move about and have a knee, when bent & weighted, doesn't give out? Walking about on level ground is great but the world is not level. I know a locking option with the leg extended is possible but I'm hoping to be able to move on uneven ground, go uphill and downhill, without having to resort to a locked out knee. Are my expectations unrealistic?

Thanks for your thoughts!

Jane

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11/7/2010

11/7/2010

Hi Everyone!

My odyssey in experiencing different knee options continues as do my questions.

For about two weeks I have been using a Otto Bock EBS Pro 3R60. It felt wonderful to be able to stand up on two feet again but I didn't like the fact that once the knee is bent, and weighted, there is no resistance to stop a fall. I tested this point when I tripped in my office and managed to connect with a very solid iron support column that jumped up in my path. A bit more than my pride was bruised but fortunately no bones were broken per the kind folks at our local medical facility.

I realize falling is certainly part of the learning curve and I know more falls will be part on any life but I'm hoping other knee options can work for me.

My leg man did arrange for me to try a Rheo Knee this past Friday but we had no luck. Despite numerous tinkering being short and a through knee amputee combination made this equipment unworkable. The equipment rep. couldn't get enough clearance to stop a toe drag when I walked.

My leg guy had been willing to try this knee because the "build height" noted in the Rheo's literature, (9 1/4) while tight, looked like it should be workable. Unfortunately the "knee center" amount was not. The rep only brought up this "knee center" reference at the end of several hours trying to make the equipment workable. He said this knee center measurement needed 17 or so inches to make the knee workable and I have only 14 +/- inches for spacing. This term is no where I can see in any company info. My leg guy said had not seen this term in the literature either. To hear this requirement at the end of this time was frustrating.

However the afternoon was productive in that I could see how much this knee stuck out beyond my own left knee. I didn't measure it but it was huge and would have to be really considered even if a microprocessor knee came along in the future. As it is my current Otto Bock knee extends about a 1 1/2 beyond my own knee.

I will be talking further tomorrow with my leg guy but I wanted to ask today if my hope to find a hydraulic knee that can allow me to move about and have a knee, when bent & weighted, doesn't give out? Walking about on level ground is great but the world is not level. I know a locking option with the leg extended is possible but I'm hoping to be able to move on uneven ground, go uphill and downhill, without having to resort to a locked out knee. Are my expectations unrealistic?

Thanks for your thoughts!

Jane

Hi Jane,

I used a Mauch hydraulic knee for 28 years. It was always difficult going downhill whether it was a ramp or ground decline. After using the Otto Bock Compact and now C-Leg, going downhill is much easier, quicker, and safer. This article states on page 11 that C-Legs can be fitted to knee disarticulation amputees.

http://docs.google.com/viewer?a=v&q=cache:-fJYKRq9KMwJ:www.ottobock.com/cps/rde/xbcr/ob_com_en/im_646a221_gb_product_lin_c-leg_enduser.pdf+disarticulation+C-Leg&hl=en&gl=us&pid=bl&srcid=ADGEESjL0_XsGq7mMYmJ7Jhfg_PL_BAIjnGw5vE5j4n7hhtd_In7rFG_5R5ORwtzTl8zoRSOgYYWrJdakIhP_qN9JZlgl283yH3CxdlrLB4TDo1qsIZO2bFDesqaCqA53arheiiuPxRO&sig=AHIEtbRd10v2hZuLSixUsO1ju42di-uBiQ

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Hello Jane,

I to have the Ottobock 3r60. I to had great concerns at the first with the knee having no stability. I had my prost man tighten it up to not bend as quickly and easily. He also moved it back on the socket and made the knee point to the outside. now saying this, Yes i was what we in the U.S. call "knocked Kneed", but i was not "smelling the carpet" and have not since. Now saying this i worked on balance and strengthing my limb in this time as i am also a kd amputee. now being @a month later, i am slowly letting the knee bend more by getting adjustments and we have set the unit back aligned. i see now that it just took time to get use to and to trust it. The knee you have is a great knee, and you can get to where you don't fall as much. Like my husband told me,he has two natural legs and he still falls atleast twice a yr. so if we fall we fall, its gonna happen. I have been now told that i am over powering the leg so i need to have it adjusted out. Yes im still scared sometimes, i wonder about falling all the time and i have to be more aware of my leg, but this knee has proved to be solid, adjust to my gait, and will allow me in time to do great things, I just have to trust in myself and work hard. and in the end i know I am doing this and it is all me and my muscles not a microproser. not to knock them but i do wonder if one tears up and that is all your use to what happens when you have to fall back on a hydr. knee and your not able to control it.. just a thought. sorry so long,but all im trying to say is give it time, and i know your worries i to cried and thought id made a mistake with this knee, but now all i see is moving forward. it will happen and it does take time. My thoughts are with you and take care.. questions just ask. i have had mine now for three months and learned alot...AKNURSE

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Hi Everyone,

Happy Bird Day to all those in the US!

After multiple attempts I think I've finally found a knee component that works for me. The third knee,Plie 2 by Freedom Innovations, just didn't quite fit me. I also now understand what Karen described at "too controlling". Before I experienced this knee for myself I thought "controlling" would be good. The overall not quite right fit, not being able to have the knee free swing, or lock straight if desired, caused me to ask for yet another knee.

I've been using the KX06 by Endolight for about a week and so far so good! No falls and no foot catch while walking. Having some resistance when the knee is pressured is wonderful. And this knee is able to free swing or lock straight with just a small adjustment. It is a bit heavier compared to the other knees but the positive points far exceed that issue. The fact the it is roughly half the cost of the electronic knees isn't too bad either.

I'm very thankful I was able to try different knees to experience first hand the different technologies. As well said by Karen, Mick and others in earlier responses no one shoe fits everyone. I encourage anyone new to this life to ask for trail tests runs.

If only I could just get out of my head my dear big brothers comment that he could use the knee to jack up his car if he had a flat. Gotta love siblings!

Thanks to everyone for their thoughts.

Jane

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Hi Everyone,

Happy Bird Day to all those in the US!

After multiple attempts I think I've finally found a knee component that works for me. The third knee,Plie 2 by Freedom Innovations, just didn't quite fit me. I also now understand what Karen described at "too controlling". Before I experienced this knee for myself I thought "controlling" would be good. The overall not quite right fit, not being able to have the knee free swing, or lock straight if desired, caused me to ask for yet another knee.

I've been using the KX06 by Endolight for about a week and so far so good! No falls and no foot catch while walking. Having some resistance when the knee is pressured is wonderful. And this knee is able to free swing or lock straight with just a small adjustment. It is a bit heavier compared to the other knees but the positive points far exceed that issue. The fact the it is roughly half the cost of the electronic knees isn't too bad either.

I'm very thankful I was able to try different knees to experience first hand the different technologies. As well said by Karen, Mick and others in earlier responses no one shoe fits everyone. I encourage anyone new to this life to ask for trail tests runs.

If only I could just get out of my head my dear big brothers comment that he could use the knee to jack up his car if he had a flat. Gotta love siblings!

Thanks to everyone for their thoughts.

Jane

Excellent news Jane, great to hear, thanks for letting us know.

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Hi Jane,

Pleased things are working out for you with the kxo6 , :biggrin: have you had a play around with the Extension & flexion to “fine “ tune the leg to suit your needs when wearing different footwear yet? .

Only you know what feels right, I often speak to people with this knee and they never alter the settings which is a great waist of this facility. A little twist of the settings can make a huge difference on how the knee responds.

Take care ……………..Mick

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11/27/2010

Hi Mick:

I haven't yet played with settings but I definitely plan to learn the different options available. The very fact options are available is what made this knee appealing to me.

My original knee, an Ottobach 3R360 pro(I think I've got the name right) is fantastic in its lightness but can't give any resistance when the knee is pressured and can't be locked out for safety. For me those two features are very important for safety. The lack of these options in my own knee drove me down this path.

Mick - any points you can offer will be much appreciated. I know enough to know I don't know what to ask - yet! Once I do know more I probably won't need to ask but since I'm not there yet please offer what advise you can.

I've been thinking over the weekend of asking the manufactures if they have considered a lighter version of the current model. I realize many of those needing their knee components come about via military conflicts - and are more than likely 5' 8" +/- or so but would a slimmer model be an option? I hate to admit it to my brother but the knee does really resemble a car jack. I'm not against the look as I'm not sure I quite need all its sturdiness and girth. A scalded down model might work for my size. Worth asking. In the mean time any points Mick or anyone else can offer would me appreciated!

Thanks,

Jane

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Hi Jane,

AS I have stated time and time again I am certainly no expert on this limbless business and normally do things that I probably shouldn’t but I do think the only way to learn about walking / getting on with a new leg set up is to get out there and try. And I am not talking about a few steps up and down some room with your leg guy / lady watching.

I am on about going somewhere outside with lots of space, and simply walking just for the sheer fun of it. (Try short grass as it doesn’t hurt so much if you take a tumble)

Adjust the settings on the limb from say 6 to 7 (on the flexion) then walk a bit more till you get use to the “feeling” then wind it up a bit more , sooner or later you will come to a setting that feels right for you.

Try it with different footwear, I have mine set on 7 for trainers, if I want to walk faster I wind it up to 8

When I am out hiking in boots I wind it up to 9

If I am hiking through long grass or heather or jumping across small ditches ECT I wind it up to max .like wise if I am trying to jog or run I have it wound up to max.

On the Extension setting I have mine set to around 2 to 3 (I don’t tend to adjust this much).

Try to walk on different surfaces: - Grass, mud, sand, man made surfaces, snow and ice; all will give a different “feed back” and feel slightly different, a lot of this can be compensated for by a little bit by adjusting of the settings…………….. Try it

Walking down hill, I guess every one has there own technique or system I have several all depending on how steep it is , and the surface conditions , again I have learnt this myself simply by going out and trying different techniques , some work some don’t , the ones that don’t work normally means a trip to the floor ,

Whilst I am on about hitting the floor, I have over the last few years found that the fear of falling in far worse than the actual fall (if that makes sense). alough I must say on normal day to day activities I haven’t taken a fall for years now , but its not uncommon for me to take a tumble when out hiking especially when walking through long undergrowth ect , but then many normal people take a tumble when out in the wilds .

I guess what I am trying to say, it up to you. How much or how far you develop with this leg is down to you , so practice ,practice and practice some more . The more you put in the more rewards you will get out.

No one said it would be easy , when I first started I kept a written log , of how far , how fast (time wise ) what I felt like at the time and then when I was having a bad day I would read back and see how far I had progressed and things wouldn’t seem as bad .

I don’t know what info you got with your kxo6 knee but I have got a couple of small documents with info about them (settings, part no, setting the leg up for you ECT) which I will gladly send you if you require them. (Send me a pm if you do with an e mail address).

The weight issue , being a big overweight type myself , I haven’t noticed any extra weight but it might be you need time to get use to it , but again I could be wrong on this (I normally am ) .and I wish you good luck in trying to get the makers to produce a lighter version .

AS an older male I don’t really worry about how the leg looks, (I don’t have it covered) & if people have a problem with how I look its there problem not mine but as a women and all the pressures that society puts on you it must be much harder. You have my sympathies. We as humans can be very shallow at times.

I am more concerned with how it (the leg) and I perform together. And picking up the pieces and getting on with my life.

Perhaps not the best advice you can get, but it’s all I got, other on this site are so much better / experienced than me.

So to sum it all up if you want to get on with your life with this leg you need to practice and make it do what you want it to do (within reason) and don’t let anybody tell you different .

Phew must stop now blister on typing finger.

Take care ………………Mick

Any more? Please ask.

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