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B/K Total Surface Bearing Sockets .... are there still other options?

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Just really want to get other peoples opinions on this and see what options others are being given around the world for socket design.

Have been a b/k for many years, though over the past few years I have had increasing problems getting a well fitting b/k leg here in the UK. Back in the day, most of us b/k's used PTB's and I didn't used to experience the problems I am now.

What seems to happen is, when I get a new socket, if it fits, I wear it for a very short time and then the knee area doesn't seem to support me and I end up bottoming out of the socket which causes problems. So for quite a while now I have semi-managed with a too big socket with loads of socks, half socks etc., to try and keep me off the end. Its also now being noticed that there is much more atrophy. I have taken advice on this and know that one option is to have the stump revised, however, other advice is that I don't need to have this done and it should be accommodated prosthetically, though months are now turning into years and I don't seem to be able to get this problem sorted out and all the time my mobility is decreasing.

Am currently in the process of another socket attempt (lost number of the amount of these I have had) and from what I have learned it seems to be that b/k sockets and liners are now all designed to be Total Surface Bearing, which apparently includes the end of the stump ...... so am beginning to see that the problems I am experiencing are maybe to do with the type of socket design that I have. Although what I am picking up on is that there are really no options on this and am learning that other B/K's are having similar problems.

So what I am asking you good folks on here is, if you are a B/K, is whereabouts in the world are you, and what design of socket/liner are you using and whether this works for you, as I can't believe there are not other options open to BK's here in the UK.

Ann

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I live in the US and have only been a left BKA for 3 1/2 years. Although the trend may be toward TSB sockets a good prosthetist should be able to make you a PTB, or any other type you know of and would be successful in. I don't believe that TSB sockets include weight bearing on the end of the stump unless you have an Ertl procedure done. There should be minimal room at the bottom and maybe just touching of soft tissue but no weight bearing on the ends of the bones. If you are sliding down into your socket too far then the socket doesn't fit you correctly. I wear a passive suction with the 5 ring seal in liner by Ossur. I love it and I don't bear any weight on the end of my stump. Can you go to someone else who might listen better to what you are saying?

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Thanks Kathy,

Its a difficult one, as I am not living in the US and the input I have access too regards prosthetics is limited, though am talking to them about my need for more specialist or alternative input. The system here doesn't really cater for this so I am again pushing boundaries a bit.

I haven't tried a seal in liner, though have seen others using them, I haven't been using a liner at all, a liner on this leg is a new venture for me, they trying a new sort of polyurethane liner which is slightly shaped.

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Ann, we've "talked" about my latest leg, with its vacuum-assisted suspension. That leg was a long time getting fitted properly, and my liner was a major part of the problem. I've always worn a liner and I generally like the way they feel...but it took having a fully customized liner made specifically for me in order to keep the base of my stump from becoming sore and irritated and the vacuum pump from "eating me alive."

Does the onset of your fit issues seem to align with the onset of your wearing a liner? If there's a relationship there, it could be something as little as an air pocket inside the liner that's "pushing" on the end of your stump. In that case, a custom-fit liner could be your answer.

I do actually feel the base of my stump against the floor of my socket, but it's not a genuine case of bearing weight there...more just a slight awareness of "where the socket truly ends" that gives me a much better sense of control over the prosthesis than any of my previous pin-lock legs ever did.

I do agree with Kathy...if you've had success with PTB sockets in the past, and there's not any sort of medical reason why you shouldn't be wearing one now, I would think that a trained prosthetist would be able to build one that would work for you. You may just have to really, really push those boundaries in order to get someone to take the time to do something "other than the current standard." You've been through such a long battle here...I really hope they can get it sorted soon!

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I'm in California and I've been a LBK for a little over four years. I've had about seven different sockets. None of them feel very good and downright bad at times. I just received a new one today. Yet another prosthetist. This guys says and does things that the other have not. Things like flexing, muscle memory etc. This socket has aggressive contours to support me in different ways than the others. I am very active: hiking, mt. biking, on my feet at work all day long. He said my other sockets are "straight sockets". I am, and have been in a pin system for the duration. They are all hesitant to put me in suction or vacuum for some reason. I don't wear a sleave either.

Right now, I am in a lot of pain. The pressure is unbearable, no matter how many or few ply I wear. He told me to wear it two hours on and two hours off. (a first for me). I've been doing this since 11:00 AM when i brought it home. He put a crappy, used foot on it as well. He didn't want to tear down my current everyday leg so i could wear that one to work while breaking in to the new socket. I've been told that this guy knows what he's doing with atheletic amputees. By the way if feels, I just want to throw it in the garbage and put my old ill fitting one on.

Does anyone know who the best prosthetist in Californina is? I've been through four now. I'm gonna get black balled! I connect with each and everyone of them personally, but I can't get a good fit!!! So frustrating, and painful. What do I do?!

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I hesitate to say this, because it's going to both frustrate you and sound like a "cop out," but the "best prosthetist" is the one who can fit you properly...it can change radically from person to person. Now, that said, there are some questions you can ask and some research you can do to try and improve your chances of meeting up with that "best prosthetist."

When you're meeting a prospective prosthetist, have you asked them about their education and experience? They really should be a certified prosthetist, they should be doing continuing education to keep up to date with current developments in the industry, and they should have a significant amount of experience successfully fitting people like you — same type and level of amp, similar activity levels, same physical condition, etc...

They should also be willing to explain what, how, and why they are doing what they're doing in the construction of your leg and how it will benefit you. For example, they should be ready and willing to tell you why they are "reluctant" to put you into anything other than a pin-lock system. (It could be as simple as the fact that a pin-lock is extremely unlikely to fall off under high activity...or you could still be shrinking, odd as that would be after four years, and a pin-lock is more forgiving with a changing limb. What ever it is, you should be able to get an explanation that makes sense to you.)

If you've done all of that and it still seems like they are being forthright with you, then you may have to look at how you are approaching your fittings. Can you explain to them, clearly and in great detail, exactly how your prosthesis is painful and under what circumstances it hurts? Can you point out the painful spots? Does it hurt constantly, or only when doing a certain activity? Does it hurt when you sit? When you're standing still? Only if you're walking up or down an incline? When you're biking? The more specific and "picky" you can be, they more clues you provide for them to try and fix the issue.

I once got really fed up with going to prosthesis fittings (I was still shrinking rapidly and I was going through a LOT of fittings), along with a number of other issues, and I just basically gave up and sat like a bump on a log with a sort of "YOU'RE the professional...YOU make it work for me" attitude. The result was the worst-fitting leg I've ever had. After several more visits attempting to "fix" the leg, again with next-to-no input from me, the technician got frustrated enough to demand, "What's UP with you, anyway? WHY aren't you talking to me?" And once I did start talking, we were able to work out a fix for the leg.

That "two hours on/two hours off" break-in routine actually is a good idea if the socket construction is truly radically different from your past legs...the "crappy used foot" sounds like it's just a lousy (and I hope a temporary) compromise...could the foot be part of the pain issue? If you can even "practice" explaining your pain situation to us here, perhaps someone will have either a solution or be able to suggest ways to better communicate the situation. Do hang in there...you deserve to have a leg that can stand up to your activity level!

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I just wrote a very long post using your suggestions. I tried to post a photo of the two sockets for comparison and lost my response. Is there place where drafts are stored?

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These photos represent the difference in sockets. Left is the current everyday socket. Right is the brand new one.

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Oooohhh...I'm not seeing the posted photos. I've always brought in photos or other data by using the "Image" or "link" buttons to post the URLs of data that I've stored somewhere online...I've never had any luck, with any of our software over the years, in trying to copy and insert anything from my own computer. Do you have your socket pics on anything like Photobucket or Shutterfly? That might be more workable for you. Please try again...it could be really helpful!

I'll have actually check with someone in tech support on the existence of any sort of cache for drafts.........I normally just scream and bang my head if I've not typed my posts in a word processing program, saved them, and then copied and pasted into the Reply text window................. :blink:

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It is normal that an initial socket (when you first became an amputee) and a socket made after you've been an amputee for 4 years and your limb has stabilized to look completely different. As your limb atrophies and shrinks the shape changes from round to more angular and the socket usually looks more triangular inside as well as having contours specific to your limb. It should not hurt as it is made to fit you exactly. If your pain is point specific then the socket needs to be modified at that spot. If the pain is in the entire limb and excruciating after about 30-45 minutes it is possible that it is pressing on the popliteal artery behind your knee and cutting off the blood supply to your limb. That usually means that the distance from the front to back of your socket is too short. A socket for an active person is made to fit snugly but it doesn't take much to make it too snug. Cheryl is right that you have to really be able to describe what you are feeling for a prosthetist to be able to fix it. I am also a physical therapist and 2 hours on and 2 hours off is typical for breaking in a new brace or leg but if you're not tolerating it significantly better after a couple of days then there is a problem and the socket needs to be modified or re-made. Don't sign anything until your leg is wearable.

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I am a BK amputee. I want to turn my suction socket into a vacuum suspension socket. I drilled a hole in the bottom of my socket to accept a small plastic elbow which I bonded into place On to the end of the elbow I fitted a 1/4" diameter plastic tube, the other end of the tube I fitted a inline one way valve, on the other end of the valve I connected it to hand held vacuum pump. donned on my socket, sealed it to my thigh with the silicon sleeve. and proceeded to pump the vacuum which I achieved. the trouble is that when I disconnected the pump I immediately lost the vacuum! Can anyone please tell me what i am doing wrong. or do I need a special type of valve

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Hey, Frank.

I'm something of a DIYer with prosthetics myself. We seem to be a rare breed. Prothetists (for understandable reasons) strongly discourage home made "improvements," but I think cautious and thoughtful modifications have their place. You can see some ideas of like-minded folks here

Any kind of vacuum is sure to suffer some slow leaks at best, so if you're going to use a vacuum pump of some kind, it's going to need to stay on. If it uses a squeezable bulb, perhaps it can hang on your belt, or the tubing could be threaded through a small hole in your pants pocket. But in terms of your specific question, I'd guess your one-way valve might not be fully functional (or reversed?), or tubing gets worked lose when you remove the pump.

When my current ill-fitting prosthesis becomes a spare, I have some thoughts of experimenting with it. I have a small 12 volt vacuum pump, and I think I can mount it on the prosthesis with 8 rechargeable AA batteries.

Meanwhile, if adjusting the fit inside the socket is part of the goal, you might benefit from these handy, inexpensive silicone pads (repurposed from original intent). For me, they've made a dramatic improvement in fit.

Steve

I am a BK amputee. I want to turn my suction socket into a vacuum suspension socket. I drilled a hole in the bottom of my socket to accept a small plastic elbow which I bonded into place On to the end of the elbow I fitted a 1/4" diameter plastic tube, the other end of the tube I fitted a inline one way valve, on the other end of the valve I connected it to hand held vacuum pump. donned on my socket, sealed it to my thigh with the silicon sleeve. and proceeded to pump the vacuum which I achieved. the trouble is that when I disconnected the pump I immediately lost the vacuum! Can anyone please tell me what i am doing wrong. or do I need a special type of valve

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I have not been on here for quite a long time but have some good news on new technology that I am now using

If you haven't heard of the EMS socket system, you will soon. I was the 2nd to receive this new inner socketry. First being a 40 year amputee BK and me being a 5 year amputee AK. Think of a golf ball and envision what the cover of a golf ball would look like inside out. Think dimple out or raised dimples. Your cast the same but the end result is a pliable socket thousands of "raised" dimples (oxymoron I know). Once my leg doc receives this piece from the manufacturer I am cast again while wearing it. When I came back the next time the socket is complete and in one piece.

The inner socket is epoxied inside the carbon socket. I also use a proprietary pump system.

Here is what is so cool about this new socket: The thousand of raised areas create a larger surface mass, 60% larger mass to be exact. Now I have a much larger area holding vacuum on my stump liner. The raised area also acts in a gripping fashion and the combination creates hold that I have never felt before.

There are now about 15 of us on the globe with this new tech. They are designed by an amputee business associate of my leg doc and are now being made by Otto Bock

I'm about 5 months in and the socket feels more part of me and the vacuum hold is amazing

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You mean my one-year-old "high tech" vacuum socket is already outdated?? (Sounds like buying a computer...if you can purchase it, it's already obsolete!) Seriously, that sounds like a fabulous idea, Capt.! Maybe by the time Otto Bock makes it back to my part of the country to demonstrate this one, I'll be ready for a new socket........? :cool:

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If it works for you, who cares right. This is just the NEXT step of technology simply using the materials that are already available and making something better (for vac patients). I was the second one to receive this and the first is another highly active AKA that is also a long time member here.

I guess I am just a bit spoiled by who my leg doc is and his proximity and relationship with the inventor/manufacturer. I can see many people that either have, or may have vacuum in the future really liking this, especially those that are very active. The new liner is also made with a one way hole/escape route for perspiration to then make its way out of the pump tube at the shoe level. Could make for some smelly sneakers!!!

I am also testing the new Rush foot as I am up for a new one. Talked to some folks that have on and they really like it for ramps (me at the airport) and its lack of dead spots. Everyone's mileage is a bit different so i will see for myself. I really like my Soleus but there is a dead spot that I feel makes me spend too much energy as it does give me the toe off I am looking for.

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If it works for you, who cares right. This is just the NEXT step of technology simply using the materials that are already available and making something better (for vac patients). I was the second one to receive this and the first is another highly active AKA that is also a long time member here.

I guess I am just a bit spoiled by who my leg doc is and his proximity and relationship with the inventor/manufacturer. I can see many people that either have, or may have vacuum in the future really liking this, especially those that are very active. The new liner is also made with a one way hole/escape route for perspiration to then make its way out of the pump tube at the shoe level. Could make for some smelly sneakers!!!

I am also testing the new Rush foot as I am up for a new one. Talked to some folks that have on and they really like it for ramps (me at the airport) and its lack of dead spots. Everyone's mileage is a bit different so i will see for myself. I really like my Soleus but there is a dead spot that I feel makes me spend too much energy as it does give me the toe off I am looking for.

How you like the rush foot.

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Hi Ann, I am UK based, It doesn't make sense that your socket doesn't fit right; it should be tight enough just under the knee to stop you dropping too far down and remain comfortable. I have been a BK for 30 years, ran in the 1992 Paralympics and I make a lot of my own adjustments. All BK sockets are patella tendon bearing to some extent but total fit all around is best for long term comfort. I currently have a silicon sock next to the skin, with a sleeve over the top. I'll be drilling a hole in the bottom of the socket to fit a one way valve for a, hopefully, tighter fit. I have an original shaped Flex-Foot fitted under the socket - new ones (along with most new designs) are over-engineered in my opinion. If I were you I would definitely go private and I would recommend Bob Watts at Dorset Orthopaedic, http://www.dorset-ortho.com/contact/I'm not sponsored by them so no financial motive on my part, and I know what I want from the NHS. Being based in the North East I live too far away from Dorset, but when I was a Paralympic athlete I worked with Bob and he is excellent, and I know people who use him now. I would definitely give Dorset Orthopaedic a ring.

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If it works for you, who cares right. This is just the NEXT step of technology simply using the materials that are already available and making something better (for vac patients). I was the second one to receive this and the first is another highly active AKA that is also a long time member here.

I guess I am just a bit spoiled by who my leg doc is and his proximity and relationship with the inventor/manufacturer. I can see many people that either have, or may have vacuum in the future really liking this, especially those that are very active. The new liner is also made with a one way hole/escape route for perspiration to then make its way out of the pump tube at the shoe level. Could make for some smelly sneakers!!!

I am also testing the new Rush foot as I am up for a new one. Talked to some folks that have on and they really like it for ramps (me at the airport) and its lack of dead spots. Everyone's mileage is a bit different so i will see for myself. I really like my Soleus but there is a dead spot that I feel makes me spend too much energy as it does give me the toe off I am looking for.

How you like the rush foot.

Hi Ann, I am UK based, It doesn't make sense that your socket doesn't fit right; it should be tight enough just under the knee to stop you dropping too far down and remain comfortable. I have been a BK for 30 years, ran in the 1992 Paralympics and I make a lot of my own adjustments. All BK sockets are patella tendon bearing to some extent but total fit all around is best for long term comfort. I currently have a silicon sock next to the skin, with a sleeve over the top. I'll be drilling a hole in the bottom of the socket to fit a one way valve for a, hopefully, tighter fit. I have an original shaped Flex-Foot fitted under the socket - new ones (along with most new designs) are over-engineered in my opinion. If I were you I would definitely go private and I would recommend Bob Watts at Dorset Orthopaedic, http://www.dorset-ortho.com/contact/I'm not sponsored by them so no financial motive on my part, and I know what I want from the NHS. Being based in the North East I live too far away from Dorset, but when I was a Paralympic athlete I worked with Bob and he is excellent, and I know people who use him now. I would definitely give Dorset Orthopaedic a ring.

I love the Rush foot! I have had many diff feet, the simplicity of the foot and the way it moves with me is awesome! It is a softer foot than what I am used to, but that takes the pressure off my stump. It does everything the most sophisticated feet do, but with out the weight and the probability of anything breaking.

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