Prostheses Give Alabama Native the Right Fit
September 2017 Issue
When James Leath met with his physician this summer, he had one request.
"I said I wish I could find a new prosthetist," says Leath, who was born 43 years ago in Albertville, Alabama, with neurofibromatosis, a genetic disorder that causes tumors to form in the brain, spinal cord, and nerves. His older sister also has the disorder and their mother died from complications of neurofibromatosis in 2012.
Leath says that although he has had to have fatty tumors removed throughout much of his life, complications from the disease have grown progressively worse in the last 12 years. "I've had tumors taken off all over my body," Leath says of his chronic disorder. "When I have one tumor removed, it seems like 25 more grow back."
Tumors can grow under the skin as well as above and can be painful. Leath had a large tumor removed from his left ankle in 1993. However, it never properly healed. "It was constantly infected," he remembers.
Due to the recurrent infection, and on his physician's recommendation, Leath had a transtibial amputation in August 2003. Eight years later, he had a transtibial amputation on his right leg following more complications from neurofibromatosis tumors.
A New, Fast Start
Shortly after the appointment with his physician this June, Leath got his wish when he met Brad Hilliker, CP, LPO, at Crosswalk Prosthetics, Priceville, Alabama. The appointment occurred at Leath's home, which is common for Hilliker, who sees most patients during house calls or rehabilitation visits. Almost from that first visit, Hilliker began taking steps to make Leath's life better when it came to his prostheses.
Within weeks, Hilliker had Leath preparing for new feet and leg prostheses.
"James comes from a traditional hard carbon socket with carbon K3 energy storing feet," says Hilliker, a former physical therapist, who became a certified prosthetist in 2000. "While functional for most patients, this was a poor choice for James because his medical condition results in frequent extreme volume changes. A lot of times James was unable to successfully don his prostheses."
One of the first things Hilliker did was fit Leath with the WillowWood Pathfinder feet. "They are an older shock-absorbing foot design with an air-adjustable shock absorber in the heel," Hilliker says. "They are highly user adjustable allowing for a varying amount of cushioning in the heel."
Hilliker says Crosswalk Prosthetics offers quite a few types of prosthetic feet. "I try to provide each patient with what I think will work best for that individual," he says. "For James, having the ability to increase or reduce the amount of impact absorption seemed necessary based on the frequency of his flare-ups."
Leath gives the Pathfinder a thumbs up. "So far, he indicates they are the best feet he's used in his roughly ten years of prosthetic use," Hilliker says. "He has adjusted the air pressure to accommodate his activities and has had no complications."
"I like the Pathfinder," Leath says. "It makes me feel more stable."
iFit, the Perfect Fit
While getting the Pathfinder feet, Leath was fitted simultaneously with the iFit prostheses. As soon as Leath tried his first set of iFit prostheses, it was almost a perfect fit, Hilliker says. "James was certainly eager to give it a try," he says. "And it's been off to the races for him since."
Leath says what he likes about the iFit, with straps that adjust like a ski boot, has been the amount of time he's been able to wear his prostheses throughout the day. "Before, I'd never be able to keep them on a long time because they would get too uncomfortable."
Now that Leath can tighten or loosen the iFit straps as needed, he has been able to wear his prostheses as long as he chooses to. "You can get them as tight as you think you need them to be, or as loose as they need to be," Leath says. "I had family here the other night and it was eight o'clock and they couldn't believe I still had them on."
Josh Mullins, vice president of business development for iFit Prosthetics, Pewaukee, Wisconsin, says the iFit is ideal for someone like Leath given the volume fluctuation he has in his residual limbs. "He has the ability to adjust the buckles as needed throughout the day as he has changes," Mullins says. "He doesn't need to continually add socks, he can just adjust the buckle and go. The padded neoprene inner liner provides a high level of comfort that is also customizable to protect sensitive areas."
In addressing the challenge Leath faces in residual limb volume shrinkage, Hilliker says that years ago, patients were issued thin socks and would stack those one after the other. "In the last 30 years or so, someone smarter than me realized it would be easier for patients to manage less sock if they were thicker," he says. "General uniformity has been agreed upon and socks are usually issued to patients in one-ply, three-ply and five-ply. And patients stack these socks as necessary to achieve a good and intimate fit."
A fit is often considered reasonable if the patient wears no more than 12-ply socks, Hilliker says. "Anything beyond 12- to 15-ply and the socket fit loses its intimately designed shape and the limb becomes what I affectionately call a ‘sausage' shape with little rotational control. Being able to adjust in a range of 35 or so ply is extraordinary."
That is what the iFit prostheses has done for Leath, who regularly experiences that level of volume change. "Use of the iFit for James lets me compensate for what seems to be about 35-ply," Hilliker says.
"Normally I would have fit multiple, removable socket liners such as Pelite, or a flexible plastic such as Proflex for James," he says.
Hilliker says Leath attempted to manage the extreme fluctuation in volume with shrinkers, "but nothing manages fluid like the pumping action of prosthetic use," he says. "Wearing vacuum or suction will control normal volume loss, but not the significant fluid changes that James experiences with his condition."
Easier on the Pocketbook
Bladder style sockets, which have been in the marketplace for years, attempt to compensate for the volume changes by having an air bladder or silicone bladder that can be adjusted to squeeze the residual limb tighter or looser depending on the need, Hilliker says. "Other than old bladder-style sockets, I have never had the ability to manage a patient's volume to this degree. For James' condition or dialysis patients, the iFit makes volume management a snap."
Bladder-style sockets are also complicated to fabricate and typically bill to insurance at a higher rate due to their complexity, Hilliker says. The iFit, Hilliker says, bills out less than a traditional socket after all codes are included. "It saves the insurance and payers money," he says.
Hilliker says the iFit socket also saves time because it can usually be fitted and adjusted for the patient in one session. "In my office, we then create a custom-molded liner and fit that to the patient," he says.
Leath says he likes the iFit because of its socket design. With the safety-locked buckle system and its shuttle lock system, which uses a simple front release button, he says it provides him with a high level of stability he wasn't accustomed to with his other prostheses.
Despite his neurofibromatosis, Leath says he tries his best not to lead a sedentary lifestyle. He has been a volunteer umpire for school baseball, softball, football, and basketball games for many years. Leath planned to put his new iFit prostheses to the test in August when he resumed his umpiring duties at middle and high school sporting events.
Betta Ferrendelli can be reached at firstname.lastname@example.org.