Wrong Turn Changes Snowmobiler’s Life
April 2020 Issue
Scott Moltzan woke to sunny, blue skies on a cold day in Fargo, North Dakota, in January 1998. The fields beyond his house were covered in freshly fallen snow.
It was a snowmobiler's dream.
After riding for a few hours, Moltzan, who was 31 years old at the time, decided to take an unfamiliar route home.
"It was sunny, and it seemed like the ditches looked nice and smooth," Moltzan remembers. "But I was the first to ride that day and there were no other tracks to follow, and that's when my life changed forever."
Moltzan's sled hit a deep hole that hurled him over the top of his snowmobile, and he hit a power pole. He lost consciousness, but when he woke, he remembers immediately getting up and trying to walk, unaware how injured he was. "I was confused because my right leg was turned around," he says. "And my foot was pointing in the opposite direction."
Moltzan says he collapsed and has no memory of a farmer finding him and calling 911 or being transported to the emergency room. "I don't remember much of the next four months except the sound of the accident and the extreme pain before the paramedics arrived," he says.
Moltzan spent two weeks in ICU, receiving six blood transfusions the first week he was in the hospital. He suffered a traumatic brain injury and his right leg had been shattered from his knee to his foot. Over the following five months, Moltzan had 29 surgeries, trying to save his life and his leg.
Amputation Stops Infection
Moltzan was eventually transferred to a hospital in Minneapolis. Three months after his accident, an infection in his lower right leg was encroaching on his shattered knee and thigh, and he underwent a transfemoral amputation to prevent the infection from spreading. "We tried everything imaginable, but they needed to amputate," he says. "I was obviously devastated, but grateful to be alive."
Moltzan, who has always been active outdoors—hunting, fishing, boating, golfing, and riding snowmobiles—started rehabilitation almost immediately after his amputation, a grueling process given his injuries. "Lying in bed for over four months, I became very weak," says Moltzan, who still experiences loss of feeling in his face and left leg.
Moltzan received his first prosthesis, a lanyard locking liner, a high-activity frame, and a hydraulic knee with an energy-storing carbon fiber foot, near the end of 1998.
Moltzan remembers using the device was difficult at best. "They made me a great socket, put me on the latest hydraulic knee and foot," he says. "But it was hard to get used to, and I would fall several times a week."
In fact, one fall was so serious he tore his anterior cruciate ligament, medial collateral ligament, and had a meniscus tear in his left knee. "I lost all confidence in getting back to just walking," he says.
Keith Wallace, CPO, Sanford Health HealthCare Accessories, Fargo, Moltzan's first prosthetist says, "Scott actually adapted quickly to using a prosthesis and did quite well. He has always been a very smooth walker, and it has always been difficult to tell he's an amputee."
A Novel Knee
Several months after Moltzan recovered from that fall, he received a call from Wallace. "Keith told me he had some great news he thought I could benefit from," Moltzan says.
That news was about the Ottobock C-Leg, which was making its debut in the United States in the late 1990s.
Initially Moltzan's insurance denied coverage for the C-Leg, he says. "They told me they didn't think I'd need the new knee." It took six months of denial letters before his insurance carrier approved coverage for the device. "We were finally able to convince them that this new C-leg would prevent falls and other injuries and health issues not only for me, but for other patients now and in the future," Moltzan says.
Moltzan was one of the first dozen or so patients in the country and the first in the Dakotas to use the C-Leg, Wallace says. "The C-Leg did everything we were taught and told it could do and so much more than we knew," Moltzan says. "The falls and wear and tear on my body stopped. It turned my life around mentally and physically."
Wallace concurs. "Enjoying the outdoors, hunting and walking through tall grass, can be challenging for an amputee," he says. "This is where a C-Leg really shines with its stability and stumble recovery features. Since getting the C-Leg, the number of falls Scott has taken has been dramatically reduced."
Embracing Care and O&P
Moltzan has been an active participant in the O&P profession almost as long as he's worn a prosthesis, as a patient model and tester for several O&P companies.
Moltzan and Adam Finnieston, CPO/L, have known each other for many years. "Scott is definitely not your typical client," says Finnieston, who owns Prosthetic Orthotic Designs, Miami. "He's very active in his prosthetic care. He has a passion for the industry and is very interested in every aspect that goes into prosthetic rehabilitation."
Wallace agrees. "Scott has always pushed the limits on what he was able to do."
Moltzan moved to Vero Beach, Florida, about four years ago and has been going to Finnieston for care for about eight months.
Finnieston developed a hybrid socket system for Moltzan—a suction socket with a seal-in liner that provides extra protection around the distal end while providing a suction fit. "Scott has an unusual situation in that he has some spurs on the distal end of his limb that eliminate any distal weight bearing," he says. "He is a long above-knee amputee and normally a client like this would be able to handle some weight bearing. He is unable to because of the spurs that cause discomfort. It's a hybrid in that he has some gluteal weight bearing that stops him from any additional distal end forces during high impacts."
Finnieston says he used thermoplastic materials for Moltzan's flexible inner socket as well as for his rigid retainer. "The thermoplastics allow for some movement and dynamic nature of the entire system, which give his muscles the ability to expand and contract a bit more than a traditional laminated socket," he says. "It's been my experience that this allows an amputee's muscle to work in a more natural fashion and allows for hypertrophy for the muscle instead of the traditional atrophy that happens when you don't allow muscles to expand."
That socket design has worked wonders for Moltzan, given his active lifestyle, Finnieston says. "He's an avid golfer and walks very powerfully so we have to limit his movement down into the socket with a gluteal weight bearing situation."
When Finnieston started providing care for Moltzan, he was wearing a straight suction laminated socket with a large seat built into it, Finnieston says. "This worked for him to a degree, but it was quite heavy, and the lamination was very stiff, not allowing his muscles the freedom to expand."
Moltzan says he wore that socket for many years. "We transitioned him into a liner after trying a straight suction socket. He's been very pleased with the results after adding the liner," Finnieston says.
Testing the ToeFlex
Moltzan continually seeks improvements in the design of every aspect of his prosthesis, Finnieston says. "This is a great quality for someone who is working in the field as a patient model and product tester in that he'll put components through a full battery of real-life scenarios. He has quite a bit of knowledge to give feedback on his experiences."
Moltzan's role in that capacity continued throughout 2019.
For roughly the last year, he has been wearing a new foot prosthesis, the ToeFlex, ST&G, Brea, California. While the ToeFlex has a the split carbon heel and multiaxial ankle, it is the two spring-loaded, independently engineered toes that help to improve his balance and smoothness as he walks that Moltzan says are the foot's best features.
The ToeFlex was an immediate improvement to his gait. Perhaps most noticeable was when he found he could walk up hills while playing golf, he says. "It was unreal. Usually I need to look for a longer, easier route usually to the left or right of the hill."
The ToeFlex has a great heel, smooth roll over, and no dead spot, Moltzan says. He is also impressed with the stability of the ToeFlex while he's on his boat and on uneven walkways. "The ToeFlex absorbs the impact on my residual limb and I have great energy at the end of the day. It has great range of motion and control," he says. "It really has been a treat to do even more than before."
Moltzan considers himself fortunate. "I think back to how lucky I was then, and now more than 20 years later how computerized knees just keep getting better with many more manufacturers and features. All the battling was worth it in those many years of explaining to insurance committees to prove the facts about the technology."
Betta Ferrendelli can be contacted at firstname.lastname@example.org.