Editor's Note - June 2021
Prostheses for major amputations and lower-limb or spinal orthoses often take center stage in O&P literature and presentations. But as every clinician knows, other more specialized areas of care are equally important to the patients who rely on them. In this issue we look at post-mastectomy care, partial foot amputations, and recent research on powered ankle-foot prostheses.
Any loss of a body part or loss of function, conditions commonly addressed by O&P devices, can have a devastating impact on an individual's sense of self. The post-mastectomy providers we spoke with in "A Lifelong Connection: The Patient-Provider Relationship in Post-mastectomy Care," point out that providing care after the loss of one or both breasts requires a unique connection, as patients are often still undergoing cancer treatment and grappling with issues of sexuality and femininity in a society where breasts are emphasized as sexual and maternal symbols. Additionally, since disrobing is important for proper fitting, women are confronted with issues of modesty at a time when they may be feeling the most vulnerable. All these issues require post-mastectomy providers to establish a trusting, nurturing relationship that goes beyond prosthetic training about proper fit and addressing possible physiological complications.
Partial foot amputations are a common complication of foot ulcers but do not garner the same attention as other lower-limb amputations. The goal of prostheses at this level is to restore function and stability lost due to the amputation, however, this may be complicated by gait deviations patients developed from ulcerations, therapeutic footwear, or other interventions prior to amputation. Beyond toe fillers, the most common prosthetic treatments for this amputation level restrict ankle motion. "Restoring Ankle Power After Partial Foot Amputations" discusses another possible approach to help patients return to safe, efficient ambulation.
Shortly after their introduction, early research on the benefits of powered ankle-foot prostheses were largely positive. While subsequent research supports their value, "Powered Prosthetic Feet: The Second Chapter" discusses recent findings that provide a more nuanced picture of reasonable expectations of powered ankle-foot prostheses and which patient populations are most likely to benefit.
I hope you enjoy exploring these more niche areas of clinical care.