Thursday, December 1, 2022

Construction Worker Transtibial Amputee Who Insists On Kneeling

James Beggs

I have a patient who received an amputation secondary to a brown recluse
spider bite and got his first prosthesis a year ago. The patient is very
demanding, complaining when he could not put his popliteal region completely
flat on the floor when he sits on the floor, for instance.

He wanted to be able to kneel or sit on the floor with zero interference. We
had made a typical transtibial total surface bearing socket, but cut the
trim lines down a bit, and eventually ended up having to add pretibial
compartment pads as well, the patient was not very compliant with sock ply
fit.

Apparently, this wasn’t sufficient. He went on his own and cut down the
anterior brim way down – probably about halfway between his ptb and the end
of his limb (he has a mid-length limb), then did the same with his posterior
brim.

He said it worked fine for him, and that it felt better – a popping in his
knee he got went away as well. Obviously, we do not advocate this, as he is
seriously compromising AP stability, but I’ve come to understand that there
is a socket design, the RCR, which actually does something very similar to
that.

I have no familiarity at all with this socket design. Does anyone out there
know of a socket design that might satisfy this very demanding patient
without compromising ap stability?

Thanks in advance!

James A. Beggs
Prosthetist, Gulf Prosthetics & Orthotics

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