I’ve got a couple questions about two different gel liner users below….
I recalled recent posts about yeast infections with those patients using tec
liners, and now I may have run into a similar problem. I’m wondering what
the infection presented as and was a cause ever found?
A patient of mine came in today with a red marks on the medial tibial flare,
medial condyle, and all around the anterior and side trimlines such that you
could probably trace the trimlines of his socket on his leg. The edge
markings presented as a series of small scrapes but no broken skin. The
other two areas were scaley and red, not pus-filled, but reminded me of
carpet burn. The patient reported feeling like there was rubbing in these
areas.
He’s an experienced wearer using custom tec liners and we reviewed his
cleaning habits. Turns out he’s been using Head N Shoulders shampoo to
clean his liner while in the shower, but stopped using that as it gave him a
skin reaction on his scalp! I thought this might just be a reaction to the
harshness of this soap, but am looking for other ideas. There isn’t any
discoloration distally, though. I guess I would have expected a skin
reaction to be all over the leg, not just a couple areas.
In an un-related case, can fitting a gel liner that’s too small cause
redness at the femoral condyle area on a conical limb? Again, a
meticulously kept patient is experiencing redness on the medial femoral
condyle and is using an Ossur Comfort liner (locking). In looking at the
alignment, I think he fights knee varus at midstance, so my other thought
was that he’s just causing excess pressure medially at this point in gait.
This problem was starting with his older prosthesis, which was too large on
his leg due to volume changes. I thought it was due to the pin suspension
and the fact that he sits a great deal at work, causing tension as his leg
pulls up out of the socket. So we tried suction. He couldn’t tolerate the
perspiration and lesser knee range of motion, so we’re back to pin
suspension. I’m running out of ideas!
Thoughts and suggestions on both would be appreciated.
Jacqueline Schmit, MS, CP
Certified Prosthetist
