Dear List Members,
You are all just simply amazing. Thank you for the plethora of replies that
I received. There are so many innovative, different ideas on formulating the
design for this gentelman’s prosthesis. I intend on combining several of your
recommendations for the final product. How fun! Thanks again for sharing
your expertise.
Lisa Urso, CPO
Albuquerque O & P
ORIGINAL POST – condensed
51 year old, male, long (8 1/2″), BKA who rejected his last endoskeletal
prosthesis due to the lack of durability of the cover. He puts significant
force/wear & tear against the upper mid, anterior aspect of the shin section when he
climbs ladders, tears it up doing yard work/hiking/auto repairs, occasionally
gets it wet when he’s fishing, and gets it really, really wet when he water
skies in it (we’re discussing alternatives). The prosthesis was relaminated
into an exoskeletal with a Kingsley Strider SACH foot.
2 Questions:
1) Based on your experience, what is the most durable covering for an
endoskeletal prosthesis?
2) Which exoskeletal prosthetic foot would you use that has some energy
return and can (at least somewhat) accommodate to uneven terrain?
RESPONSES
The most durable endo cover is a laminated cover… though more work than a
soft cover with the right layup these can be very durable. As for the foot,
the OWW sach (I know… SACH) has a removable heel bumper that is exchangable
with different durometers. In addtion to that I think the Seattle Lite with the
attachment block or a Carbon Copy2.
The College Park Tru Step can be used on an exo setup. For a man of his age
it may very well perform quite good. I work in a childrens hospital and we fit
several of these a year, there is some periodic maintanence required to
replace bumpers and bushings but this is quickly done and the rest of the foot is
pretty durable.
You can use a variety of the FlexFeet series w/the exoskeletal prosthesis. I
have had very good results & luck w/same.
We just put a 300 pound fellow on a foot from freedom innovations. I believe
it was the FS3000. We mated it to an exoskeleton leg. You can order the
footshell and foot to be compatible with an exo. Seems to work pretty well and
definitely has dynamic response and good tolerance to uneven terrain. Patient is a
large animal vet and puts it to extremes.
Hope this helps.
We do a few exo’s here at the Shrine Hospital. Try Seattle’s carbon foot.
Epoxy foot to prosthesis and put a hot glue plug in the bolt hole. The other
option is a low profile variflex using a female pyramid distally with lamination
from the foot up.
OK, I thought I was being naive when I read it the first time as others would
reply.. I have a few divers who use exoskeletal limbs (hollow as swimming
legs) and fitted with Flex Feet distally so the upper part is hard and the
lower is functional to a high degree…and has only a few cm of foam low down
between the foot cover and the bottom of the limb…
Otto Bock’s central fab does a laminated endo cover that is very durable,
basically it is a thin lamo done over shaped foam under very light vacuum so as
not to pack out the shape. My friend Scott Madsen at API in Paso Robles, CA
can do this for you as well.
I have been a tech for 16 years, but can’t really help you on the foot. I’ve
seen a lot of people use Bock’s 1d10 and Kingsley feet, but they all leave
something to be desired in the uneven terrain dept.
1. I TEND TO USE THE PRS UFLATE SKIN… REQUEST THAT IT BE REINFORCED AND
PRS should DO IT FOR YOU… It lasts longer than most of the other skins I have
tried.
2. I HAVE WORKED WITH TEXAS STATE PRISONERS WHO WEAR THEIR PROSTHESES IN
THE SHOWERS, IN THE MUD, WORKING IN THE FIELDS, ETC. AND HAVE REALLY WORKED THEM
OUT AND HAVE HAD FAIRLY GOOD SUCCESS WITH THE SAFE II FOOT – WATERPROOF /
HEAVY DUTY… CAN BE USED WITH ENDO OR EXO AND IT HAS DECENT ENERGY
RETURN……..
I have a few farmers and loggers wearing the College Park Trustep that are
true exos. We have a method of creating a exo shell over endo components so we
can use any foot we deem appropriate.
I have had good luck using SAFE II feet for exo applications as well as for
situations where cost is a significant factor and the individual is active.
These feet come in several configurations and adapt surprisingly well to uneven
terrain. They also have a waterproof foot available and all have had a good
record of reliability. Their main disadvantage is in being slightly heavy.
Make the shape over the endo parts with plaster.
Drape with 4mm PP homopoly.
Open the back weld with a cast saw or chisel.
Remove plaster.
Put PP cover and re-weld.
Sorry I missed your earlier posting. I have had good luck with the
Campbell-Childs SAFE II foot. They make a specifically waterproof model, and it is very
effective for use on uneven ground. Not particularly energy storing, but it
is quite durable.
Responses continued in Part II
