———-
From: Ferris, Peter WHSCC
To: Shands
Subject: FW: BK Case Study of Distal End Pain
Date: Friday, May 01, 1998 1:12PM
———-
From: Ferris, Peter WHSCC
To: Steeves, Mike WHSCC
Subject: BK Case Study of Distal End Pain
Date: Friday, May 01, 1998 12:50PM
Brief History: Patient is a 52 year old male, caucasion, 224 pounds, 6′
left ,middle one-third BK.
Occupation: Construction and heavy equipment operator
Condition of limb: Healed with healthy skin sencondary to trauma .
Dogear scar on the lateral edge of distal suture is a sight of
sensitivity. Within the last 18 months has had a suture come out and
cellulitis susequently. The most recent prothesis was not comfortable
after the cellulitis.
Present prosthesis: Leather lined, pelite liner, PTB socket, Cuff strap
suspension, endoskeletal shin with a College Park foot.
Evaluation and Procedure:
Attempts using the Alpha liner with a Thermolyn check socket was not
satisfactory, Patient wanted a leather/pelite insert. (I found the
Thermolyn expanded and did not find it rigid as 3/8 inch copolyester.)
Attempts casting with the Otto Bock BK casting technique were not
satisfactory either. The distal end pain I wanted to eleviate remained.
Discussion: Because the patient desires to have a leather/pelite
insert total surface bearing sockets using urathane or silicone should
not be considered. The Otto Bock casting technique helped with initial
walking but continued walking resulted in the distal tibia hurting even
though the limb did not touch bottom. At this time I would like to
minimize the hammocking effect of the 5-ply socket. Attempts to tighten
the proximal socket were not comftorable.
Immediate Plan: A Delta II CAD-CAM socket was fitted in the past after
several check sockets. This will be tried again. Also another hand
cast will be taken and modified to accommodate previous concerns in the
attempt to get to use the previous experiences to the benefit of the
patient.
Request: Would like discussion on:
1. The use of Otto Bock rigid 12mm Thermolyn for heavy and active
users.
2. Socks contribute to distal pain when the socket is open distally.
What can be done to minimize the “hammocking effect”?
3. What has personal experience shown to be more succussful, Alpha or
TEC liners?
