At times I have thought that the fitting process for a prosthesis is similar to that of a boxing match. There are three rounds with the socket, at least in my experience thus far. The first two rounds beat up your limb, try your patience and test your will. The final round is excitement, anticipation and if you’re lucky – the win! Before I dive into that I want to mention the foot that I went with is AMAZING and will continue to transfer from socket to socket for several years. It is the Fillauer All-Pro. It was my top contender due to it’s versatility. This foot is waterproof and comes with a removable foot shell. I opted for the standard black shell rather than one that looks like an actual foot. I liked the ease of upkeep, durability and how it is resistant to stains. The leg has many similar features to running blades, but also has a heel. A heel is key for walking and standing as it prevents you from having to balance on your forefoot all the time. The flex in the heel allows for a more natural gait and other activities like hiking and navigating uneven terrain.
1. Get cast for a temporary socket (pin lock) and have it outfitted with a stable heavy clunky foot. Then through trial and error have adjustments and modifications made in various appointments. Learning balance and gaining strength while battling skin issues, soreness and weight bearing discomfort.
2. Shrink significantly to where no modifications will make the socket bearable at best. Get cast for a second temporary socket. Again, through trial and error have adjustments and modifications made in various appointments. This time putting on a lighter more flexible foot (All-Pro by Fillauer). Relearning balance with a foot that allows movement and working on my gait. Loving the fit!
3. Waiting 5 weeks for the definitive socket that was scheduled to be back in 9 days, but was delayed due to Covid and unforeseen circumstances at the lab. Receiving the leg and having it not fit correctly due to my limb shrinking and changing shape during that time. Several appointments and modifications to make it tolerable, but not good.
Pin Lock System
There are definitely some positives with this systems. It is quick to put on and take off. There is not a ton of bulk, nor is it complicated. I really appreciated it for when I was in a hurry. This system was waterproof which was awesome because I could throw on a sleeve and hop in a pool, lake or ocean! (Just a quick note- my foot is also waterproof and does not have a computer component which made this possible. Other feet cannot get wet even if the socket can, which is one of the main reasons why I choose the foot I did.) A couple of the things that drove me crazy were the pin itself. At times I had to hop and really push to get clicked and have it secure. Other times it did not click all the way in and I walked right out of my leg! However, the greatest annoyance was the clicking sound. For the majority of my time with it, even after trying a pin lock with a one way valve, I would have a small click with each and every step. It drove me bonkers! Most importantly I was not a huge fan where I was carrying the weight of my prosthesis. Since the pin is at the distal end of my limb to secure the socket and foot, that is exactly where it pulled and felt heavy. Think about holding a glass of water next to yourself in comparison with holding that same glass of water out at arms length for a period of time – which one feels heavier even though they weigh the same?
1. Get cast for a temporary socket (elevated vacuum) and have it outfitted with a stable heavy clunky foot. Then through trial and error have adjustments and modifications made in various appointments. Battling pressure points and not being able to get the socket to where it was tolerable.
2. Get cast for a second temporary socket and have a few adjustments made. Attach my fancy foot and get used to the fit, feel and balance of the new system. Loving the fit!
3. Receive the definitive socket 9 days later and have it fit like a glove!
Elevated Vacuum System (Limb Logic by Willowwood)
This system has the capacity to hold my leg on with using suction or by vacuum. Not that I have run into this situation yet, but if I am unable to charge the device and the battery runs out, my leg will still function. It has a one-way valve that allows the air to be pushed out with each step, while not letting it back in. When the vacuum is engaged the fit is more snug and helps reduce volume changes throughout the day. This system really feels like the prosthesis is an extension of myself because it holds on all the way around my leg up through my thigh. That being said, because I have the liner and a sleeve on top to seal the vacuum I have my leg covered to the upper portion of my quad. Sometimes the layers provide resistance that can limit some movement. I don’t foresee it being an issue once I build my strength back up in my quads and hamstrings. With all the layers it can be a little warm at times, but only a little bit more so than the pin lock liner. This system is also waterproof which is amazing! I can swim and shower in it without worrying about damage.
Staying in the Ring
Going through this process is draining – physically, mentally and emotionally. It really pushes you to your limits. It’s about knowing when to push on because you need to continue to build your hip flexors even though you’re exhausted, but also knowing when to call it because over doing it will set you back and cause bruising or swelling to your limb. Keeping your spirits up knowing so much will be in reach soon, even when it is not happening anywhere near the timeline you had in your head. Allowing yourself time to cry and be frustrated because EVERYTHING is harder! The energy you use to do things one-legged with a knee scooter, walker, i-crutch or prosthesis is so much greater than with two functional legs.
I can honestly say that it has taken all of me to get through the last ten months. Now truth be told my post-op amputee journey has been a breeze compared to most, if not all, of the stories I have heard from others. I healed well and quickly. We never had to fight our insurance company for coverage of an appointment or leg. I have a supportive husband and twelve year old daughter who help out at home. I also work from a home office and never had to worry about a commute. I am not discounting my struggles, but I do recognize that it could have been more challenging and my heart breaks for those who are in that situation.