April 3 2018 - Going to a Different Prosthetist

Today I decided to try a different prosthetics company. The prosthetist I have been going to since my amputation, seems to be trying less hard for my business than he did before. I have no specific complaints about any of his work, so maybe I just wanted a change.

I have been walking about 12km a week, mostly just to the shops for coffee. A few weeks ago I tried a local ParkRun. Park Runs are 5 km run/walks. There are athletes that finish in about 30 minutes, and fat, old ladies pushing a baby carriage that finish in just under an hour.
My fastest two leg ParkRun time was 35:39. My fastest time since amputation was a 1:24:48.

Last week I did a ParkRun in 1:56:19. I was exhausted and very slow. The terrain was very uneven the entire race. Uneven terrain means that the leg will sometimes unlock when I don't want it to, and sometimes will stay locked when I need to bend it while swinging it forward. Uneven terrain require me to concentrate on the ground immediately in front of me, where the prosthetic foot will land. This is not fun, and requires total concentration.

This is the foot I have now. An Ossur Vari-Flex. All the prosthetists I have talked to, say this is the foot of choice for most amputees.

I have always felt that the solution to uneven terrain is a flexible ankle. My Vari-Flex has a zero flex ankle.
Last year I borrowed, for 2 weeks, an Ossur Proflex ankle. It has hydraulics in the ankle so the foot can move the toes up and down to match the terrain.

It made uneven terrain a bit easier. It made slopes a bit easier. I would gladly have paid a few thousand Rand for that ankle...It was R87,000. Definitely not worth that much to me.

Today I called around to see if any other Prosthetic companies have any ankles to loan me. One place sounded much better than the others, so I drove there. They have a 2 hour evaluation exam and test, that is done by a Physio lady, and a prosthetist.
They are very modern, and proud of their technological approach to the prosthetic business. One thing I liked very much about their methods was they insisted on real world conditions.
My old prosthetist did all his alignment on a flat floor. I always felt that he could get it perfectly set up in that room, but it was all wrong before I even got out to my car. These new people first aligned everything on a flat floor, then took me outside to the real world. Steps, slopes, loose tiles, and rocks.

They strapped a small electronic measuring device on my prosthetic ankle, then made me walk supper fast for 6 minutes. This device measures acceleration, impacts, distance, cadence, and stride length. They also had video cameras to record me walking from all sides.
We studied the videos and the computer printout from the device after my walk.
They both said that my foot problems seem to be knee related. I told them my knee was fine, and the problem was lack of flex in the ankle.
I had to be careful, because these people seemed to know what they are talking about, and I always think I know everything.

While they were doing computer things, I chatted to a double above knee amputee. He works at a disabled children school. He told how he puts his single, above knee amputee kids on a pure straight leg with a J type carbon fiber running foot. He says that the kids run much faster over uneven terrain without any knee at all. He says the knowledge that they won't fall makes them go much faster than having a very expensive knee, that may make them fall.

This Para-Athlete runs with no knees. It looks funny, but he doesn't fall, and is very fast.

The prosthetist and the Physio lady both said that I may be faster on uneven terrain with no knee. I need to think about that.

They both said that I need more push off (energy recovery) in my prosthetic foot. They found an old Fillauer All-Pro foot and put it on my leg. It looks like this.

We then did the 6 minute fast walk with the measuring device strapped on. My stride was longer, and I was a bit faster. They say that it should have lots more give and flex on uneven terrain. They loaned it to me for a week.
Tomorrow I will go to one of the ParkRun venues near me that has rough terrain, and give it a try.

When I was done, and getting ready to leave, a lady came in. She was an above the knee amputee from cancer, so we had a great talk. She is getting a loaner knee. The top of the range Bionic knee from OttoBock. She was excited. The OttoBock guy said his job was to put as many people on OttoBock products as possible, even if it was just for a week or two. He said that he had another loaner that he wanted me to try out. It is a super Bionic knee. Lots of Artificial Intelligence in that knee.  Here is what it looks like:

If the actions of the knee fit one of many event criteria, then it thinks you are tripping and it takes corrective action.
It senses when you are standing still and will lock the knee. It senses when you are sitting, and goes slack. It senses if you are walking fast, and varies the resistances to match. It is programmable via blue-tooth, so you can change program profiles via a cell phone. You can read more about it here..

https://www.ottobockus.com/prosthetics/lower-limb-prosthetics/solution-overview/genium-above-knee-system/

A very fancy machine, but it costs almost what my house, and my car together are worth.

I will go back to these people in a week, to return the foot I am trying out, and maybe the OttoBock guy will have dropped off the Genium knee for me to do a 2 week trial.

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