May 25 2018 - Prosthetic Accessory Test

It has been a month since my last blog. Not much has happened, but what has happened has been depressing, and exciting.
Friday 4 May 2018
My socket had been bothering me, so I visited my Prosthetist. He had a bunch of new "Toys" for me to try out for my prosthetic leg.  :-)
Toy1 - A rotation adaptor is a device that fits between the socket and the knee that allows the lower leg to rotate. While sitting, this allows the lower leg to be twisted 360 degrees. I can rotate at the knee and put the foot right in front of my face.

This guy is using a rotation adapter

I personally could not find any use for it, other than as a party trick.

Toy2 - A screw that replaces the normal pylon, so I can lengthen and shorted the pylon. This looks like something I could really use.

During the ParkRuns, I battle when the terrain slopes down from left to right. My left prosthetic leg is always way to long, and that makes walking very difficult. If I could shorten and lengthen the leg easily it would help me lots.

Toy3 - An ankle device made for ladies that change their heel height often. If the heel is thicker/taller, then the toe will not have pressure on it to break the knee loose as I walk. High heel shoes mean the prosthetic knee will remain stiff. This problem is also evident when walking down a hill. My weight never transfers to the toe as I go downhills, so the knee never bends.

This device changes allowable heel height (actually the angle of the foot) with the push of a button.

This is my old fixed ankle.

Heel height Variable Ankle.

You can see the big white button on the side. Pushing it releases the foot, so the angle can be changed. It only is variable for about 10 degrees, I wish it did more.

Toy4 - An extension assist. This is a spring and cable assembly added to the inside of the knee to help push the knee into the straight extended position.

It takes pliers and about 5 minutes to install. There are three different strength springs. 

---

On the ParkRun I was doing that Saturday, there is a 1 km section where shortening the left leg 1.5 cm would help, and a 1.5 km section where a 3 cm shorter leg would be nice. On the rest of the run, a normal length would be best.

The fancy screw pylon would only add or subtract about 1 cm to the length of the leg. My prosthetist suggested that maybe I could just lossen the bolt, and slide the pylon out of the ankle or out of the knee, then tighten it back up. I tried that and found I could safely lengthen and shorten the leg by a total of 3 cm. :-)

I Cut the pylon shorter, then marked the pylon with lines to indicate the different lengths I would require for the different parts of the run.

I decided to not use any of the new "Toys" on the Park Run because I had not practised with them.

----------------

Saturday after the ParkRun.... 

:-( My poor stump is in such bad shape. Blisters, and lots of pain. 

The leg shortening worked well for the first half of the race. I was at the half way point 15 minutes earlier than last time. I was feeling good.

Then my stump bottomed out. PAIN.... I stopped and took the leg off and added a thick stump sock, hoping to stop the stump from going so far into the socket. That made the socket very tight, and I could feel throbbing, which means blood can not get out of the stump. After about half a km, the stump was again bottomed in the socket. Every step hurt, and the throbbing meant I could not add more socks. 

The second half of the run was on pavement, and it took me 25 minutes longer than the first half, which is on rough terrain. 

I could feel blisters forming on the stump, then the blisters popped, and soon the sweat was getting into the popped blisters. 

I finished with a very slow time, went straight to the car and removed the leg, then headed for home. Once home I could not put the leg on because the stump was so sore. Fortunately my crutches were in the car, and I could get into the house.

A quick shower, and lots of anti-inflammatory drugs, and into bed.

I was not able to put the leg on for three days because of the swelling of the stump. I had two rows of blisters, and lots of sores on the end of the stump.

The next 10 days were short walks only. I did get to try out the "Toys". The rotation adaptor was put aside. I could not find a use for it.

The screw pylon was also set aside. The sliding of the pylon in and out of the knee and ankle, worked very well, and is quicker than screwing in and out the pylon.

The extension assist ended up having a benefit I had not considered. The spring makes the leg go straight much quicker, and it slammed straight. I was able to set the extension resistance more, and then the fast extension got smoother. The biggest benefit was that the spring locks the knee as a soon as it is straight. I no longer need to make sure the knee is straight, and locked before putting weight on it.  It automatically goes straight and locks. I like that a lot. I feel much safer.

I tried the different springs. The stiffest was very stiff, and may have been ok for a hard core sprinter. The lightest spring was ok for walking around the kitchen. I ended up using the middle firm spring.

I next put on the variable ankle. I doesn't seem to have enough travel to be of any use. I took it back off, and put on my solid ankle. Then after two days I decided to try it again. It weighs more than my solid ankle, and I can feel the extra weight. It does seem to help some when walking down hill, because I can lower the toe, and that allows the knee to break loose on downhills. But then I took it off.

Then a few days later I put it back on. Duh!!!

I went to a place that had a long wheel chair ramp. It is about 10 meters long, and is exactly a 10 degrees slope. 

I set the ankle so it is good for flat ground when the toe is at the farthest up position. Then before going down the hill, I push the button, and stomp on the heel to force the toe as far down as it will go, then push the button again to lock the ankle in that position. With the toe down like that it is very hard to walk on level ground, but I can walk normal down the slope. That is very nice, because I normally have to walk down slopes with a stiff prosthetic leg because the knee will never break loose. With this variable ankle set to max toe down I can do the wheelchair slope easily. 

The price of the variable ankle is about R12,000 ( $1000). 

Yesterday I went to get measured and fitted for a new socket. Hopefully it will not be one that allows bottoming of the stump.

The new variable ankle is almost one cm longer than my fixed ankle. I need to shorten my pylon, so it will be adjustable like I did on the ParkRun. But since I am getting the new socket in a few days, I will wait before cutting the pylon.

-----