NHS Maltings User manual

Mi 131007 12.12.12Planned review date, November 2015
Maltings
Mobility Centre
Wearing a Prosthesis
An information guide for patients
following leg amputation.
In partnership with:
The Dudley Group NHS Foundation Trust
The Shrewsbury and Telford Hospital NHS Trust
Walsall Healthcare NHS Trust
Safe & Effective | Kind & Caring | Exceeding Expectation

Maltings
Mobility Centre
Wearing a Prosthesis
An information guide for patients
following leg amputation.
In partnership with:
The Dudley Group NHS Foundation Trust
The Shrewsbury and Telford Hospital NHS Trust
Walsall Healthcare NHS Trust

1
Wearing a Prosthesis
An Information Guide for Lower Limb Amputees
Contents Page
Introduction 1
Glossary 1
What is a prosthesis? 2
Parts of a prosthesis 3
Standard features of a below knee prosthesis 4
Standard features of an above knee prosthesis 5
Measuring you for a prosthesis 6
Fitting your prosthesis 6
Delivery appointment 7
Prosthetic training 7
Getting on with your life 8
Things you will need to learn 8
Socks 9
Walking aids 10
Reviews 11
Care of your prosthesis 13
Care of your residual limb 13
Care of your remaining limb 14
Going on holiday 16
Falls
• Preventing falls 17
• How to get up from the floor 18

2
Introduction
This booklet is aimed at guiding you through the process
of prosthetic rehabilitation. We hope that it enables you to
understand what will happen during this time. However, if
you are unsure about anything do not hesitate to ask one
of the staff.
Glossary
• Prosthesis Artificial limb
• Prostheses Artificial limbs
• Prosthetist The Prosthetist is the person
responsible for the provision of
an appropriate prosthesis and
educating the client in its use.
• Socket This is a container which is made to fit
the shape and measurements of your
residual limb
• Suspension This holds the prosthesis onto your
residual limb
• Cosmesis This is the outer covering, which gives
the limb its shape and appearance
• Oedema Excess fluid in the tissues of the body

3
What is a prosthesis?
This is the formal name for an artificial limb (in this case
leg).
The prosthesis only fits the person it is made for.
There are various types of prostheses available.
Prostheses vary in:
• The way they look
• The way they work
• The way in which they are held on to you (the
suspension)
The type of prosthesis you have will be dependent upon:
• Your health and fitness
• Your body weight
• Your residual limb shape
• Your amputation level
• Your lifestyle
The primary assessment by the rehabilitation team will
enable a suitable prosthesis to be made for your needs and
goals.
If your needs and goals alter in the future you will be
reviewed to see if any part of your prosthesis needs to be
changed.

4
Parts of a prosthesis
The next two pages give an idea of the standard parts that
go into the making of a prosthesis. To make the diagrams
clear, they are shown without the cosmesis, and suspension.
The diagrams are to give you an idea of what the parts are.
Please do not think that all prostheses are exactly the same
as the diagrams - there are many prosthetic manufacturers
and each make various types of prostheses.
Cosmesis (not shown)
This is a cosmetic cover, which gives the limb its shape and
appearance. A continuous foam tube is shaped, as far as
possible, to match your remaining limb. Stockings or a
‘plastic skin’ will then cover the foam tube.
Suspension
There are different types of suspension, which secure the
prosthesis to your residual limb. When your measurements
are taken for your prosthesis, you will be assessed for the
type of suspension you need.

5
Standard Features of a Below Knee
Prosthesis
Standard Features of a Below
Knee Prosthesis
5
Liner
This is a removable inner socket made
ofaexiblematerial.
Socket
This is the part of the prosthesis,
whichyourresiduallimbtsinto.It
can be made of plastic or laminated
material.
Shin Tube
This lies between the socket and the
prosthetic foot. It is made of strong
lightweight material such as carbon
bre,aluminiumortitanium.
Prosthetic Foot & Ankle
There are many different types
of foot and ankle combinations
available.Yourindividualneedswill
inuencethechoicemade.
6
Standard Features of an Above
Knee Prosthesis
Socket
This is the part of the prosthesis, which
yourresiduallimbtsinto.Itcanbe
made of plastic or laminated material.
Knee Joints
There are various types of knee joints.
Some are designed to swing free; others
are designed to stay in a locked position
for walking and can be unlocked for
sitting.YourProsthetistcanprovidemore
information.
N.B. prosthetic knee joints are only
required if your amputation is at a level
through the natural knee joint or higher
up the leg.
Shin Tube
This lies between the prosthetic knee
joint and the prosthetic foot. It is made
of strong lightweight material such as
carbonbre,aluminiumortitanium.
Prosthetic Foot & Ankle
There are many different types of foot
andanklecombinationsavailable.Your
individualneedswillinuencethechoice
made.

6
Standard Features of an Above Knee
Prosthesis

7
Measuring you for a prosthesis
When it has been decided that you are ready for your
prosthesis the Prosthetist will record the shape of your
residual limb by one of the following:
• Plaster casting
• Tape measurements
• Computer measurements
• Photography
or a combination of the above.
Your Prosthetist will decide on the most appropriate
method.
Measurements will also be taken of your remaining
limb. This will enable the technicians to shape the foam
cosmesis to resemble your remaining limb. Following these
measurements your prosthesis will be manufactured and
a further appointment will be made so you can try your
prosthesis for the first time. This is known as the fitting
stage.
Fitting your prosthesis
At the fitting stage adjustments can be made to ensure
that your prosthesis is as comfortable as possible, and
to make sure it works properly. To allow easier access
for these adjustments your prosthesis will not have the
cosmetic cover fitted.
It is very important to let the Prosthetist know if anything
is not comfortable. Please do not be afraid to say if
something does not feel right, as it is important that you
let the Prosthetist know what you are feeling.

8
The prosthesis may be left uncovered for use in the
physiotherapy gym. This enables any adjustments to be
made as your residual limb settles down and as you become
used to the prosthesis.
Delivery Appointment
The cosmetic covering is applied at this time unless you
prefer to use it without any covering. Your prosthesis
may seem wider than your remaining limb; this is because
appearance of the prosthesis is dependent on the shape
and the remaining swelling of the residual limb. In time the
residual limb usually shrinks and so smaller sockets can be
provided.
Prosthetic Training
Your Prosthetist and therapist will show you how to use
the prosthesis. You will need a certain amount of practice
before you are safe to use it at home, please be patient.
It is important to realise that it takes a lot more energy to
walk with the prosthesis than with your own leg, therefore,
learning to walk may be quite tiring.
The activities you practice will depend on your individual
abilities and requirements, your amputation level and your
general health. These activities may include practising
walking outdoors, walking up and down steps, up and
down slopes, getting on and off the floor, walking
forwards and backwards and around obstacles, getting in
and out of a car etc.

9
Getting on with your life
The assistance of an Occupational Therapist (OT) may
be helpful as they can advise you on ways you can help
maintain your independence. The OT can assess and refer
for home adaptations and equipment which may help you
with your personal and domestic activities of daily living,
leisure activities, returning to work or driving etc. When
you start using your prosthesis at home the OT may also
work with you at this stage, by assessing your activities
whilst you are using the prosthesis.
Things you will need to learn
• Whether your prosthesis is fitting you properly and, if
necessary, how to maintain the fit by the use of more or
less socks
• How to put your prosthesis on and take it off safely
• How to regain your balance on two legs
• Which walking aids are suitable for you
• Learning where you will feel pressure from the
prosthesis and checking on how well your skin is coping
with the new pressures
• Gradually building up the time spent wearing your
prosthesis
• How to keep your prosthesis, residual limb and the
remaining limb in good condition

10
Socks
Socks are issued by the Prosthetic Service and worn
between your skin and the prosthesis. The socks help to
protect your residual limb and make your prosthesis more
comfortable to wear.
Socks are made from terry towelling, plain cotton, nylon,
wool or wool blend. They come in different sizes, lengths
and thickness. Your prosthetist will inform you of the type
of sock that you will need to use.
The number of socks you wear will depend on the size
of your residual limb in relationship to the socket, e.g.
sometimes the residual limb might be swollen and the
socket may then feel tight, or the residual limb may have
shrunk and the socket will be too big.
To achieve the correct fit, you may have to replace a thick
sock with a thin one, or add a thin or thick sock to the
one / ones that you are wearing. Your prosthetist and
physiotherapist will be able to give you advice on how to
check that you are wearing the correct combination and
amount of socks.
When you have your prosthesis you will be issued with a
supply of suitable socks. Once these wear out, replacement
socks can be obtained through your local amputee clinic or
by phoning the Prosthetic Rehabilitation Services Centre
(Maltings Mobility Centre) directly.
Suspension Sleeves
Your suspension sleeve should be cleansed regularly in
accordance with manufacturers’ guidelines which will be
provided to you by the Prosthetist.

11
Important things to remember are:
• Always wear clean socks daily
• When washing your socks, follow the manufacturer’s
instructions
• Always give your socks enough time to dry
• Never darn or patch your socks
• If you find that you are wearing more socks than usual,
please contact the Prosthetic Service for advice
• Compression residual limb shrinker sock - It is important
to remember to wear this sock when you are not
wearing the prosthesis. This will help to ensure that the
residual limb does not swell when you are not wearing
the prosthesis. They are not normally worn whilst
wearing the prosthesis. You may reach the stage where
this sock is no longer required - your local prosthetic
team will advise you on this
Walking aids
When you first use the prosthesis you will usually practice
within a set of walking rails (parallel bars) to give you extra
support and confidence. Most new prosthetic wearers will
need some kind of walking aid to begin walking at home
safely. Your Physiotherapist will discuss with you the best
type of walking aid for your particular needs, and will
arrange its supply. You will be told how to look after your
walking aid and what to do if there are any problems with it.

12
Reviews
After taking delivery of the prosthesis, various clinic
appointments will be arranged, so that the Prosthetic
Rehabilitation Team may check your progress and the fit of
your prosthesis.
As you become a more confident prosthetic user you will
not need such regular appointments, but you will be
able to request them as required. Although you may be
discharged from the prosthetic training, you are never
discharged from the Prosthetic Rehabilitation Service,
as we need to keep a regular maintenance check on the
prosthesis.
Care of your prosthesis
You will be responsible for keeping your prosthesis in good
condition:
• Hygiene
Wipe out the socket and, if applicable, the liner of your
prosthesis every day using a clean damp cloth. When
washing special liners always follow the manufacturer’s
instructions. It is best to do this at night so they are dry
for the following day.
• Storage
Store your prosthesis in a clean, dry place when you are
not using it. Do not let your prosthesis get wet; if it does
allow it to dry naturally and contact your Prosthetist for
advice.

13
• Footwear
Do not change the heel height of your shoes without
consulting your Prosthetist; as this may change the way
the prosthesis feels when you walk – making you feel
unbalanced
• Maintenance and repairs
Your prosthesis is a mechanical device and will require
maintenance at the Prosthetic Clinic. If you are a very
active person the prosthesis may need more regular
maintenance to avoid wear and tear problems. This also
applies to heavier clients who may need to be reviewed
every few months
If any part of the prosthesis needs alteration or adjustment,
please contact your Prosthetic Clinic.
If you notice any of the following:
• Noises coming from your prosthesis, such as squeaking
• Looseness in any joints
• A change in how your prosthetic foot feels to walk on
• Problems with the prosthetic knee units
• You develop sore areas
Stop using the prosthesis and contact the Prosthetic Clinic
for advice.
Do not try to adjust the prosthesis yourself, as this may
cause damage and make it unsafe to walk on.
Regular checks on your prosthesis ensure that it remains in
a good and safe condition. This is important for your own
personal safety.

14
Care of your residual limb
• General hygiene
Wash your residual limb every evening using a non-
perfumed soap and warm water. Rinse it well and pat it
dry
• Regular inspection
Examine your residual limb every day for signs of
redness, rubbed or sore areas, blisters or other skin
problems. It may be helpful to use a hand-held mirror
to check all areas of your residual limb. If you have any
worries, then contact the staff at your Prosthetic Clinic
for advice
• Creams
Avoid the use of creams on your residual limb unless
advised by a doctor / therapist
• Socks
Change your residual limb socks daily or more often in
hot weather when you sweat more
• Oedema
Swelling of your residual limb will occur after
amputation, but this will gradually reduce and your
limb may continue to shrink for many months. A
comfortable fit of your prosthesis can usually be
maintained by altering the number of socks you wear,
or you may need adjustments to your prosthesis
Swelling may be kept under control by use of the
compression sock whenever your prosthesis is not being
worn. A member of the prosthetic team will advise you
how and when to wear it.

15
Care of your remaining limb
Having had an amputation, you must take care of your
remaining limb. This is particularly important if your
amputation was as a result of poor circulation or diabetes.
• Smoking
If you are still smoking then this will increase the
likelihood of further disease in your remaining limb. If
you seriously wish to give up smoking, please ask your
Prosthetic Clinic or GP for information.
• Footwear and socks
Avoid tight socks / stockings that may hinder your blood
flow. Check that there are no creases in your socks.
Wear comfortable supportive footwear and inspect
the insides of your shoes daily for foreign objects e.g.
drawing pins, nail points, torn linings and rough areas.
Wear clean socks / stockings daily.
• Hygiene
Wash your foot daily and dry it thoroughly. If you notice
any red areas on your foot or any broken skin, please
contact your GP.
• Chiropody
Diabetics and those with poor circulation should
arrange to have their toenails cut by a chiropodist. If
you cut your own toenails this is best done after your
foot has been soaked in warm water; the nails are softer
and easier to cut. Cut them straight across and not too
short.

16
• Skin Care
Consult your GP about the most appropriate product for
any skin problems. If your skin sensation is poor, then
avoid excessive heat such as an unwrapped hot water
bottle or sitting in front of the fire. Always check the
temperature of the bath water with your hand or elbow
before you get into a bath
• Swelling
If your foot and ankle are prone to swelling, then keep
them raised on a leg rest if you are sitting for long
periods. Make sure your knee is supported and that
your heel has no pressure on it. Consult your GP if you
are concerned about any swelling in your leg
• In Bed
Avoid sleeping with pillows under your knees or hips as
this may lead to tight joints and muscles
• Exercises
Keep doing the exercises that you were taught by your
physiotherapist
If you are concerned about the condition of your remaining
limb at any time then get in touch with one of the
following:
• Your GP
• Consultant surgeon (if you are still being reviewed at
hospital)
• A doctor in the Prosthetic Service