Amputation (TT and Foot) Flashcards
What shape do you want transtibial amputation
cylindrical shape
What shape do you want transfemoral amputation
conical
How long do you ideally want the residual limb in TT or TF amputation?
35-50%
What is the problem with a short residual limb
shorter level arm, creating gait difficulties
What is the circumferential measurement goal with a transtib amputation
distal end to be equal or at least 1/3in greater for prosthesis to fit
What is the beat option for edema management
rigid removable dressing
What are interventions for phantom limb sensation
desensitization techniques, mirror box
What are the interventions for phantom limb pain
gabapentin, TENS
What are the key muscles for gait we want to examine?
quads, hip flexors, hip abd, hip extensors
When doing MMT what do we want to keep in mind?
no pressure until incision heals
hand placement the same on both legs
What muscles are at risk of contraction for TT
knee flexors, hip ER/flex/ABD
What muscles are at risk of contracture for TF
hip flex/ER/ABD
What is the best positioning for a person with amputation
prone
Where do you place pillows to prevent contracture
at distal end of residual limb (TT)
laterally for hip ER and ABD
What is the main reason for amputation? What is the second?
vascular disease (DM and PAD)
second is trauma
What is the decision making for level of amputation?
sufficient vascularization
infection
joints
What is a lisfranc amputation
a disarticulation between the cuneiforms + cuboid and the metatarsals
What is a chopart’s amputation
a disarticulation between the talus and navicular and the calcaneous and cuboid
What is a symes amputation?
remove basically the whole foot including talus and calcaneus
What is the difference between endo and exoskeletal prosthesis
endo: has a pylon, could have foam over it, more adaptable
Exo: hard shell all the way, more durable
What are the 2 types of sockets
Patella tendon bearing or total surface bearing
What are the pressure tolerant areas
femoral condyles
patella tendon
Tibial shaft and ant compartment
fibular shaft
posterior compartment
What are the pressure intolerant areas
fibular head
tibial crest
distal anterior tibia
hamstring tendons
What does an adjustable socket-less socket look like? what are the benefits?
usually has a ratchet, more pressure on tolerant areas
What K level might have the waist belt suspension?
K1
What K level might have the joints and corset suspension?
K1
supracondylar suspension
cuff strap suspension
Sleeve suspension
How does the suction suspension work?
rub alcohol on residual limb and by putting it into sockets, the air comes out and suction is formed
What are the locking liners suspensions
pin and lock
shuttle lock system
lanyard
What K level is household ambulater and fixed cadence
K1
What K level is fixed cadence, multiple surfaces, low level barriers
K2
What K level is stairs, variable cadence, uneven terrain
K3
What is K4?
specific athletic feet
Which foot has no ankle movement
SACH
When the cushion heel is too stiff you ___, when the cushion heel is too soft you ___
buckle
hyperextend
A single axis foot has __ mvmt but no __
DF/PF
no in/ev
the PF bumper is used for which rocker?
If its too stiff you__, too soft you__
1st Rocker (loading response)
buckle
hyperextend
multi axis foot has which mvmts
DF/PF, M/L
What K levels is single axis foot and multi-axis foot
single: K1
multi: K2
What is he keel made of in a K1 foot? K2? What does the keel do
K1 - wood
K2 - rubber
gives toe off in trailing limb position, the rubber one has some energy storing
What kind if foot is light weight, carbon fiber, energy storing
What K level?
dynamic response foot
K3
Can the microprocessor foot accommodate different heel heights?
NO
What kind of foot has constant feedback about surface and adjusts to different shoes
microprocessor foot
What feet do K1 qualify for?
SACH, single axis
What feet do K2 qualify for?
multi-axial, flexible keel
What feet do K3 qualify for?
dynamic response, flex-foot, multi-Axial
What is bench alignment
5 degrees of socket flexion
5 degrees socket adduction
foot slightly inset, medial border in parallel to line of progression
Why is the socket set to 5 degrees flexion (anteriorly)?
elongates quad –> increase shock absorption during LR
Why is the socket set to 5 degrees of adduction? where do we want to pressure?
to create varus moment at the knee
pressure distal lateral - tibialis anterior
pressure proximal medial - tibial crest
Why is the foot slightly inset?
to create a narrow BoS and more energy efficient
What is the bench alignment for the illiac crest? Why?
level to or 1cm shorter on prosthetic side for foot clearance
bench alignment for heel hight
too low:
too high:
hyperextend
buckle
What are you looking at with dynamic alignment
stance stability
swing clearance
equal step lengths
energy efficiency
What intrinsic problems will a PT influence
weakness
contracture
pain
fear
