Exam 5: Prosthetics PartFoot, Bilat, HighLE, UE ReadingGuide and Class discussion

Question 1

What are 8 disarticulation/transection surgeries used in the foot?

Answer 1

• Forefoot
  
  • Digit (metatarsophalangeal disarticulation of one digit)
  • Ray (tarsometatarsal disarticulation of one ray)
  • Transmetatarsal (cut through metatarsal bones)
• Midfoot
  
  • Lisfranc (tarsometatarsal disarticulation)
  • Chopart (midtarsal disarticulation)
• Hindfoot
  
  • Syme’s (disarticulation of the talocrural joint; tarsotibial disarticulation)
  • Two more that are similar to Syme’s functionally, but rarely used on adults:
    
    • Pirogoff (wedging transection of the calcaneus, followed by bony fusion of the calcaneus and distal tibia with all other distal structures removed)
    • Boyd (calcaneus remains largely intact rather than being wedged before arthrodesis with the tibia)

Question 2

What are 3 forefoot amputations?

Answer 2

• Forefoot
  
  • Digit (metatarsophalangeal disarticulation of one digit)
  • Ray (tarsometatarsal disarticulation of one ray)
  • Transmetatarsal (cut through metatarsal bones)

Question 3

What are two midfoot amputations?

Answer 3

• Midfoot
  
  • Lisfranc (tarsometatarsal disarticulation)
  • Chopart (midtarsal disarticulation)

Question 4

What are three hindfoot amputations?

Answer 4

• Hindfoot
  
  • Syme’s (disarticulation of the talocrural joint; tarsotibial disarticulation)
  • Two more that are similar to Syme’s functionally, but rarely used on adults:
    
    • Pirogoff (wedging transection of the calcaneus, followed by bony fusion of the calcaneus and distal tibia with all other distal structures removed)
    • Boyd (calcaneus remains largely intact rather than being wedged before arthrodesis with the tibia)

Question 5

What is a Chopart amputation?

Answer 5

• A Midfoot amputation
• Disarticulation of the Talocalcaneonavicular joint (midtarsal disarticulation)
  
  • Separates the talus and navicular as well as the calcaneus and cuboid.

Question 6

What is a lisfranc amputation?

Answer 6

• A midfoot amputation
• Separates the three cuneiform bones and the cuboid bone from the five metatarsal bones (tarsometatarsal disarticulation)

Question 7

What is a Transmetatarsal amputation?

Answer 7

• Forefoot amputation
• Cut through the metatarsals (metatarsal transection)

Question 8

What is a ray resection?

Answer 8

• a forefoot amputation
• Removal of one Ray (tarsometatarsal disarticulation of one ray)

Question 9

What is a digit amputation?

Answer 9

• A forefoot amputation
• Removal of one Digit (metatarsophalangeal disarticulation of one digit)

Question 10

What is a Syme’s Amputation? (simple)

Answer 10

• A hindfoot amputation
• A disarticulation of the ankle
• Syme’s (disarticulation of the talocrural joint; tarsotibial disarticulation)
  
  • Retains and re-attaches the heel pad

Question 11

What are two hindfoot amputations besides the Syme’s and when are they used?

Answer 11

Two more that are similar to Syme’s functionally, but rarely used on adults because there is not enough room to put prosthetic foot under the residual limb):

• Pirogoff (wedging transection of the calcaneus, followed by bony fusion of the calcaneus and distal tibia with all other distal structures removed)
• Boyd (calcaneus remains largely intact rather than being wedged before arthrodesis with the tibia)

Sometimes used in children (I assume because RL side will not grow while soudn side continues to grow and there will be more room for a foot underneath the residual limb)

Question 12

Describe a typical partial foot amputee who lost it due to vascular insufficinecy (4)

Answer 12

1. Pt typically has vascular insufficiency (still)
2. is usually between the ages of 60-70 years,
3. has compromised proprioception and sensation, and has
4. weak lower limb musculature.

Question 13

Describe typical gait limitations for individuals with partial foot amputations, especially in the presence of vascular disease. (3 main with several sub-points)

Answer 13

1. May be able to ambulate without a prosthesis
2. Slow gait velocity, Inefficient, somewhat dysfunctional gait
   
   • May compensate for unstable knees due to weak quads and impared prorprioseption by keeping knee extended during loading response.
     
     • (bad b/c it causes extra force on joints)
   • Has lost forefoot lever arm
     
     • Abrupt unloading from premature toe break and forefoot collpase
       
       • (short contralateral stride length)
     • Higher pressure on residual foot
3. Plantar Flexion contracture common

Question 14

Describe typical gait limitations for individuals with partial foot amputations, especially in the presence of vascular disease:

• what are two things that contribute to Slow gait velocity, Inefficient, somewhat dysfunctional gait (and what are some consequences)?

Answer 14

1. Slow gait velocity, Inefficient, somewhat dysfunctional gait
   
   • May compensate for unstable knees due to weak quads and impared prorprioseption by keeping knee extended during loading response.
     
     • (bad b/c it causes extra force on joints)
   • Has lost forefoot lever arm
     
     • Abrupt unloading from premature toe break and forefoot collpase
       
       • (short contralateral stride length)
     • Higher pressure on remaining residual foot

Question 15

What is a bad thing that can happen if a partial foot amputee compensates for poor knee control by keepign knee extended during loading response?

Answer 15

• this sacrifices shock absorption at knee and hip, increasing the likelihood of cumulative joint trauma at hip and knee.

Question 16

How is compromised forefoot support related to higher energy costs?

Answer 16

Compromised forefoot support increases center of gravity displacement. A penalty of higher energy cost results.

Question 17

Explain the relationship between forefoot rocker and peak dorsiflexion in partial foot amputees and walking velocity

Answer 17

Walks with significantly slower velocity (Delay in forefoot rocker, delay in peak dorsiflexion)

Question 18

Expalin why peak vertical GRF are higher for the sound limb in someone who has a partial foot amputation

Answer 18

There is an abrupt and prmature unloading of the amputated side during late stance and body-weight must transfer quickly to the sound side.

• Amputated side has
  
  • premature toe break and forefoot collapse
• Fear, insecurity, and pain aggravated by increases pressure near the amputation site collectively create an abrupt transfer of weight to the sound side, thus increasing the magnitude of the initial vertical force peak.

**this also reduces the step length of the sound side

Question 19

What is the relationship etween the plantar surface-area of the forefoot and the magnitude of pressure that is on the foot?

Answer 19

As plantar surface area of the supporting forefoot is reduced the magnitude of the pressure is increased.

Question 20

What is the consequence of a plantarflexion contracture in someone with a partial foot amputation?

Answer 20

Pts with partial foot amputation frequently have plantar flexion contracture develop from muscle imbalance.

• any PF contracture, in turn, increases pressure at the distal residual limb during terminal stance, causing discomfort, pain, and risk of ulceration

Question 21

What happens to a shoe if it is worn by a partial foot amputee without prosthetic replacement?

Answer 21

Shoes worn without prosthetic replacement of the missing forefoot quickly become disfigured (collapse at the toe break)

Question 22

Name the areas of the residual foot most vunerable to tissue damage during walking. (f4)

Answer 22

1. Distal end, first and fifth met heads
2. navicular,
3. malleoli
4. tibial crest (front, shin-bone area I think)

Question 23

Describe two actue prosthetic options for someone with a partial foot amputation? (not symes as far as I can tell)

Answer 23

Neuropathic walker developed at Rancho Los Amigos locks the ankle in custom molded, foam lined, thermoplastic AFO. Rocker bottom is contoured

• provides optimum protection for insensate foot
• Helps with first priority immediately after amputation: to protect the remaining tissue.

Custom shoe insert with in-depth or post op shoe for people with adequate protective sensation

Question 24

What is the top priority just after a partial foot amputation is performed due to dysvascular issues?

Answer 24

first priority immediately after amputation: protect the remaining tissue.

Question 25

What are some long term footwear options for a partial foot amputee (excluding symes)? (6)

Answer 25

1. Modified shoe with Toe fillers
2. Custom shoe inserts with toe fillers
3. UCBL orthosis
4. Cosmetic Slipper Designs
5. Prosthetic Boots
6. AFO

Question 26

Modified shoes with Toe Fillers

• what is it?
• what challenge does it have?

Answer 26

Modified shoes with Toe Fillers

If a simple filler is prescribed, an extended steel shank or band of rigid spring steel should also be placed within the sole of the shoe, extending from the calcaneus to the met heads. The challenge is to match the appropriate d

Question 27

Custom Shoe Inserts with Toe Fillers

• What is it/Advangates?
• Who is it good for?
• Is it combined with any other equipment?

Answer 27

Custom Shoe Inserts with Toe fillers

• A foot orthotic with arch support and filler is preferable to the simple filler because it can be used in different shoes and because it provides plantar support to an already compromised weight bearing surface.
  
  • Common for pts with hallux or first ray amputation.
  • Commonly used with an extra-depth shoe

Question 28

UCBL orthosis (for partial foot amputation)

• What is it/advantages?
• who is it good for/extra features?

Answer 28

UCBL orthosis

• better controls subtalar and forefoot position than custom made shoe inserts
• Can be effectively incorporated into a custom orthosis and filler for persons with partial foot amputations.

Question 29

Cosmetic Slipper Designs (4 points)

• What is it/advantages?
• who is it for?

Answer 29

Cosmetic Slipper Designs

• made for pts who consider cosmesis paramount.
• Based on “life cast” (an alignment impression of a human model).
• Provides little ambulation advantage but does increase shoe life.
• May be appropriate for transmetatarsal amputees who place a premium on cosmesis.

Question 30

Prosthetic Boots

• what are they/advantages?
• who are they good for?

Answer 30

Prosthetic Boots

• laced or hook-and-loop ankle cuff closures
• Appropriate for Lisfranc or transmetatarsal disarticulation or amputation.
• may be the general prosthesis of choice for most pts with midfoot amputations.

Question 31

AFO (for partial foot amputations) (4-5 points)

• what is it/advantages?
• who is it for?

Answer 31

AFO

• Shell supports the plantar aspect of the foot, incorporates the heel, and extends up the posterior leg to the belly of the gastroc. Circumferential anterior strap stabilizes the limbs in the AFO.
• Provides advantages of the arch support/UCBL orthosis and boot with max containment and lever arm for support and substitution of the rocker mechanism.
• Enhanced stability and control because of high proximal trim line.
• Excellent solution for pts with partial foot amputation and may be the prosthesis of choice for the active pt with a Chopart of Lisfranc amputation.
  
  • Joints can be incorporated and helpful for a pt with high activity level.

Question 32

What are 5 types of prostheses for Syme amputations?

Answer 32

1. Canadian Syme Prosthesis
2. Medial Opening Syme Prosthesis
3. Sleeve Suspension Syme Prosthesis
4. Expandable Wall Prosthesis
5. Tucker-Winnipeg Syme Prosthesis

Question 33

Details on the Canadian syme prosthesis (3)

• cosmesis
• strength
• who is it good for?

Answer 33

Canadian Syme Prosthesis

1. older, rarely used
2. relatively cosmetic
3. less sturdy because of posterior window

Question 34

Details about Medial Opening Syme Prosthesis (4)

• alternate names
• cosmesis
• strength
• who is it good for?

Answer 34

Medial Opening Syme Prosthesis

1. Also known as the Veterans Administration Prosthetic Center Syme Prosthesis
2. Relatively cosmetic
3. Provides more opportunity for anterior-posterior strength of prosthesis (Because window is on the medial side)
   
   1. stronger than Canadian
4. choice for many pts with the syme amputation

Question 35

Sleeve Suspension Syme Prosthesis (6)

• alternate names
• how it works
• cosmesis
• strength
• adjustibility
• who is it good for? (3)

Answer 35

• also called stovepipe syme prosthesis
• Has inner flexible insert or sleeve that has filler material in the areas just proximal to the distal expansion. (put the residual limb in the the flexible insert, then slide both into the hard outer shell)
• bulky, not very cosmetic
• Sturdier, than previous designs
• More adjustable and forgiving than other Syme designs
• Often chosen for
  
  • obese or very heavy-duty wearer or for
  • pt with recurrent prosthetic breakage with other designs.
  • when major fitting problems are anticipated

Question 36

Expandable Wall Prosthesis

• alternate names (2)
• how does it work?
• cosmesis
• who is it good for?
• Other disadvantages/advantages? (2)

Answer 36

1. also called
   
   • flexible syme prosthesis
   • bladder syme prosthesis
2. Inner socket wall just proximal to the distal expansion that is elastic or expandable enough to allow entry of the limb into the prosthesis and still provide the level of total contact around the ankle donned
   
   • Normally requires a double prosthetic wall
3. Slightly bulkier and less cosmetic at ankle than Canadian or medial opening counterparts
4. Requires more extensive fabrication process
5. Act of donning and doffing is relatively simple
6. May be the prosthesis of choice for pts with upper limb dysfunction or cognitive impairment.

**for symes amputation

Question 37

Tucker-Winnipeg Syme Prosthesis (6 points)

Answer 37

1. rarely seen in USA
2. Ignores total contact by utilizing lateral and medial donning slots
3. Well suited for children
4. Contraindicated for pts with severe vascular disease or those prone to window edema
5. loss of total contact can affect proprioception and control of prosthesis
6. Permits prosthesis that is relatively cosmetic, easy to don ,and not prone to noises that are sometimes created by rubbing at the window covers of canadian and medial opening designs.

Question 38

Describe the syme’s amputation in more detail

Answer 38

the amputation

• disarticulation of the ankle (talocrural disarticulation, tibiotalar disarticulation)
• A Syme amputation is an amputation done through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis (artificial limb)

Question 39

Two possible problems exist in amputation at the Syme level (not necessarily a problem for prosthetic component selected)

Answer 39

1. migration of the distal heel pad (which may be surgically avoidable; also why you do not do immediate FWB)
2. poor cosmetic result (which can sometimes be partially addressed by removal of the malleoli)

Question 40

What are two challenges for prosthetic component selection and socket fit for a Syme’s amputation?

Answer 40

1. bulbous distal end
2. Small amount of space between distal end of residual limb and floor. Hard to attach foot without causing a leg length difference (and needing to add a heel wedge to the sound side)

Question 41

General alignment guidelines for syme amuptation

Answer 41

1. placing syme foot in slight dorsiflexion relative the shin section mimics normal gait patterns
   
   • for pts with quad weakness, the dorsiflexion angle can be reduced to minimize excessive demands on quads.
   • Current practice is to set the foot at approx 5 degrees DF.
2. Alignment can be significantly compromised when knee flexion contracture is present. To prevent breakage and premature wear from the anterior lever arm, the degree of anterior (linear) displacement of the socket over the foot is generally reduced from that of a transtibial prosthesis
3. Socket is positioned in an angle of adduction that matches the anatomical adduction angle of the tibia (creates as smooth a transition as possible at the ankle and knee so that prosthetic foot rolls over with the sloe flat on the floor)
   
   • creates a slight varus moment.
4. Socket adduction angle , foot eversion angle, and linear displacement affect the external varus moment at the knee during midstance. For an efficient and cosmetic gait, the knee must displace approximately 12 mm laterally at midstance.
   
   • can add joints and thigh corset to provide extra knee support and protection if needed.

Question 42

Describe the basics of alignment stability for the high-level LE amputee while standing quietly.

Answer 42

Standing quietly

• weight bearing line
  
  • posterior to the hip (extension moment)
  • anterior to the knee (extension moment)
  • anterior to the ankle (dorsiflexion moment)

Question 43

Describe the basics of alignment stability for the high-level LE amputee during ambulation

Answer 43

Initial contact GRF

• anterior to hip (flexion moment)
• anterior to knee (extension moment)
• posterior to the ankle axis (plantar flexion moment)

By Midstance GRF (alignment stability is maximal, and like that of standing)

• posterior to hip (extension moment)
• anterior to knee (extension moment)
• anterior to ankle (dorsiflexion moment)

Preswing GRF

• GRF moves posterior to knee joint axis, allowing the knee to bend passively to f

Question 44

Describe basic socket design for the high-level LE amputee.

(general things)

Answer 44

There are a variety of socket designs. The most critical factors for successful use are careful fitting and secure suspension.

• Flexible thermoplastic or silicone materials within a rigid laminated frame are more comfortable and increasingly popular compared to the more common hard sockets.
• Suspension is achieved by carefully contouring the socket just proximal to the iliac crests whenever possible.
• shoulder straps may be needed if pt is obese or has no ileum.

Question 45

Suspension for high level (hip disarticulation, hemipelvectomy, translumbar) sockets

Answer 45

Suspension is achieved by carefully contouring the socket just proximal to the iliac crests whenever possible.

shoulder straps may be needed if pt is obese or has no ileum.

Question 46

what are three types of high-level LE amputations?

Answer 46

1. Hip disarticulation
2. hemipelvectomy
3. Translumbar

Question 47

details on hip disarticulation sockets (1)

Answer 47

hip disarticulation, encapsulation of the ascending pubic ramus may add stability if it can be tolerated.

Question 48

details on transpelvic sockets

Answer 48

transpelvic socket must fully enclose the gluteal fold and perineal tissues and completely contain the soft tissues on the amputated side.

• early transpelvic sockets extended upwards to contain the lower ribs, but this is not always necessary in muscular or lean pts.
• diagonally directed compressive force in the socket design, supports and contains transpelvic tissue and eliminate the risk of perineal shear and tissue breakdown

Question 49

Details on translumbar sockets

Answer 49

Translumbar sockets achieve weight bearing with a combination of soft tissue compression and thoracic rib support

• because of loss of more than half of body mass, weight bearing tolerance is better than might be expected.
• designs allow pt to vary the compression by adjustable straps are common.
• pts need socket for effective seating and wheelchair mobility.
  
  • many can also ambulate some (but w/c is primary mode of mobility)

Question 50

In the dysvascular patient, how does loss of one limb affect the risk of eventual bilateral limb loss?

Answer 50

It greatly increases it. As many as 50% of people who undergo amputation of one LE due to dysvascular issues will subsequently lose the other LE within 5 years.

Dysvascular issues is the major cause of bilateral LE limb loss in the USA.

Question 51

How do energy consumption, overall rehab and gait expectations change for the bilateral LE amputee?

Answer 51

In general, as the level of amputation moves higher

1. energy consumption increases
2. Rehab is more difficult, requires more time
3. Pt is not expected to reach as high a level in rehab or recover as high a level of gait function.

Question 52

Name two advantages of “stubbies” for the bilateral TF amputee.

Answer 52

(easier to use)

1. require less energy than a full prosthesis
2. require less balance than a full prosthesis

Question 53

What two types of UE amputations account for 80% of UE amputations?

Answer 53

*Transradial and transhumeral amputation account for 80% of UE amputations

Question 54

Describe and name the various levels of UE amputations. (6)

Answer 54

1. Wrist disarticulation- separates the carpal bones from the radius and ulna
2. Transradial- amputations that occur within the substance of the radius and ulna
3. Elbow Disarticulation- humerus preserved but ulna and radius are removed
4. Transhumeral- amputations that leave more than 30% of the humerus length
5. Shoulder disarticulation- less than 30% of the proximal humerus remains
6. Forequarter and Scapulothoracic amputations- more proximal amputations that invade the central body cavity, resecting the clavicle and leading to derangement of the scapula

Question 55

What are 5 types of UE prostheses?

Answer 55

1. passive
2. Body-powered
3. Myoelectric
4. Electric
5. Hybrid

Question 56

6 Details of passive UE prostheses

Answer 56

1. does not possess ability to actively position a mechanical elbow in space or provide grasp and release function
2. functional by supporting objects or stabilizing items during bimanual tasks or activities
3. suspension is a self suspending design with socket interface geometry or suction negative pressure
4. typically light
5. can be made of latex which is cheap, but stains and breaks down in UV light
6. can also be made of silicone- more expensive, but durable, no staining, high cosmesis, and increased coefficient of friction

Question 57

5 Details of Body-powered UE prostheses

Answer 57

1. powered by shoulder movements and cable excursion
2. shoulder movements are typically one or a combo of shoulder flexion, scapular protraction
3. Range for best function is below shoulder and above waist. below waist and above head are very difficult for controlling functional grasps. Behind the back tasks are impossible.
4. Good for it’s reliability and durability
5. suspension is typically figure 8 but may use self suspending socket and may use locking or suction valve mechanism

Question 58

8 details about Myoelectric UE prostheses

Answer 58

1. uses EMG signals created by small electrical potentials generated by contraction of residual muscles to operate one or more devices
2. In transradial amputation, electrodes placed over flexor muscle residuum to control grasp; electrodes placed over extensor muscle residuum to control release
3. Many possibilities re: size, placement of electrodes, need for remote or non-remote preamplification electronics. All decided by prosthetist, who also considers placement based on amount of soft tissue, presence/absence of scar tissue, and material medium with which the interface will be created.
4. Patient is able to develop precise speed and grip strength strategies since electrodes are sensitive to speed, force, and amplitude of muscle contractions
5. Ex: transradial patient can use quick contraction of forearm muscle residuum to switch between control of hand and wrist
6. Programmable controllers, also seem to be called microprocessors may be helpful to amputees learning to control their prosthesis and are struggling to differentiate the various amplitudes with certain muscle contractions. They pre-program certain movements (like a pattern of movement such as all LE movements required to pick up cup) with certain contractions which expand what the new amputee is able to achieve. Options can be adjusted and expanded as new amputee becomes more proficient with their muscle contractions to control movements
7. Three approaches used to program (modify movements) microprocessor
   
   1. adjustments made through direct connection with computer
   2. wireless
   3. implementation of coding plugs
8. For some new amputees (indication not given) an early postoperative fitting with a myoelectrically controlled TD may be integrated in a rigid dressing. Has shown positive psychological and physiological benefits.

Question 59

Myoelectric UE prosthesis: what are the three approaches used to program (modify movements) of a microprocessor?

Answer 59

Three approaches used to program (modify movements) microprocessor

1. adjustments made through direct connection with computer
2. wireless
3. implementation of coding plugs

Question 60

8 details of electric UE prostheses?

Answer 60

1. if myoelectric is just too difficult for patient to master, may opt for use for switch control as an alternative for operating electric prosthetic components
2. does NOT use electrodes and muscle contractions
3. little training required, can develop functional grip strength in short period of time
4. switch control systems require extremely small movement (small excursion and light force) to trigger which is ideal for people with limited ROM and strength
5. Most switches are activated by pulling a strap or cable , but some are activated by depressing a lever or button
6. Limiting factor: most switches do not have the capacity to provide proportional output to control electronic components
7. Servo-resistor or sensing resistor are needed for porportional control. Important because the presence of proportional control is linked to complexity of fine motor control
8. Electric hands use “three jaw chuck” grasping patterns, however there are more compliant hands now that utilize all 5 fingers though it does not sound like it is completely commonplace yet.

Question 61

4 details of hybrid UE prostheses

Answer 61

1. Allows pts with varying degrees of functional capacity to be fitted successfully with components from two different arenas. For some individuals, integration of tech from conventional and externally powered systems is best
2. Prosthetic systems can be configured to use the electrically powered elbow with a body-powered mechanical TD or an electrically powered TD with a non-powered elbow. (can also incorporate myoelectric and spring assisted mechanical devices)
3. Good arguments can be used to support both strategies.
   
   • final decision is based on pt’s ability to use proprioceptive feedback from cable system as well as available inputs for the electromechanical system.
4. Frequently sought because insufficient range or strength is available to provide complete functional control at the elbow joint and TD with conventional systems.
   
   • frozen shoulder
   • unstable joint (subject to frequent subluxation)
   • shoulder disarticulation

Question 62

What is a voluntary opening terminal device?

Answer 62

Voluntary opening system: the terminal device is closed at rest, and the wearer opens the hand by means of the cable

Question 63

what is a voluntary closing terminal devices?

Answer 63

the terminal device is open at rest, and the wearer closes the hand by means of the cable

Question 64

5 Details of a voluntary opening system/terminal device

Answer 64

1. able the wearer to apply volitional force and excursion of the cable to open the TD. Once tension is released from the cable system, the object being grasped is “trapped” in the device, allowing the wearer to position the object in space as the task demands.
2. The grip strength (prehensile force) is dictated by some external closing mechanism, most frequently springs or elastic bands. Can add multiple layers of elastic bands or multiple springs, but must be matched to wearer’s ability to create and sustain cable excursion.
3. Grip strength is constant and cannot be voluntarily modified when handling heavy or fragile objects.
4. There are challenges with matching pt ability, cable friction, to get the right balance. However, some manufacturers have tried to help this by incorporating ways to adjust force with adjustable settings.
5. Not often chosen for
   
   1. pts with transhumeral amputations because of the limited cable excursion available to them.
   2. bilateral amputees if convention

Question 65

5 Details of a voluntary closing system/terminal device

Answer 65

1. the key advantages is ability to volitionally grade prehensile force adapting it to the characteristics of the object that is to be held
2. Significantly higher forces can be applied through the cabling system
3. Usually limited only by the motor powers available from the wearer or by discomfort of the residual limb
4. The pt must maintain both excursion and power as to retain the object in the TD.
5. The TD of choice if bilateral conventional prostheses are recommended.

Question 66

Notes from class: partial foot amputations

2 take home points

Answer 66

1. may not need prosthesis
2. Shoe-fillers are usually not enough. Pt needs more support (the whole ankle complex)

Question 67

Notes from class: partial foot amputations

2 Stratagies for prevention of deformities

Answer 67

1. Extended/Rigid shanks in shoe (more about gait deviations)
2. AFO including one with supramalleolar control

Question 68

Notes from class: partial foot amputations

T/F: prosthetic boot and AFO are the same

Answer 68

false

(the boot adds more support?)

Question 69

Notes from class: Symes

What happens to the heel pad?

Answer 69

it is preserved (attached to the bottom of the residual limbs)

Question 70

Notes from class: Symes

What happens if pt weight bears too early?

Answer 70

Heel pad will migrate

Question 71

Notes from class: Symes

Two downsides

Answer 71

1. Boney bolbous ends (can try to shave malleoli to help with this, and there are special prostheses to help with this)
2. Hard to keep pelvis level when they put ankle-foot mechanism under it

Question 72

Notes from class: High Level amputations

What are a couple of points Dr. mincer made on the last day of class?

Answer 72

1. Have all the problems of a transfemoral amputee, but now missing hip joint too
2. Decreased ambulation ability (probably don’t function with prosthesis at high level)

Question 73

Notes from class: Hemipelvectomy

What are some points Dr. Mincer made the last day of class

• Other problems besides gait

Answer 73

• Another problem besides gait
  
  1. body image
     
     1. Teenagers are most likely to get bone cancer
  2. Sitting
     
     1. sitting sockets are needed (built into prosthesis or a seperate prosthesis for those who always sit)