“How do I know what prosthesis is right for me?”
I get this question a lot.
Here’s my answer, and it’s probably going to annoy a lot of you…
It just depends.
You may read that, and say “duh. What a cop-out answer.” But really, there’s no truer statement. You may ask, “what does it depend on?” Well, to name a few…
…your activity level, both before the amputation and your current activity level
…are there other injuries or medical conditions you’re working around?
…what are your goals? What do YOU genuinely want to do? (NOT what do others want you to do?)
…how much of a residual limb do you have?
None of these factors will automatically lead you to the perfect answer, but they will help guide both you and your prosthetist when building your socket or choosing the right prosthetic equipment for you. The truth is, there’s no ONE right answer.
I don’t pretend to be an expert on this subject. After all, I did just say it depends on each person, so I can’t speak to every person’s case. I’m not a physical therapist, and I’m certainly not a prosthetist. I can only speak from where I’ve been personally and what I’ve learned over the years since getting my very first prosthesis as a toddler. From that experience, here’s a couple of thoughts and important lessons I learned…
You will most likely not get the perfect prosthesis in the first go-round. There will ALWAYS be something to adjust. The rest of your body, including your residual limb, can change over time, which will call for socket adjustments. What you think works great in the clinic probably won’t work after trying it in real life at home. You will be uncomfortable. Your socket will probably cause you some discomfort. I cannot stress this enough…these things are NORMAL. Every person goes through it. While adjustments need to be made and the entire process is incredibly frustrating, it doesn’t mean something is wrong with you, or that you’re going about it the wrong way.
The socket is by far the most difficult part of getting a new prosthesis, but arguably the most important. If the socket doesn’t work or fit right, the rest of your fancy equipment is pointless. Can’t utilize a really cool foot if the socket won’t stay on, ya know?
Sockets are extremely unique to each person. I grew up attaching my prosthesis with a TES belt around my waist. When I was 23, I moved to a combo of suction and a pin-lock system. The entire set up is built around my residual limb and my goals to be active. I can’t TELL you how many extra leg appointments I had in the beginning phases. Either the suction kept breaking or parts of the socket kept coming loose. Not to mention my skin kept breaking out in blisters because of the way it was reacting to the liner material I used.
If you’re in this current phase of the process: you are not alone in feeling frustrated. Give it time. I’m NOT telling you to live with unnecessary pain for the sake of “sucking it up.” I AM telling you to give the socket and any adjustments a fair chance before you decide that something won’t work for you. I hated my socket for about 3 months before I adjusted and fixed some of the major issues. I cried a lot over it. Now, I look back and realize all that frustration and patience was well worth it. Half of what I do now is possible because my socket helps enable me to maintain a high level of activity.
2. Following the socket….it’s time to decide on a knee (if you’re an AK amputee) as well as a foot. Side note: let’s just take a sec to appreciate that missing a leg means you can say sentences like “I’m going foot shopping.” If that’s not a great conversational piece, I don’t know what is.
One of the most important factors to remember in this process: a microprocessor knee may seem like the fanciest, most high-tech option. It does NOT mean that it is the best option for you. There are several different types of prosthetic knees: single-axis, polycentric, hydraulic, manual locking, and more. Deciding what is best for you is a conversation between you and your prosthetist, when you take several factors into account. You have to look at your past and current activity level, your goals, your current level of balance, the length of your residual limb, age, etc. All of those things play a really important role in deciding what equipment will work for you best.
I use a microprocessor knee now, and have used microprocessor knees since I was in high school. Up to that point, I did not have the strength or stamina to use one. I started with manual locking knees as a child (much simpler/safety focused), then moved to hydraulic (more fluid but I fell all of the time), and eventually moved to microprocessor when I could handle it. For one, they are MUCH heavier than most other knee types. Just a question to ask yourself: why deal with a heavier knee that has a lot of need for maintenance and room for technological error if you really don’t plan on using it to its full potential? That question isn’t meant to be insulting - it’s meant to bring some clarity to the decision-making process. “Fanciest” doesn't always mean “best option” when we’re talking fake legs, people.
If you do decide that a microprocessor knee is the best fit for you, there are several different types! (I know, the decisions never seem to end.) My opinion: no knee is “better” than another - it depends on what you like. For instance, before I got my C-leg 4 by Ottobock, I used the Plie 3 knee by Freedom Innovations. It worked great for me - my two favorite features were how lightweight it is and the fact that the rechargeable batteries are removable. When I switched to the C-leg 4, I did so because I was familiar with Ottobock and was interested in features like its stance-lock phase (very helpful to maintain certain exercises poses and a better boxing stance) and the phone app for the knee. (Yes you read that correctly - there is a PHONE APP for my KNEE. Another great conversational piece.)
Before I made that decision, my prosthetist also allowed me to try the Rheo Knee by Ossur for a few days. I remember the knee being very fluid and easy to use, but this particular knee defaults to “swing” phase over “stance” phase. This isn’t a bad thing at all - it allows for a very natural and easy walking gait - but it also means you have to be careful about where to plant the knee so it doesn’t give out from under you in “swing” phase. Because I rely so much on the “stance” phase of my knee in kick-boxing, I decided that the C-leg 4 was a better option for me.
Choosing a foot also depends on your lifestyle (shocking) and the type of knee you have. I’ll be straight up - I don’t know much about prosthetic feet. I’ve only tried out a few, and I definitely pay less attention to the foot than my knee, although it certainly is an important factor. I usually rely on my prosthetist’s advice for this. Currently I use the Proflex SC Torsion by Ossur (overall, most of the feet I’ve used before have been made by Ossur).
I hope these descriptions aren’t putting you to sleep. Why am I even going into this amount of detail in this blog post? To show you that it really does depend on your personal body and lifestyle body. There’s no one right answer. What works perfect for Joe Smith on Instagram may not be the best option for new amputee Suzy Q, who is watching Joe’s videos for motivation. Best way to find what’s best for you? Research. Set realistic goals for yourself. Talk to your prosthetist about you’re current situation and future goals. And remember…LOTS of trial and error.
I’ll leave you with two general thoughts to keep in mind as you navigate the world of prosthetics.
Remember that you don’t have to settle for less than you’re capable of. If you feel ready to move forward and do things beyond what your current prosthesis is allowing you to do, say something. Don’t lie down and assume “my prosthetist knows best. That equipment isn’t accessible to me.” NO. YOU know best. YOU KNOW YOUR BODY BEST. If you don’t want to settle, then don’t. Ask to try something new. At the end of the day, no one cares about your prothesis more than you. You are the one to live with it. People can encourage you, but you have to be the one to push yourself and make your goals a reality - no one else can do it for you.
Are you scared to ask for more because of the money/insurance fiasco? Been there. My advice, yet again, is to ask questions and to research. I recently got a running blade through a CAF grant…it didn’t cost me a dime. I didn’t even know that was a thing until a few years ago. Figuring out insurance can definitely be a speed bump when choosing prosthetic equipment, but it isn’t always a full-on roadblock. There are ways to make it work - trust me, I know from experience. I’m 28, pay for my insurance independently (which has terrible coverage), and I’m not rolling in money. Where there’s a will, there’s a way.
Now…time to go leg shopping.