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Tips and Tricks

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What might prevent you from wearing your prosthesis and maintaining an active lifestyle? Infections: an infection can incubate easily in a prosthetic socket – a non-breathable, warm, contained environment where your natural body oils and sweat mingle, enhancing the breakdown of skin and the growth of bacteria .

Pus/drainage, odor, hot spots, fever, sudden pain, breakdown, blisters, and rashes are all signs of infection. How do you avoid them? Follow these simple preventative steps:

  • Make sure you wash your residual limb at least once per day with anti-bacterial soap (the soap should be unscented and unpigmented). If you sweat excessively, or are prone to rashes or infections, wash more frequently. Make sure to avoid alcohol-based lotions, as they actually dry out your skin, making it more likely to break down and increasing your risk of infection. A small amount of baby oil, on the other hand, maintains moist, soft skin. Whichever part of the prosthesis is in contact with your skin – the inner socket or liner – should also be washed with hot water and antibacterial soap on a daily basis.
  • If you wear liners, it is imperative to always have a pair for each residual limb. You must alternate the liners every day to permit them to maintain their elasticity and shape, and to ensure that they dry out completely before you put them back on. Liners should be cleaned with the side that touches your skin turned IN, using the following process:
    • (a) Wash the liners with hot water and antibacterial soap, shaking the water-soap mixture inside the liner for 30 seconds.
    • (b) Dump the mixture out of the liner and rinse again with hot water until no soap remains (at least three times).
    • (c) While the liner is still wet, add 4 drops of baby oil to the inside and rub it around thoroughly.
    • Once a week, after rinsing the liner but before adding the baby oil, apply isopropyl rubbing alcohol to the inside of the liner and rinse with hot water.
  • Maintain your prosthetic fit! Poor fit may lead to the symptoms described above, all of which increase your risk of infection. If you are a below-knee amputee, carefully monitor your sock ply throughout the day and adjust it whenever necessary. If you begin to experience pressure and pain in a particular area, make sure to make any adjustments you can (e.g. adding or removing socks), and if that does not help, contact A Step Ahead for a prosthetic adjustment.
  • The best way to prevent your fit from worsening is to maintain your body weight. Stability of body weight is the number one key to avoiding fit issues. The following are guidelines for weight fluctuations and how they will affect your socket fit:
    • 3-5 lbs. – noticeable difference that may require minor socket adjustments
    • 5-10 lbs. – requires major socket adjustments
    • 10-15 lbs. – may require complete reevaluation of socket and residual limb and probable casting for new socket
    • 15-20 lbs. – may need new entire new prosthesis and re-categorization of prosthetic components
  • Similarly, the wrong prosthetic alignment can cause pressure, swelling, and breakdown. Make sure to wear the correct heel – both in terms of its hardness/softness and its height – for your prosthetic foot. Discuss heel height issues with your prosthetist. If you like to change your heel height, your prosthetist can create a leg with an adjustable ankle.
  • Keep your residual limb dry. If you sweat a great deal, take your limb and liner off several times a day and dry it with a clean towel. Do not use an antiperspirant unless it is one of the brands suggested by your prosthetist.
  • If you suffer from decreased sensation in your residual limb, make sure to remove your prosthesis several times a day to check for signs of abnormal pressure areas. Otherwise, you can experience significant breakdown before you are even aware there’s a problem.

Itchy Rash – If you develop a mild rash, use an over-the-counter steroid cream. Also, make sure that your socket or liners are completely rinsed free of soap after washing. Keep your residual limb dry. Seek medical advice if these steps do not work.

Fungal Infection – If you experience an itchy, burning rash akin to athlete’s foot, use a topical anti-fungal cream and make sure your residual limb is dry. Seek medical advice if this treatment does not work.

Verrucous Hyperplasia – This is a condition caused by poor socket fit and is characterized by the development of a wart-like skin growth at the far (distal) end of the residual limb. If untreated, it can lead to an infection that could require revision surgery. Seek immediate prosthetic treatment to remedy the fit issue and seek medical advice to treat your skin.

Ingrown Hair/Folliculitis – Use ichthymal, a drawing salve. Never shave or use depilatory on your residual limb.

If you experience any of the following symptoms, emergency attention is required to prevent the infection from becoming life-threatening:

  • Your residual limb feels cold, turns blue, or you develop persistent pain deep in the muscles. These signs may indicate that your circulation has become impaired.
  • An area of your residual limb emits a bad smell.
  • The glands in your groin or armpits swell or become painful.
  • Pus/thick discharge seeps from any area of your residual limb.
  • An ulcer develops anywhere on your residual limb.
  • Skin becomes black/gangrenous.

By using common sense and caution, you can minimize the risk of infection, treat it at its earliest stages, and maximize the amount of time you are able to comfortably wear the prosthesis.

You Can’t Get it On!

On some days, you may have a great deal of difficulty donning (putting on) your prosthesis. Wearing a shrinker or Ace bandage while you sleep and up until you put on your prosthesis in the morning can help prevent swelling overnight. If you are a new amputee, you should wear a shrinker and/or Ace bandage whenever the prosthesis is off. Wearing shrinkers additionally helps shape the leg and prevents “dog-ears” or other shape irregularities that can complicate your fit in the socket.

Another potential cause of difficulty putting the prosthesis on is hot and humid weather. These conditions can cause your residual limb to swell and sweat, making it difficult to don the prosthesis. If this is the case, try (if possible) to get into an air-conditioned room or vehicle. After five to ten minutes, attempt to don the prosthesis again. If you are not diabetic and do not have a circulatory condition, you can also try applying a bag of ice over your residual limb, but make sure that you place a towel between the ice-filled bag and your skin. After 5 minutes, remove the ice and try to don your prosthesis again.

If you continue to have problems, a small amount of non-medicated baby powder applied under the liner may help you. However, continued use of baby powder over time can lead to mechanical issues that will require the prosthetist’s involvement to fix.

You Can’t Keep it On!

What does it mean if your prosthesis keeps slipping off when you walk? If your prosthesis has an air valve, one possible explanation is that you have a leaky valve that is letting air into the socket, breaking the vacuum required to keep the prosthesis on. Another possibility is that the prosthesis was not fully on to start with. Finally, the socket may have become too loose. If you continue to have this problem after donning the prosthesis and verifying that it is on your body correctly, you should call the prosthetist and expect to make a visit to remedy the problem.

Even when you are not confronted with an emergency, regular care and treatment is necessary to achieve a successful outcome. We make it a point to follow up with our patients to make sure that they schedule regular visits. Follow-up permits us to make sure that your prosthetic components are functioning properly and are not showing excessive wear, that all attachment points are secure, and that your socket fits comfortably. Failing to come in for this regular treatment can lead to more serious health problems, and we strongly advise all clients to stop by at the recommended intervals for their own benefit.

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