Seven Points of Comfort

 
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 by Kevin Carroll

Seven points of comfort from world-renowned prosthetist Kevin Carroll, MS, CP, FAAOP

  1. Hygiene –

Prosthetic users find that washing their residual limb both in the morning and at night generally works well to maintain optimal hygiene with their prosthesis. However, it is especially important that you wash at night because bacteria builds up on the residual limb as the day progresses and will stay on your skin at night. If not properly cleaned, this could lead to skin breakdown.

  1. Perspiration and your prosthesis –

Perspiration tends to be a big problem for a lot of prosthetic users. To minimize perspiration on your residual limb, use an antiperspirant, similar to what you would use under your arms. ARRID XX Extra Dry tends to work well. To minimize perspiration, use it twice a day – once in the morning before donning your prosthesis and once at night before bed.

After doing this for a period of time you may find your skin gets dryer so you will then need to apply skin lotion. Try using the moisturizer at night (versus in the morning) to obtain a good balance with the antiperspirant. The Neutrogena brand of skin lotions tend to work well.

  1. Socket fit –

It’s crucial that your socket fits your residual limb well. As your limb changes in volume size, you have to be vigilant to maintain a proper fit. Socket fit can be sustained by maintaining a healthy weight.

However, when you maintain your weight, there will still be changes in your limb from time-to-time. It may be necessary to add or remove a sock, or use liners that have different thicknesses. When in doubt, consult your prosthetist.

  1. Volume management –

In addition to maintaining a healthy weight to obtain an ideal socket fit, it is also important to keep from losing muscle tone in your limb. In order to do this, you should continue to exercise your muscles. This can be achieved by tightening and relaxing your muscles. Fire up your muscles as hard as you can (i.e. if you’re a below-the-knee amputee, try to flex your foot as if it is still there). It’s crucial that you maintain muscles because as the saying goes, “if you don’t use it, you’ll lose it”.

  1. Pain management –

Some prosthetic users will encounter a painful limb from time-to-time and will need to have strategies to overcome the pain. One of the most common sources of pain in a person’s residual limb is at the nerve ending. This is called the neuroma. If you extend your arm and make a fist – imagine your entire arm is the nerve; look at your fist and that’s what the neuroma would look like under a microscope.

Often times this problem goes undiagnosed and can lead to a lifelong series of pain and discomfort for the prosthetic user. Sometimes it is as simple as your surgeon or rehabilitation physician evaluating the problem and injecting the area where the neuroma is located with an anti-inflammatory called cortisone. Many times this will lead to comfort for the prosthetic user; sometimes however, the neuroma may need surgery to have it removed.

  1. Alignment –

In the early stages following amputation, adjustments need to be made to your socket and the alignment of your prosthesis due to physical changes. This is necessary because the swelling decreases and your muscles may vary in size.

  1. Prevention of breakdown –

It is critical that you evaluate or check your residual limb on a daily basis for tissue breakdown, blisters, discoloration, abrasions, irritation, etc. Oftentimes sores, blisters, and the like can lead to larger problems.

It’s important to utilize a mirror for checking areas of the limb that may be difficult to see like the back of the knee, end of the residual limb, etc. If you have poor eyesight, make sure to have a family member check your limb on a daily basis. Prevention is always better than the cure. At the first sign of a problem, immediately seek attention from your prosthetist or physician; regular visits to both will ensure a healthy residual limb and desired comfort that goes along with utilizing a prosthetic limb.

Please note: This article is only intended for educational purposes. You should consult with your prosthetist and physician on a regular basis.