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I have not personally used ROSS but I have seen it and interacted with it and the company at conferences. My co-worker who also does mobile prosthetics did get one for her van to sanitize liners while she is seeing people for their appointments. She has said it's really easy to use and it has held up well so far. I have also heard good things about it helping manage sweat and improve overall health of their skin. I know it is a large investment, from my understanding they do offer a free trial period and financing.

So glad they have been helpful! Let me know if you have any questions and wishing you the best!

@TheLegLady thank you.

Yes! I always warn new amputees that are using a pin that there will probably be moments that get frustrated, angry and want to chuck their prosthetic leg out the window. Glad to hear the sleeve suspension has been working out better for you!

I have used both successfully for people with diabetes. Typically diabetes isn't a main determining factor when it comes to pin or sleeve suspension. The main factors are going to be the ones mentioned the video. In addition though, when it comes to diabetes and using a prosthesis, you do want to make sure the socket is fitting well regardless of the suspension type. You also want to be mindful of sugar levels and A1C. You also want to be routinely checking the skin of the residual limb (and the intact limb), along with keeping the liner and your residual limb clean. This is true for anybody, but most of the complications I see are correlated with either a poor fitting socket or skin irritations.

We typically don't have any major issues with Medicaid IF the individual is at home. Medicaid will not pay for a prosthesis in a skilled nursing facility (even if the prosthesis is what would allow the individual to be able to go home). However, if the patient is at home typically they do require prior approval and sometimes additional documentation, which is an added step, but generally everything gets approved.

@@TheLegLady thanks, that takes a weight off my mom and my shoulders. She has been paying for blue cross blue shield of nc marketplace for a while since before I got back on Medicaid ( I moved from Miami, Florida a little over a year ago and had to have the insurance so I could go to a rehab for drug abuse) Since I’ve already completed the rehab I want I have her drop the blue cross is why I was asking because I don’t want her to have e to pay for it any longer and I don’t think k I need it if I have full Medicaid. Your replies are much appreciated. I’m starting my RUclips journey to learn and hopefully help others like I have gotten from your channel and others like footless jo and Annika and it’s good to see that even though your channel and theirs has become larger that you guys still reply pretty fast and with such emphasis. Thanks so much. God bless you and your family!

It's great to hear you were able to get acclimated to it so quickly! Any wight change of even 5-7lbs can definitely make a difference in the way the socket fits and feels so great to hear you are accommodating the change in volume with socks. If you are up to wearing 2, 6-ply socks (so 12 ply total) they should be able to add some padding to the socket to help snug it up. 8-12ply is really the max you want to be wearing. Insurances, including Medicaid, will pay for a new socket and new supplies (2 lines, 2 sleeves, and socks) at the 6 month mark. But you can get a new socket started and the approval process started so it is ready to deliver right at the 6 months. When it comes to the type of socket what do you mean by "socket system". Were you referring to the pin system since it sounds like you already have sleeve suspension? Limb length, in itself, wouldn't be the main determining factor, although it is a factor. I have had people with both long and short residual limbs be successful with both pin and sleeve suspension. Each style has pros and cons and a lot comes down to patient preference and what they want to use the prosthesis for. It sounds like you are very active and want to do a lot of different things. One option could be a sealing pin system, so you use the pin system most of the time, but for more high intense activities you can add the sleeve for more security. Will you be moving soon? I do mobile prosthetics and am based out of Morganton, NC. Winston Salem would be a reasonable distance for me to travel. Best way to reach out would be through the website: sunshineprosthetics.com and request a consult. Or there is also the Sunshine Prosthetics - Morganton google page. Would be happy to answer any further questions more indepth.

@@TheLegLady thank you so much for your detailed reply. It is much appreciated and I do live in Morganton right now. I will see if I can get a consult with you guys before I leave. I think the main reason my prosthetist said no pin system maybe is because of what’s left of my tibia bone is sticking out substantially and that is what causes me the most pain. I did get padding inside my top piece of the prosthetic last visit but for sure need to get a new top piece soon although it had only been about 3 months.

Oh wow 😳 How long ago was this? How are you doing now?

What would you do differently?

I have not personally worked with the Ohio Willowood system a lot, although I do have a lady I am currently working with who has used that system and prefers it to other systems. When doing her new socket we kept with that system and from my stand point it's easy to work with and fabrication/set-up is straightforward. We did change her liner and sleeve though from Ohio Willowood to Alps. I have found the Alps liners and sleeves to hold up better.

That is so awful! So much of it is ridiculous delay tactics. I hope it comes though soon if it hasn't gone through yet and you have a good team fighting with you! Glad you found the video helpful.

If the two bones were cut at the same length it can definitely cause potential fitting issues. If you are feeling pain all in the bottom, sometimes that's indicative of the socket fit is too loose specifically in key areas. The goal is to have a socket that equally distributes pressure over the whole of the limb, so you are not having areas of high pressure at the bottom or at boney areas. Hope you and your team can find a solution and help get you more comfortable!

Thank you for the encouragement for him!

Appreciate the feedback and you sharing you experience! I have run into that a few times as well with others I have worked with.

You don't need to worry about the bone continuing to grow, especially as an adult, but sometimes bone spurs can form. There is the Ertl Procedure which essentially created a "bony bridge" between the ends of the fibula and tibia. Not everyone is a candidate for the procedure and there are pros and cons to the procedure. It is not standard though and not typical of a transtibial amputation.

@@TheLegLady There must be some way to stabilize the two bones though, right? Screws, or muscle?

Glad to hear the video was helpful! Some of the main things: 1. Having your home prepared and ready for after surgery. Make sure you have a plan on how to get in/out and around your home. Right after surgery it’s usually a good idea to have something by the bed (could be a wheelchair or walker) to prevent falls. I’ve had a couple people after surgery feel like their leg is still there and try and stand up out of bed and land on the residual limb. 2. After surgery as you are healing and as you can start to tolerate it, touching and massaging your residual limb will help with the nerves healing and preventing any adhered scar tissue. There have been some people I have worked with that was never told that and ended up having some adhered scar tissue that can be uncomfortable. 3. At the pre-surgery consult ask about length. Some surgeons have left the residual limb too short unnecessarily which can make fitting and using a prosthesis more difficult. Sometimes there are medical reasons to go shorter but around mid calf is ideal. 4. When it comes to preparing the other leg, nothing too much aside from keeping it strong and protected. Hopefully you will be able to get your prosthesis quickly so you won’t be solely dependent on that side for too long. If you have the ability to and need to hop on that side occasionally to get around that’s okay, but I’m always telling those I’m working with to limit how much they are hopping. It puts stress and strain on the muscles and joints that they are not built for and is a risk for injury. Hope those things are helpful and reach out with any other questions!

Glad to hear the pin system has been working well for you!

Thanks! Do you have a below knee amputation? Sometimes the stiffness of a shoe or the heel stiffness of the foot can cause the prosthesis to want to rotate. More often than not though, it has more to do with the socket shape and fit. When sitting and standing some times it may have to do with some hip weakness, not having the foot in an ideal position, or not putting weight through and using the prosthesis to help you stand. (For above knee amputees, depending on the chair, and the way the socket is designed that can cause some rotation when sitting and standing). A sleeve suspension won’t make too much of a difference there unless there’s some weakness or laxity at the knee (but a lot of that can also be addressed with a well-fitting, well-designed socket).

​@@TheLegLadywow thank you very much for a detailed response, very helpful. I am AK amputee. I have noticed the pin does unscrew itself so every after few hours I have to check & screw it back. What if one was to superglue it to the linee, will that cause any problems?

Sorry, I have another question. Is it necessary for the foot to point downwards? Although this does make the leg more stable, but it kind of messes with the height. Since the tip of the foot is pointed down, the length of the leg has to be shorten a little to allow the foot to swing otherwise it won't have enough clearing space. Can the leg be made more stable without pointing the foot down? Thank you in advance..

@@bahatimabala3430 superglue would only be a problem if you need to remove the pin for any reason (one example would be if you need to switch the pin to a different liner). I am typically using blue LockTite to keep pins in place.

@@bahatimabala3430 Most likely there would be a way to make the leg more stable without the foot pointing down, especially since it was causing you to trip. Without seeing it, it's hard to tell you any thing definitively. If you felt like you were falling backwards and all your weight was on the heel, and that was why the foot was moved to point downwards, you could try to place a small wedge under the heel of the prosthetic foot instead. If the foot was pointed down to try and make the knee more stable: 1. most knees have an adjustment to increase stability 2. stability of the knee is going to be mostly impacted by where your weight line falls and the angle/position of the socket relative to the knee. So if you're looking at the side of you socket and divide it in half and drop a straight line from that point - typically the line should fall through the axis of the knee (where it bends) and through the posterior 1/3 of the foot. If that line is to far forward the knee will be too stable and will be hard to bend. If the line is too far back, the knee will be more unstable and will bend easily.

I have had some people that prefer crutches, but I typically suggest starting with a walker and then progressing to a cane and then on to no assistive devices if they are able and if that's a goal for them.

Do they prefer underarm crutches or forearm@@TheLegLady

What's the oldest patient you've had that preferred crutches?

Typically after casting, I will scan the cast in a flexed position of about 7-10 degrees (more if needed). So that flexion is built in. If I need to add more flexion I can do that with set screws at the pyramid. If I am doing up to 15 degrees for flexion tightness or contracture I will move the socket slightly more forward than normal so the weight line still falls at a good spot through the foot.

Depending on the specifics of what is going on, you should be able to walk with different types of shoes but it may require adjusting the alignment of the prosthesis. If you have a prosthesis with an alignment that was initially set up in a flat shoe and you then go into a shoe with a higher heel height, or vice versa, it will change the alignment of the prosthesis and also potentially change the forces acting on the ankle, knee, and hip (both anatomical and prosthetic joints). Sometimes when I have people that want to change shoes I will reassess alignment just to insure I don't have to change anything alignment wise for them to still walk well and safely.

Thank you so much for encouraging him!

We all need some encouragement and Some one to show it is Posible, I look at all the Service members that have cam back with both legs or more gone Like Joie Jone on Fox News He walks so well with 2 prosthetics they can due it hell so can I. I look up to a service members in so many ways, Tell him Keep up the video as well and he can due it. @@TheLegLady

So glad to hear it was helpful! Let me know if there are any other questions that come up and wishing you guys the best!

Wonderful! Hope it has been helpful. Let me know if there are any specific questions or topics you are interested in!

Alright, thank you so much.

It's hard to tell when the limb will stop hurting after amputation. The prosthesis should not be causing direct pain. Everyone is different but some of the main things that have been shown to help pain in the limb: massaging, compression, and/or use of a prosthesis.

You are welcome! Hope they help!