Socks. Seems so simple.
Simple thing for prosthetic patients to have that they're going to get a bag
full of socks when they get their prosthetic. Different levels of socks.
It seems simple but it's vitally important and honestly one of the most
frustrating things patients deal with is regulating socks correctly.
So why is it so important?
It's important because the prosthetist is going to make a prosthetic socket on a
give that fits the patient on the day that it was made and as the patient
progresses and becomes more functional walking,
they're going to tend to taper and shrink and shape their residual limb.
It's not going to be the same size as that occurs.
Something's got to fill the void between the two.
On a given day someone may actually have eaten too much salt the night before
and swell up some and you have to take some socks off.
So remember the human body is a dynamic organic machine that's changing every
day and socks are the only way that you can adapt the fit of a fixed socket to
the patient on that given day. Now there are different types of socks.
This is a one ply sock.
This sock happens to have a hole in the end that is if they're using a pin
system or a lanyard system without a system like that, a vacuum suction system,
you can just have a straight sock without a hole in the end.
The hole's very important for a pin system,
which we'll look at when we put the socket on.
There are three ply socks and there are different types of socks. Um,
and there are different manufacturers of socks.
So what you're going to get many times is with your particular prosthetist,
a chart that shows the different socks and what the thicknesses are.
Red will mean a certain thickness gray, green, blue.
You need to understand with your socks what that means because it doesn't matter
how many socks you're wearing it might...
It matters the ply of sock you're wearing.
So if you're wearing three socks that are one ply each,
that's very different than wearing three socks that are three ply each.
The three ply's going to give you nine ply sock with three times what you're
doing with the other volume.
You have to understand that you want to wear the least number of socks to get
the greatest ply so you're not piling up any more socks than you have to.
Now with this idea of regulating socks on an ongoing every day means that you
have to take socks with you,
no amputee should leave the home without having at least a one ply and a three
ply sock either in their back pocket rolled up in their glove box or in multiple
different places because if you're out in the middle of the day and you begin to
lose fit right,
it becomes very uncomfortable and dangerous fairly quickly and you need to be
able to adjust those socks to get the fit right again and so you can continue
going through your day. Shoes.
Very important to the prosthetic wearer.
A lot of people think they get their prosthetic device,
whatever shoe they stick on there is going to do well.
That's really not the case. You want to have the right shoe for the job,
and that is many times a cross trainer type shoe.
That means a shoe that has the right heel to toe drop-off.
Prosthetic feet are usually set at about a three eighths inch dropoff from heel
to toe and cross trainers are about in that family. In the same light,
here are strong upper that can lace around or Velcro around the prosthetic foot
to keep it in place and the base is wide and stable and has a shock absorbing
heel. That way it won't slip when the patient's walking and it'll keep them more
stabilized through the gait cycle. So this is the right shoe. Um,
however, a couple of things are important,
patients many times will go in and be fit on their first day with a particular
pair of shoes and then decide,
I think I'm going to switch my shoes before I go start therapy or I go somewhere
else.
That's difficult to do if you haven't been trained and assessed each shoe to fit
correctly. So let's go through some different shoes.
There are different types of cross trainers and different types of sneakers that
can work very well, have a different style of base.
The good thing for the prosthetic we talked about,
but it's also good for the residual or for the contralateral limb because that
can have a shoe that has a nice wide base, a shock absorbing sole.
You can put inserts in it as well to give them the best base of support.
However, I have lots of patients who say,
I only want to wear a dress shoe and we're lucky now that we have dress shoes
out there that have a rubberized virbam soul.
It's basically a sole of a tennis shoe and address you.
The thing you have to look for is a low to heel to toe relationship.
They make that that shoe as level as possible and it's stable enough upper to
hold the prosthetic foot in place. As far as for the contralateral limb,
it has to have a wide enough toe box that you're not going to cause compression
of the foot in the issue.
So here's an older shoe where you see a thicker heel which has very rigid heel.
This foot,
this prosthetic would be tipped forward and every time the patient steps it
would be a clunky one to slip the heel out to the side.
So you kind of want to stay away from rigid-soled, high heeled shoe.
It's just not going to fit well. A more stable shoe is a lower.
Now if we go to the opposite extreme and we say more of a Docksider a very
popular shoe can also lace up, get in place,
but it was very limited drop off from heel to toe.
This type of foot will or shoe will work well,
but you're going to have to put some wedging underneath the heel to hold that
foot up at a level position when they're walking.
Now putting the shoes on can be a trick unto itself.
So shoe horns are really helpful to have around because getting that shoe on in
a foot that doesn't articulate or doesn't move up and down is a,
is a stiff thing or is a difficult thing and you want it to be a good snug fit.
So standard shoe horns are great.
These extra long shoe horns are really great if you can't bend all the way over,
but get down to getting that foot in place.
Now the last shoe that people talk about is boots.
Difficulty with boots is a couple of things. One with no zippers on the side,
very hard to get the prosthetic foot in if not impossible. Second of all,
there's a large heel to toe relationship,
which means that often the whole prosthetic or everything is tipped forward that
makes it an unstable. And the third issue is mainly weight.
You've got a fairly heavy weight hanging at the end of a pendulum of the
prosthetic. If you do feel strongly about using a boot,
a couple of things are important. Make sure that boot can zip down the side.
So you have the chance of getting the prosthetic foot in.
Make sure the heel to toe relationship is as low and level as possible so that
you have the best chance of the getting out of a, what we call a vertical pylon.
So let's talk about that.
A vertical pylon is important because that's gonna establish how you know
whether you've got the right shoes for you. If you look at this pylon,
it is vertical. That means that device is set up with balance.
If it's leaning back, it becomes unstable to fall backwards.
If it's leaning forward,
it's going to make the knee want to buckle and the then the device to
potentially collapse. You always want pylon vertical,
so if you get a new pair of shoes, you put them on the prosthetic foot,
set the foot up on a table and make sure that that pylon is vertical.
If the pylon is leaning posteriorly, then you, or backwards,
then you're going to need to put some wedging underneath the heel to level it
up. If it's leaning forward in a high heeled shoe or a boot,
you really is not something you can use,
it's going to be too unstabling to the device and very difficult for the patient
to walk.
So picking the right shoe is really important to the patient to get the right
fit and the best walk. Once you've picked a pair of shoes, that works.
It's really important also to stay with it.
I would suggest to patients a lot of times for at least two to three months when
you're first getting started,
don't change the shoes cause even a good shoe fit will change the feel of the
walk and you want to master your walking control first.
Then you can look at various different shoes that you can potentially change
into, uh, over time.
The last issue is there are things what's called adjustable ankles.
So prosthetically if you get an adjustable ankle/foot or a prosthetic foot,
that can adjust to different heel heights, that is an option.
The benefit is you can do that with a different shoes.
The negative is that it's not going to give you the same amount of energy return
or stability that comes from a non-articulated ankle foot,
and so you have to make the right choice for you and the right shoes for you.
Thanks for watching and we hope that you found this information helpful.
This video is part of a series on prosthetic rehabilitation ranging from
managing the residual limb after amputation and progressing to running with a
prosthesis.
We encourage you to view our other videos in this series and to share them as
well. You can find them on our YouTube channel at YouTube.com/MissionGait.
To stay up to date on our latest content,
click the link in the corner to subscribe and be sure to like and share this
video.