My Leg Doesn't Fit

 So first question first...is there too much room or too little room in your socket? 

Too much room: you need to add socks. If you have socks on make sure you increase your number but are keeping to as few socks as possible. If you have 3 socks on of the same ply can you use one sock of a thicker ply? It reduces the chance of wrinkles and therefore can reduce the chance of pressure where you don't want extra pressure or get a sore from localized pressure for hours. If you have 8-10 ply of socks on have you reached out to your prosthetist or if you are actively in PT, please make sure your physical therapist knows. Rule of thumb for most sockets at 8-10 ply we need to start making arrangements for a new socket.

Too little room: if you have socks on take some off. If you don't have any socks on, do you have a flexible inner liner (typically white) that is able to be removed from your prosthetic, is so pull it out. If you do this you may need a sock ply or two on as this increases room quickly. If you don't have a flexible inner liner that you can remove try some seated cardio or if you have access to equipment get on an arm bike or recumbent bike/stepper. Helping circulate your blood can help your body reduce edema/swelling. 

Both scenarios above are pretty common. The first usually comes as your body changes after amputation. Muscles atrophy, swelling from surgery decreases, the shape of your limb changes and this process is called limb maturation. This is expected and it is the reason why you were given a "big" bag of socks when you received your leg from the prosthetist. The socks help you manage comfort and proper fit until you have changed enough for a new socket, which could be 4 months after you received your first prosthetic or it could be a year after.

The second scenario is usually due to swelling in the limb. Honestly you can be doing everything right and wake up one morning and your leg can be tight, think about from a jewelry perspective, some mornings you wake up and your rings are tight (most likely during the summer, especially here in Maryland) and some mornings you will wake up and your rings will spin around your fingers. If your rings on your hands are tight, your leg/arm may be tight. If your liner will go on get your liner on, but also reflect back on other things that you have done or eaten. Did you have foods high in salt the last couple of days...chips, pasta, seafood with Old Bay, beer? Did you drink enough water? Yes I did just type that, if you are swollen you may not have drank enough water, our bodies need water to process waste products out of the system properly. When we are dehydrated are bodies don't work efficiently. Coffee, iced tea, lemonade, diet sodas...none of these counts towards keeping you hydrated. Water is the bulk of what we are made of and it is the bulk of what we need for hydration. For those of you telling me that you don't want to have to run to the bathroom more, think about it this way, the darker your urine color is the more concentrated the uric acid the more it irritates the bladder. If you drink more water it will decrease the acidity levels and thereby help decrease it as a bladder irritant. Next possibility is, have you been wearing your liner or your shrinker over the last couple of days, if not than this may be your culprit. As above, get your shrinker on if nothing else, but preferably getting your liner on is better since it is typically a little less stretchy than the shrinker. It also controls the shape of your limb better and will help it return to the shape needed for a good socket fit.

If the above information is unable to help you problem solve your situation, please reach out to your prosthetist as a new socket may be needed or your socket may have the ability for minor alterations that your prosthetist will have you come into the office to address.

Please feel free to comment or leave suggestions for new topics. 

Pain, what can I do?

 Treatment options are many and varied. So when I give you a list of 10-15 options don't expect them all to work nor that the first one you try will work. You may try your first option and get good results but you may need to try half of the list before you get relief. Don't get discouraged. Here we go.

1) Patting/Tapping: This is gentle, think burping a baby. It is exactly like it sounds, patting or tapping the residual limb to provide a change in information that the nerves in the leg are taking to your brain. This is a part of desensitization of your limb, in the long run this will help prepare your limb for having a liner and a socket on.

2) Rubbing: Again this is gentle, you can also use a soft (think silk or microfiber) cloth on your skin. You are looking to give the nerves/brain something else to process. This is a part of desensitization of your limb, in the long run this will help prepare your limb for having a liner and a socket on.

3) Mirror Therapy: This has a lot of research behind in from the VA and it does work, again this is something that works for some individuals. You would place this between your legs with the mirror facing your non-amputated limb so that your eyes/brain see you with two legs again. Then you can move or rub your leg on the sound limb to address the pain in the region that amputated side that is no longer there.

4) Guided visualization/meditation: Okay so this one isn't for everyone, it does however help your brain with the distraction that it needs. There are so many options on YouTube, just search guided meditation and you will get options for taking walks on the beach or in the woods, or visualize yourself in a mountain hut or on a tropical island. Distraction is the key element, so finding something that works for you may take a few different tries. From experience try both male and female voices as that can definitely make a difference in being able to relax.

5) Virtual Reality (VR): This works along the same lines as guided visualization/meditation but is a more active approach. It is a great tool for distraction and changing the focus of what your mind is addressing. There are multiple platforms available for use with gaming systems or your cellphone. Research is key to finding what will work best for you. This can also be done as a therapy treatment where available where you would see yourself completing exercises with limbs intact.

6) Repositioning Limb: Sometimes the way we are sitting with our limb (arm or leg) can trigger phantom limb symptoms. Easy solution is to change position, may need to try several options to decide if this will work for you.

7) Biofeedback: Using EMG biofeedback has been shown to help with cramping PLP and is used to help with learning to relax the muscles that are involved. Temperature biofeedback is used when there is a "burning" PLP in the residual limb and you learn to raise the heat in the extremity by increasing blood, this is typically when you find that your residual limb is colder which is attributed to decreased blood flow.

8) Acupuncture/Accupressure: While there is not a lot of evidence to explain why it works, there has been evidence to show that it does help decrease the need for pain medication. Acupuncture would require going to someone who practices traditional chinese medicine where are accupressure can be performed at home with someone who knows which pressure points are needed to reduce the pain.

9) TENS: Technique has long been used for pain management with low back pain, ankle and knee pain has been shown to work with electrodes placed either near the end of the residual limb, on the opposite leg at the "site of the pain" or at the level of the spine where the nerves from the leg/arm come back into the spinal cord. Work with your physical or occupational therapist to figure out pad placement

10) Massage: This is generally safe especially if you have no sutures or staples present. You can have a licensed professional give you a massage, it can be a self massage or someone you trust with some guidance can perform a massage. It touches on so many benefits that include, relaxation and improving blood flow to the limb massaged that this is good even if it doesn't help with the pain.

11) Music: This is completely individual, it can be used to relax (maybe in combination with a massage) or as a distraction (favorite artist or radio station). Find something that works for you, if you don't have earbuds or headphones now may be the time to look into a pair so that you have access to music just about anytime anywhere. If you are focused on music and/or moving to the music this can give you relief from the pain.

12) Shrinker: Wearing your shrinker or liner for the majority of the day can also help manage symptoms by providing a general level of pressure over your residual limb. If you are just starting with a liner you may need to slowly increase your wear time of the liner and use a shrinker when you take the liner off as liners do not let your skin breath and for some patients this process takes time to build up for all day wearing.

Below is a link to an article published by the Amputee Coalition of America that has some of the above techniques mentioned as well as broader descriptions of the techniques. May you find a couple of techniques that assist in your pain management.

phantom-pain.pdf (amputee-coalition.org)