Category: Lower Limb Prosthetics

Support Services

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Physiotherapy, Occupational Therapy & Exercise Physiology

Physiotherapy is currently available onsite at APC ‘s Alexandria and Northmead offices to assist amputees in varying stages of their prosthetic usage:

  • Gait re-education from initial fitting of the first prosthesis through to advanced functioning (eg. return to recreational activities, running, gym programs).
  • Upgrading/teaching the use of a new prosthetic prescription.
  • A program for the use of micro-processor knee joints.

Physiotherapy at APC Prosthetics is provided by Cathy Howells, a registered physiotherapist with a special interest in amputee rehabilitation and over 30 years’ experience working exclusively with amputees.

It is important as an amputee or someone with limb difference to maintain good muscle strength, flexibility and stability, to ensure your ability to use your prosthesis continues well into your later years. Working regularly with a physio throughout your life as a prosthetic user, can act as a reminder to engage the muscles you may not be using as much as you should be, or to help you kick some bad gait habits you may have developed. OTs can help you learn how to use your prosthesis (especially Upper Limb) for specific tasks and training, along with recommending any modifications that need to be made to your home or car. EPs are great for ongoing amputee targeted training, or if you have a sport or recreational activity you would like to learn to get back to or start doing since being an amputee.

How you access a physiotherapist and other allied health services depends on your funding.

  • ENABLE: A referral from your GP will be required, you can get 5 free PT visits per year if you are on a care plan. We can assist by writing a referral to back up your need for this support service.
  • NDIS: Talk to your planner at your next plan review to ensure there is sufficient funding available for the number of visits you require for the length of plan. Your prosthetic AT Assessment and request will advocate for any additional services deemed necessary for you to succeed with your prosthesis and goals.
  • INSURANCE: This will be negotiated with your case manager.
  • PRIVATE: There is always the option to go directly to a PT etc if covered by private health insurance or by paying directly. Your prosthetist can write a letter of referral/handover to communicate with your chosen provider in order to best help you succeed.

Medical Services 

The team at APC Prosthetics work closely with your rehabilitation specialist to ensure you receive the best treatment outcomes based on your health, healing and any other medical conditions that may affect your prosthetic use. Due to the long history of APC attending many amputee clinics for over 20 years, we have solid communication and a multidisciplinary team approach that leads to the quality service you will receive.

Specialty Prostheses

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Specially designed prostheses are often required when an amputee wants to perform activities that exceed day to day ambulation or activities.

APC Prosthetics continues to lead the profession in prosthetic innovation. Our team is internationally recognised in specially designed and sporting prostheses in a broad range of activities including athletics, skiing, cycling, golf, weightlifting and more. If you are interested in competitive or social sporting activities, we are happy to provide contact details for the respective sports institutes and sporting bodies.

Waterproof Prostheses

The most common specialty prosthesis is a waterproof prosthesis, which enables the amputee to use the prosthesis for tasks involving water, such as showering, swimming, or accessing the beach. Recent development of waterproof fibreglass feet have provided great advances in water-based recreational activity, and specially designed devices are also available to allow for the use of flippers.

Recreational Prostheses

The development of “hybrid” prosthetic components has expanded greatly, in particular the numerous designs of prosthetic feet which allow the amputee to access a wide range of recreational activities without compromising general walking e.g. Cheetah Xplore, XC Torsion, etc.

Task Specific Prostheses

A prosthesis used for a specific task/sport/activity – e.g. A weightlifting arm, drawing attachment, skiing or running prosthesis, etc.

If you have any questions about specially designed prostheses, please contact us.

Osseointegration

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Osseointegration (OI) is the structural connection between living bone and a load- carrying metal implant. First introduced into dentistry in the 1960s, OI has been an option for some lower and upper limb amputees since the 1990’s in Europe. The prosthetic components are attached directly to the implant via a connector, eliminating the use of a traditional socket. Whilst there may be numerous functional benefits to OI, there are also a variety of advantages and disadvantages to explore when considering if this option is right for you.

APC Prosthetics has been actively involved in the establishment of amputee services for OI users since its introduction to Sydney in 2010 and we have been managing over 500 amputees who have undergone the procedure. If you would like to find out more about OI, please ask to speak to one of our prosthetists.

New Amputees

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Amputee Treatment

The amputation of a limb is a life changing experience, and the requirements of each client are different and will change throughout their life.

Our philosophy is to work with each individual to comprehensively assess their needs, establish their requirements and then deliver the appropriate solutions.

All of our clients’ needs are unique, so our highly experienced prosthetists work closely with multidisciplinary health professionals to establish a customised treatment solution for each of our clients. The team includes Medical Specialists, Physiotherapists, Occupational Therapists and other health professionals.

APC Prosthetics has a strong support system to assist clients in challenging situations and work closely with Government/Health authorities and national professional bodies including EnableNSW, DVA, the NDIA and AOPA. We also maintain close relationships with global prosthetic technology groups, which allows us early access to the latest technological developments in both prosthetic components and manufacturing technology.

At APC Prosthetics, we are dedicated to achieving the best outcome for our clients, aiming for the best possible comfort, the best possible function and the best possible lifestyle.

Treatment Pathway

Interim Prosthesis:

The first phase of the prosthetic rehabilitation is the provision of an interim prosthesis. This generally occurs approximately 6 weeks after amputation when the suture wounds have sufficiently healed. The aims of the interim prosthesis are to establish early mobility and commence gait re-education as early as possible.

After a comprehensive assessment with the rehabilitation team, the rehabilitation specialist issues a prescription for the interim prosthesis. The prosthetist will then take a plaster cast of the residual limb, which is called a plaster negative. The plaster negative is then used to make a replica of the residual limb, which is modified to achieve a comfortable socket. The socket is then moulded over the plaster model.

Various liner materials are used to act as a cushion between the socket and the residual limb, absorbing and dissipating shock, shear and torque forces that occur during walking and standing on the prosthesis.

Next, the prosthetic components are connected to the socket and the client returns for their first prosthetic fitting. During this process one of our highly skilled prosthetists assesses the socket-fit and analyses gait to determine optimal alignment. The correct alignment of the prosthesis is essential to ensure maximum comfort and function.

You can expect regular modification to this first prosthesis, as the residual limb undergoes significant changes in shape and volume during the first months. After approximately 3 to 4 months the prosthetic interim socket will be replaced with the first definitive socket.

Definitive Prosthesis:

For your first definitive prosthesis, the prescription process is then repeated (dependent on your funding body, eg EnableNSW, NDIS, Insurance, etc.). The prosthetist will take a new cast of your residual limb and the manufacturing process begins again. The materials used to manufacture the definitive socket include fibreglass, carbon fibre or specially designed plastics. Utilising the latest manufacturing technologies and high-tech materials ensures a durable and extremely light socket.

The prosthesis is trialled for several days. It’s important you trial the check socket in as many real-life scenarios as possible in order to give your prosthetist quality feedback on the suitability of the fit and function. After the successful completion of the trial period, the prosthesis is cosmetically finished, to deliver a pleasing aesthetic result.

As the shape and volume of the residual limb will change over time, it is very important that the client sees their prosthetist on a regular basis (every 3 to 6 months), to ensure the socket is still fitting properly. Sometimes it is necessary for the prosthetist to make adjustments to the prosthesis to compensate for any changes. However, if the changes are too significant, a new socket (socket replacement) might be required.

Ongoing Care

Physiotherapy:

Physiotherapy is a vital factor throughout the entire rehabilitation process, including muscle-strengthening exercises and gait training. Your amputee clinic will have onsite physiotherapists who specialise in amputee gait training, and APC also offer specialised Physiotherapy sessions in our modern and fully equipped gymnasiums tailored to the individual needs of each client.

Lower Limb Prosthetics

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Prosthetic limbs are custom designed and made for each amputee. Over the past couple of decades significant advancements have been made in terms of prosthetic components and socket design. The use of lighter and more durable materials has resulted in improved comfort and function. The socket design and the components determine the level of comfort and function we can expect from a prosthesis. We will briefly overview the components of lower extremity prostheses.

Socket and Interface

The purpose of the prosthetic socket is to transmit forces from the residual limb to the prosthesis. A well-designed socket which is regularly reviewed or replaced as you change in shape will provide comfort and stability during walking and standing on a prosthesis. Your socket generally will be made of a combination of plastics, resin, fibre glass and carbon fibre to create a lightweight, durable prosthesis.

The interface/liner is intended to absorb shock and shear forces on the residual limb. It fits between your residual limb and the socket and can be made from various soft materials. Modern interfaces are generally constructed from silicon and urethane polymers, which help protect the tissue. They can also assist with suspension of the prosthesis by incorporating a pin that connects to a locking mechanism in the socket, or a seal which provides a negative pressure system.

Foot and Ankle

The human foot-ankle is a very complex functional unit. It provides stability as well as flexibility, absorbs forces and utilises muscle to generate energy for efficient and comfortable walking.

Over the past decades we have witnessed major improvements in design and manufacturing of prosthetic feet, allowing much more energy efficient and natural walking.  As each patient has different needs and lifestyles, it is vital to select the most appropriate prosthetic foot to achieve maximum comfort and function.

Knee Joints

Knee mechanisms for trans-femoral (above-knee) amputees have also seen major technological advancement in the last decade, greatly improving safety and function. Microprocessor controlled knee units have led these advances.

Incorporation of hydraulic and pneumatic mechanisms allows modern knee units to adapt to variable cadence and assists walking on slopes and stairs. New design concepts for multi-axial knee units have seen increased stability without the accompanying instability downside of higher energy expenditure. Your prosthetist will work closely with you to find a prosthetic knee prescription that works best for your lifestyle and goals.

There are many different socket design styles, suspension methods, prosthetic feet and knee units, which your prosthetist will work closely with you to prescribe the most suited based on your level of amputation, functional capabilities, goals, daily activities and lifestyle.

Kids

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APC has been providing prosthetic services for children with limb difference and amputation for many years. We are involved in the Limb Deficiency Clinics at Westmead Children’s Hospital and Sydney Children’s Hospital in Randwick, where we work closely together with rehabilitation teams to ensure the best outcomes for the kids we see.

We see a wide range of kids and families from across NSW; from Sydney and surrounds, to more regional and rural parts of the state. APC is an ever-growing family, now with 4 branches and associated outreach clinics, so we reach far and wide across NSW.

Working with the paediatric population is so special because each child is incredibly unique and has their own unique needs and goals. Here at APC, we love working together with kids and their families to help them realise those goals, and help dreams become a reality through providing the most appropriate prosthetic technologies; be it an upper-limb prosthesis to assist in riding a bike, or a lower-limb prosthesis for running and sports, and everything in between!

At APC we understand that each child has their own individual presentations, needs, and wants, and love working together with kids and their families to achieve the best results for all.

NDIS

Most children with limb difference are eligible for NDIS funding. If you’re not sure whether your child is eligible, speak with one of our prosthetists, or check out the eligibility criteria on the NDIS website.

We have been working closely with the NDIS since it was first rolled out in New South Wales, so we have an in-depth understanding of how to best help your child get the prosthetic services they need through the NDIS.

Funding for your Prosthesis

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Depending on your individual circumstance, your prosthetic care will be funded by one of the following funding bodies:

EnableNSW

EnableNSW – Prosthetic Limb Service provides funding for a basic prosthetic limb to all eligible amputees. Residents of NSW are eligible for admission to the PLS, provided they hold a valid Medicare Card. If you would like to find out more about the PLS please click on the following link:

http://www.enable.health.nsw.gov.au/services/pls

NDIS

The National Disability Insurance Scheme provides funding for eligible amputees under the age of 65. The team at APC Prosthetics have vast experience in navigating this scheme to ensure our client’s prosthetic care is optimised. See our guide here.

If you would like to find out more about the NDIS please click on the following link:

https://www.ndis.gov.au/

Insurance Clients

Patients with an insurance claim will be assessed comprehensively by a multidisciplinary team to determine the prosthetic management plan.

Once approval has been granted by your case manager, we will commence the prosthetics treatment immediately.

If you would like to find out more about this, please contact your case manager or alternatively, contact APC.

Private Clients                                                      

APC Prosthetics is Australia’s leading private prosthetic clinic and provides comprehensive services to private clients.

Private clients are free to determine what prosthetic technologies they wish to incorporate in their prostheses without restrictions. The specialists at APC are happy to provide consultations and advice without any demands or commitments to our clients.

Please feel free to contact APC if you wish to review your current and future treatment options.

Cosmesis

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There are many different cosmetic options for your prosthesis, for both upper and lower limb, and it’s vital to consider what is important to you so that your prosthetist can design a prosthesis that not only is functional to you, your lifestyle and goals, but you can accept, want to wear and be proud of.  The more we can make your prosthesis be a part of your life, whether it be from blending in or standing out, we are willing to try and make it happen!

 

Realism

For some, they want their prosthesis to look as close to an intact leg or their sound side as possible. This often helps these users to accept their prosthesis and promotes higher usage/wear rate. The level of realism attainable depends on your funding body.

Some options available are:

  • Foam cover shaped in house to resemble your sound side.
    • Covered with a cosmetic stocking.
    • Covered with a silicone cover ordered and fabricated externally. These vary in price dependant on level of detail.
  • Exoskeletal prosthesis – either solid or hollow prosthesis without modular components, made in-house & shaped to your measurements, with a pigment mixed in to match your skin tone.

Fashion/Statement

Other prosthetic users prefer their device to represent their fashion sense, their favourite football team, a favourite colour or even have tattoos! For these clients, there are many options for cosmesis that we can achieve both in-house or work with external companies to order in a cosmetic option right for you.

  • Provide your prosthetist with fabric of your choice to be embedded into the lamination of your socket.
  • Choose a colour of pigment to be mixed into the resin for your socket.
  • Your prosthetist can take measurements and order a removable cover for you from companies such as Alleles and UNIQ. These can be beneficial also in filling out long pants and protecting your clothing from the componentry/preventing tears.

There are many more options available so if you have something specific in mind it is important to talk to your prosthetist early on so we can make your prosthesis just right for you!

Care for your Stump Socks

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The two main reasons for wearing stump socks are:

  1. To protect the residual limb from excessive rubbing against the socket.
  2. To allow the prosthesis to fit better as your residual limb changes. You may find that you wear only one sock in the morning, but have to add a second one as the day progresses. In this case, the sock is used to fill the space between your residual limb and the socket.

Socks & Pelite liners

It is important to find the right combination of socks when using a prosthesis with a pelite liner. This combination can change both throughout the day, and over the life of your prosthesis. With a pelite liner, as you reduce in volume, you may find you need to fill the space between your residual limb and the liner, and/or between the liner and the hard socket to snug up the fit. If you have any queries on how to do this, you can ask your prosthetist.

Socks & Silicone liners

Unlike in traditional pelite liners, when using socks with silicone/gel liners, the sock is used outside the liner between the liner and the hard socket which maintains contact of the silicone/gel with your skin.

Pin liners: It is important to ensure the pin is completely through the hole located at the end of your sock so that the fabric doesn’t get caught in the lock body. If this happens, it can cause the lock to stick and you will have trouble doffing your prosthesis.

Seal-in liners: If your prosthesis uses a rubber sealing ring to create a vacuum suspension, talk to your prosthetist to ensure you understand volume management for your liner type. Some do not support the use of socks. If it does, make sure that the sock is neatly tucked under the sealing ring prior to donning your prosthesis.

If you find you have reduced in volume to an extent that you are slipping inside the liner itself, contact your prosthetist as you may need a new liner, or an alternate solution to be found.

Cleaning your stump socks

It is very important to keep your stump socks in a clean and hygienic state. They should be changed and cleaned daily.

Here are some DO’s and DON’TS that will help you clean your prosthetic stump socks correctly:

Do:

  • Hand wash only.
  • Use approved wool detergent to wash your prosthetic stump socks.
  • Squeeze suds gently through the prosthetic stump socks and rinse with clear warm water.
  • Roll the prosthetic stump socks in a towel to blot out the extra water.
  • Hang stump socks out to dry.

Don’t: 

  • Do Not wash with hot water – this might cause your prosthetic stump socks to shrink.
  • Do Not twist & rub wet socks as this may cause the socks to lose their shape.
  • Do Not wring them out.
  • Do Not use a clothes dryer to dry prosthetic stump socks.

Care for your Prosthesis

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Liner Care

If you have a prosthetic liner you should wash it on a daily basis. Ensuring the soap/detergent you use is non-abrasive, mild and no fragrance. These substances and harsh detergents and chemicals can slowly eat away at the silicone or gel and reduce the life of your liner.

There are a few ways you can clean your liner:

  • Option 1: invert your silicone liner and using a damp cloth with a mild detergent, gently wipe it out.
  • Option 2: with your liner the right way out, use warm, soapy water to fill the inside. Swirl around the liner and tip out the water. These first two methods are good for mid-week cleans when the external fabric of the liner is in clean condition
  • Option 3: you can completely submerge your liner in warm, soapy water to deep clean the outer layer of protective fabric as it is required.

NOTE: Make sure to remove any grit, skin or fluff from the inside of your liner, as this can cause both skin irritation/rubs or reduce the effectiveness of the suspension of the liner.

It is important in all methods to rinse out the liner with clean water (no soap) to remove any soapy residue as this can cause skin irritation/contact dermatitis.

To dry your liner:

Pat dry with a microfibre towel (or other no-fluff towel such as a chamois) and/or leave it overnight (hanging upside down and right way out) to dry completely.

If you have been provided with two liners, you can wash one and wear the other while it dries.

Never put your liner in a washing machine or clothes dryer, as it may damage or even destroy it. Your liner’s warranty will not be applicable if used in this way and damage is caused.

Socket Care

Upper Limb (UL) users: Your socket should be cleaned weekly. Simply wipe it with a damp cloth and a mild detergent and dry it thoroughly before you put it back on. You should regularly clean the hand and/or cosmetic glove.

Trans-tibial (TT) users: Your socket should be cleaned weekly. Simply wipe it with a damp cloth and a mild detergent and dry it thoroughly before you put it back on.

Trans-femoral (TF) Users: Your socket should be cleaned daily. Wipe your socket with a damp cloth and a mild detergent and dry it thoroughly before you put it back on.
It is not necessary to use an antiseptic to clean your prosthesis. DO NOT use Dettol or other solvents to clean your socket or liner.

Prosthetic Components

DO NOT clean any of your prosthetic components, as they have very specific maintenance requirements, which should only be carried out by your Prosthetist. If you are concerned about any of your components, please contact us.

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