Advice on Use of Your Prosthesis

If you have any questions on how to put your prosthesis on and take it off, please ask your Physiotherapist or Prosthetist. Instructions will be different depending on the level of amputation and the type of prosthesis you are using.

Transfemoral (above knee) amputation:

You should feel you are sitting on the back ledge of the socket. The socket should not be pressing into your groin either at the front or in-between your legs.The belt should be secure around your pelvis and the shoulder strap, if using one, secure over your opposite shoulder.

Transtibial (below knee) amputation:

For a prosthesis held on by a strap or knee sleeve

You should feel that you are taking weight on the area just below your knee-cap, on either side of your shin bone and your calf muscle at the back. You should not be getting pain at the end of your residual limb.

If there is a strap above your knee it should be secure but still enable you to get a finger underneath otherwise your circulation may be affected.

If you have a knee sleeve to hold your prosthesis on, this should be pulled up above your knee so the top edge comes half way up your thigh. There should be no creases in the knee sleeve when it has been pulled up.

For a prosthesis held on with a liner that has a pin:

If you have a liner with a pin, you should have to work a little to push your residual limb into the socket. You should be able to get nearly all of the clicks when you put it on in sitting. Extra clicks when you start walking are normal. With this prosthesis you should feel you are taking weight all over the residual limb rather than in specific areas.

Transfemoral (above knee) amputation:

Add sock(s) if:

• you have slipped too far into the socket and the prosthesis feels short;
• you are experiencing discomfort in your groin;
• the prosthesis feels loose;
• you feel air being squeezed out of the socket as you walk.

Remove sock(s) if:

• you are not fully into the socket and the prosthesis feels long;
• you are not sitting on the back ledge of the socket;
• the prosthesis feels too tight.

Transtibial (below knee) amputation:

For a prosthesis held on by a strap or knee sleeve

Add sock(s) if:

• you have slipped too far into the socket and the prosthesis feels short;
• you feel pressure on the bottom edge of your knee-cap;
• the prosthesis feels loose;
• you feel pressure at the end of your residual limb on walking;
• you feel your residual limb moving up and down inside the socket as you walk.

Remove sock(s) if:

• you are not fully into the socket and the prosthesis feels long;
• you feel pressure lower than the soft tendon below your knee-cap;
• the prosthesis feels too tight.

For a  prosthesis held on with a liner that has a pin

Add sock(s) if :

• you get all your pin clicks in sitting and the prosthesis goes on too easily;
• the prosthesis feels loose;
• you feel pressure at the end of your residual limb on walking;
• the prosthesis is rotating when you are walking.

Remove sock(s) if:

• you are not fully into the socket and the prosthesis feels long;
• you are unable to get all of the pin clicks once standing;
• the prosthesis feels too tight.

Remember your residual limb will continue to change shape and size in the first few months and you will have to allow for these variations by changing the amount of socks you wear. Expect changes even throughout the day.

You can wear the prosthesis for about 3 hours a day for the first few weeks. Then increase by half an hour every day until you are wearing the prosthesis all day.

If you have problems with your residual limb you may be given different instructions, if so follow the instructions you are given.

During the first 2-3 months it is important to check the skin on your residual limb regularly,as it will take time to get used to wearing the prosthesis all day.

Yes. During the day when you are not wearing the prosthesis you should wear your Juzo to help maintain the shape and size of your residual limb. This could be when you are unwell or while you gradually build up tolerance to wearing your prosthesis all day.

You should not wear your Juzo at night.

Once you are wearing your prosthesis all day you will not need to wear your Juzo but keep it safe in case you need it in the future.

Do not wear the prosthesis and contact the Centre for advice. You may need to make an appointment to see a member of the Nursing Staff, and Prosthetist if necessary. Do not wear your Juzo until advised to by the Nursing Staff.

If your residual limb swells, this will change the fit of your prosthesis.

If you are not able to put on your prosthesis, first try reducing the number of socks you are wearing or use thinner socks.If you are still not able to put on your prosthesis, wear your Juzo for an hour, then try again. If you have a below knee amputation, you can also elevate your residual limb on the stump board of your wheelchair or on a stool.

If you have tried changing the socks, using the Juzo and elevating your residual limb but are still not able to achieve a good fit, please contact the Centre for advice. You may need to make an appointment to see your Prosthetist.

Do not wear the prosthesis and contact the Centre to make an appointment as soon as possible. Often you can be seen on the same day, though you may not be seen by your usual Prosthetist. Depending on the problem, it may or may not be possible to repair on the day. To help reduce the risk of breakages, regular monitoring of your prosthesis by the Centre is important. Please ensure you attend your prosthetic review appointments.

Your prosthesis has been set up for the shoes you were wearing when you attended for fitting.

It is important that you use shoes with similar heel heights or you will change the position of the prosthesis. This could affect your walking and comfort of your socket.

If you want to change the heel height of your shoes, you will need to see your Prosthetist who will make any necessary adjustments. Do not attempt to adjust your prosthesis yourself.

Following discharge from Physiotherapy your Prosthetist will see you after approximately 6 weeks. If you and your Prosthetist are happy with the prosthesis at this appointment, arrangements can be made to have it covered.

If you want the prosthesis to be covered sooner you can discuss this with the team while you are still attending walking training.

Not everybody has their prosthesis covered; you can choose to leave it without a cosmetic cover if you wish.How do I keep the pr

The inside of the socket should be wiped down at the end of each day with a clean damp cloth and dried thoroughly.

If you wear a soft liner it should be cleaned with mild soapy water (preferably antibacterial) everyday and left to dry overnight. This is important to prevent skin problems and infections of the residual limb.

You should wear clean socks everyday. If you do not have enough socks or need new ones either ask the Prosthetist at your next appointment or contact the Centre for socks to be sent to you through the post.

If you wear white cotton socks these can be washed with your usual laundry. Wool socks should be washed by hand. Washing instructions can be found on the packaging.

Wearing an artificial limb can make your residual limb perspire as air circulation is restricted inside the prosthesis. It is very important to keep your residual limb clean. Wash it every day with warm water and a mild soap. After washing, it must be completely dry and should be carefully checked before the artificial limb is put on.

Please ask for advice from the ALAC nursing staff if the skin on your residual limb is dry, you may need to use a moisturising cream. If your skin is not dry you do not need to use a moisturising cream. Moisturising may soften your skin, which could cause your skin to rub more easily when you wear your prosthesis.

Check at least once a day for signs of rubbing from the artificial limb. Use a mirror for difficult to see areas. Rubbing will create an area of reddened skin which, if neglected, may turn into a blister. Any skin break should be treated immediately and you must stop wearing your prosthesis. Contact the Centre for further advice if needed.

It is important that you take great care of your remaining leg.

• Wash your foot every day, checking between the toes, and dry your foot thoroughly.
• Toenails should be cut after a bath or a soak when the nails are softer. If you have diabetes, have poor circulation, or you find it difficult to reach your foot, do not attempt to cut your own toenails. A Podiatrist can give you regular foot care. Please speak to the Centre staff if you are not being seen by podiatry.
• Hard skin and corns should also be left to a Podiatrist to treat.
• Your shoe must give good support and fit properly without digging in or rubbing.
• Make sure your sock does not cut into your skin – socks with elastic tops can sometimes restrict the circulation.
• Do not shave your legs, as this can cause small areas of infection around the hair.

This will be different depending on the level of your amputation and what the prosthesis has been provided for. Some people are given a prosthesis to assist walking and others to assist with transfers [e.g. moving from a wheelchair to another chair]. 

After your Prosthetist has fitted your prosthesis, you will attend physiotherapy twice a week to learn how to use it. It could take between a few weeks and a few months to learn to use your prosthesis safely. The length of time varies as some people find learning to use a prosthesis easier than others. Your Physiotherapist will set goals with you and review them during your treatment so you can monitor your progress.

Yes. Until you are wearing the prosthesis all day everyday, you should continue with the exercises that you were given by your Physiotherapist. This will help to improve your muscle strength and flexibility to help you reach your goals.

We advise that you use walking aids for at least 8 weeks after starting to use your prosthesis. This will help you to increase your confidence and build up tolerance to taking weight on the residual limb without it becoming sore. If you experienced problems during initial walking training you may have been advised differently and should follow the instructions you were given.

Many people who have a lower limb amputation do not manage to walk without the support of a walking aid[s].

Do not feel you should be able to walk without aids especially if this affects your safety.

If you wish to progress from a frame or crutches, you should contact the physiotherapy department at the Centre for advice or to arrange an assessment.

If you are using sticks and feel safe, confident and have no wounds on your residual limb, you can progress yourself onto one stick. Keep the stick in the opposite hand to your prosthesis. It is advisable to practise indoors first before going outdoors.

You may be able to progress to using no walking aids indoors but make sure you feel safe. You may still need to use a walking aid when you walk outdoors.

A member of the physiotherapy department can also review your walking aids at any of your prosthetic appointments.

Motto: Good to heaven, bad to hell

This applies to slopes, kerbs and stairs.

When you go up:

1. Lead with your sound leg.
2. Bring the prosthetic leg up to the same step.
3. Bring the stick(s) up last to the same step.

When you come down:

1. Put the stick(s) down first.
2. Step down with the prosthetic leg to the same step.
3. Step down with your sound leg to the same step.

For safety always use a hand rail if there is one.

It is possible to do the stairs sideways holding on to the rail in front but this will depend on the side of amputation and which side the hand rail is on. The motto written above should be applied to this technique as well.

If you have amputations of both legs, it is advisable to use 2 rails to do the stairs. Follow the instructions you were given by your Physiotherapist on which leg to lead with when going up and down.

Not unless your Physiotherapist feels that you would benefit from further walking training to achieve your goals. If so you may be referred to a local physiotherapy department or community physiotherapy team to continue your treatment.

Your Prosthetist can also refer you back for further physiotherapy following any of your appointments if they feel you need to improve your walking or have concerns about your safety.

Alternatively, if you feel your walking has deteriorated or you have other goals to achieve you can also contact the physiotherapy department directly; the number can be found at the back of the booklet.

If you wish to improve your general fitness, your Physiotherapist can refer you to the National Exercise Referral Scheme. There are leaflets about the scheme available from the Centre.

Following discharge from Physiotherapy your Prosthetist will see you after approximately 6 weeks. Your Prosthetist will then decide when you need to be seen again.

If you have a problem with the prosthesis between visits contact the Centre for advice first.You may then need to make an appointment to see your Prosthetist.

• Phantom limb sensation is described as feeling the limb is still attached to the body. It often feels shorter or in a distorted position.
• Phantom limb pain is the feeling of pain in the missing limb, often at the end of the limb in the foot and toes. It can be described as burning, aching, shooting or stabbing. Often pain comes in bursts, only a few people have constant pain and it can be made worse by stress or anxiety.
• Most people develop phantom limb pain in the first few days after the amputation but some may develop pain months or years later.
• Phantom limb pain may not go away but what you feel may change over time and become less painful.

Approximately three quarters of amputees experience phantom limb pain, but the precise cause is unknown. Over the years several theories have been suggested, but with no conclusive evidence. This can make phantom limb pain very difficult to treat effectively.

• Medication:
  • Anticonvulsant drugs – these are used to treat epilepsy but can also be used to relieve nerve pain. These include gabapentin or pregabalin.
  • Antidepressants – as well as treating depression, these drugs are also useful at relieving nerve pain. An antidepressant often used is amitriptyline.
  • Some patients may benefit from treatment with strong painkillers, such as tramadol and morphine.
  • You can discuss your medication for phantom limb pain with the Centre or your GP.
• Wearing your prosthesis: Some patients find wearing their artificial limb as much as possible can help lessen the pain.
• Some patients also find it useful to massage their residual limb and keep busy which can help distract from the pain.

If you want to talk to another person who has had an amputation please ask a member of the team to give you our information leaflet on how you can access this support.

You can contact Community Occupational Therapy through your local Social Services Department to review your home situation.

Occupational Therapy can also be contacted through the Centre. They can provide advice and visit you at home if necessary.

Equipment is available from local mobility shops or via mail order catalogues. If you are uncertain about the most appropriate equipment for your needs please contact the Occupational Therapist at ALAC.

A Community Occupational Therapist can also assess your needs and some equipment may be available through your local Social Services Department.

If you are experiencing any difficulties in connection with your wheelchair contact the wheelchair service at the Centre. They can arrange for someone to come out to assess and make repairs or arrange a further assessment by a member of the wheelchair team if necessary. The contact number for the wheelchair service is 01443 661799.

If you are returning to the same job, you can get support from the Access to Work scheme through the Jobcentre. It gives you and your employer advice and may support with the extra costs that could be needed to enable you to return to work. It may also pay towards the cost of getting to work if you are unable to use public transport.

If you are not returning to your previous job, you may be unsure as to what opportunities are available to you. If you contact your local Jobcentre, they can arrange for you to see a Disability Employment Adviser who can offer you an employment assessment to help identify what type of work or training will best suit your abilities.  Click here for more information from the Gov.uk website.

If you need advice about driving, you can ask your GP or any healthcare professional to refer you to the Wales Mobility and Driving Assessment Service at Rookwood Hospital, or you can refer yourself. Click here to find out more.

Remember before commencing driving following amputation you must inform your insurance company and the DVLA in Swansea.

You can also obtain written information on driving from the Centre.

You can get information on benefits from the Disability Benefits Help line, Citizens Advice Bureau, Care and Repair Cymru or Age Cymru. They can give advice and do a benefits check with you to check what you may be entitled to claim. More information can be found at http://www.direct.gov.uk.

You can find out about participating in sports from Sport Cardiff  or Disability Sport Wales. The Disability Sports Directory is also available from the Centre; ask a member of staff if you are unable to find it in the information racks.

Swim Wales is an organisation which aims to ensure swimmers, including those with a disability, have the opportunity to compete within the sport. They provide support from learn to swim programmes up to competitive world class programmes and have clubs throughout Wales. The Swim Wales leaflet is also available from the centre; ask a member of staff if you are unable to find it in the information racks.