Caring for the skin of the residual limb is one of our most important responsibilities, one that must not be neglected. This is particularly true for the lower limb, which is now doing a job it was not designed to do – bearing weight. Feet have a much tougher outer layer, but even they can run into problems if they are not washed regularly, if they have poor circulation, or if they are forced into ill-fitting shoes.
Today, since most prosthetic sockets and liners are made of materials that prevent air from circulating around the skin, many active people experience sweating within their socket. In addition, dead skin cells are constantly “sloughing” off and being replaced by new cells. This combined residue will remain on the skin and surface of the socket or liner unless both are washed at least once a day. Left alone, the residue will form salt crystals and promote bacteria that can cause abrasions and fungal or bacterial infections. If left untreated, these infections can spread and even become lifethreatening.
General skin care tips are included in the 2005 edition of First Step – A Guide for Adapting to Limb Loss (see “Caring for Your Skin,” page 58, or www.amputee-coalition.org/first_ step_2005/caring_for_your_skin.html). Here, we will look at some of the additional and potential problems we face when wearing a prosthesis.
As always, if the reason for your amputation was diabetes or a circulatory condition, the care you take of your residual limb is of prime importance. Maintaining the fit of your prosthesis at all times will help prevent problems, so it's important to have regular checkups with your prosthetist. The smallest blister or break in the skin can become infected if the appropriate care is not taken immediately. Always contact a member of your rehabilitationteam as soon as you have a problem, and he or she will instruct you on what steps to take.
You would never dream of taking a bath or shower with your shoes and socks on or of not washing your feet or changing your socks for several days. The same holds true for maintaining your socket and liners as well as the skin of your residual limb.
The causes of some of the most common skin care problems fall into three main categories: a poorly fitting prosthesis, improper hygiene, and allergies.
Sometimes, however, it may take a bit of detective work to determine the cause. For instance, a blister and even some rashes can be caused either by pressure or by a reaction to some material. The treatment will depend on the cause. Skin is more fragile if we have a vascular disease and becomes even more so as we get older. It is our responsibility to care for it the best way we can.
When a problem occurs, be prepared to give your healthcare provider the best history you can. This is where a little deductive reasoning can go a long way. Did you forget to wash your liners and now you have an itchy rash? Are your liners brand new and now you have a line of blisters around the edge? Have you had an angry red patch over a bony part that didn't fade within several minutes after removing your prosthesis and now you have a skin breakdown? Did you shave your residual limb where you now have an infected spot? Have you gained or lost weight and discovered that you now have a skin breakdown? Has your limb been riding up and out of your socket, creating an irritated circular area on the end of your limb that is becoming rough and “lumpy” looking? All of these problems can be treated fairly easily if caught early but can become significant if neglected. Always contact a member of your healthcare team as soon as you have a problem.
It is wise to keep a supply of the following items handy for emergencies when you can't get to your healthcare provider immediately, especially when traveling:
- A tube of antibiotic ointment to protect a skin abrasion
- A tube of “athlete's foot” cream for a rash caused by sweat (more washing needed)
- A tube of over-the-counter cortisone cream for an itchy rash
- A small bottle of mineral oil or baby oil (A small amount applied to the skin around the top of a liner can help prevent the blisters that sometimes appear there.)
- An extra pull-on sock or bandage. The use of powder is not recommended because it dries the skin and, if used under a liner, may cake and cause a breakdown. If you feel you must use it, do so at night and make sure the limb is free of powder before you don your prosthesis.
Many people ask about shaving or waxing
their residual limb. Neither practice is advisable,
however, because each can cause hairs
to grow inward with pressure from the socket
interface and may lead to folliculitis (follicle
infections). Laser therapy is a possible
alternative. It works by targeting and heating
dark pigmentation in hair follicles, resulting in
long-term reduction of hair growth. However,
this procedure works better for some people
than it does for others. You should always
consult your healthcare provider before
embarking on any treatment of your
limb.
Corns, calluses and patches of hardened skin are indications of pressure or irritation. Don't try to remove them with over-the-counter liquids, blades, pumice stones or other products. The appropriate treatment is to remove the pressure. If you do get a skin breakdown, don't try to cover it with a dressing or plaster inside your socket. This just adds bulk and additional pressure and could actually make the wound worse. A “paint-on” dressing may protect the wound but, again, check with your healthcare provider for advice or help.
Final Thoughts
Maintaining a well-fitting prosthesis means learning and understanding what determines the right fit for you. Consult your healthcare team whenever you have a problem; check your entire residual limb daily (and your other limbs if you have circulatory problems); eat a healthful diet; drink plenty of water; maintain a steady weight; stay as active as you can; and remember to take all of your prescription drugs as instructed.
Does this sound like a lot to do? You're right, it is, but neglect will almost certainly lead to additional conditions that require even more attention. Remember, prevention is so much better than treatment.
