Volume 18 · Issue 4 · May/June 2008 | Download PDF
by Paddy Rossbach, RN, Former Amputee Coalition President & CEO, and Terrence P. Sheehan, MD
Proper limb and skin care is essential to your health and mobility. Prosthetic sockets trap sweat and prevent air from circulating around your residual limb, which can create a virtual paradise for bacteria. Bacterial and fungal infections can lead to skin irritation, abrasions and eventually skin breakdown. Left unchecked, this could lead to infection and ulcerations, leaving you unable to use your prosthesis for an extended length of time.
The following tips can go a long way toward keeping minor problems from turning into a crisis.
- If you are a new amputee, it’s better to take a bath or shower at night rather than in the morning, as your limb will swell in hot water or when dangling as you sit or stand to shower, making it difficult to put on your prosthesis. In the beginning, you should use a shrinker at night, and put on your prosthesis when you get up from the bed – in other words, don’t let your leg hang down or it will swell. As time goes by, this will become less necessary.
- If you have a transtibial (below-knee) amputation, never sit or sleep with a pillow under your knee, as this will lead to a contracture (inability to straighten the knee).
- If you have a transfemoral (above-knee) amputation, do not sleep with:
- Your limb resting on a pillow, as this promotes a hip flexion contracture (inability to completely straighten your hip)
- A pillow between your legs, as this lengthens the inner thigh muscle that helps you keep your legs together when you walk, and shortens the outer thigh muscles so that you walk and stand with your feet apart.
- Do not rest your limb over the handle piece of your crutches.
- Do stretching exercises daily to make sure that you can straighten your knee and hip; this makes walking, and even lying in bed, more comfortable.
- Wash your limb with mild soap and water every day (more often if you sweat heavily) and pat it dry with a soft towel. Be patient and allow it to dry completely. If this is not done, you will be at risk for fungal growth that could lead to infection or abrasion.
- Check your limb for red pressure patches that last more than a few minutes after you remove your prosthesis; these may be a sign that the socket needs checking. If left untended, these red patches may result in skin breakdown.
- Check for skin breakdown twice a day – if you can’t see the end of your residual limb, use a mirror. This is particularly important for people with diabetes.
- Softening cream should only be used if the skin is extremely dry and at risk of cracking. It should only be used temporarily unless cleared by your doctor.
- Do not use talcum powder on your limb, as it can ball up and create an abrasion. If you must use a powder, cornstarch is better.
- Do not use alcohol or unknown chemicals/ creams on your limb.
- Remember – your limb is covered all the time, so be very careful if you expose it to the sun. Use sunscreen SPF 30 or better.
- Do not shave your limb; the resulting short hairs get pushed back into your skin, becoming ingrown hairs that can become infected.
- If the skin of your limb opens, go straight to your doctor and prosthetist.
- If you are having a fit problem with your socket, causing skin breakdown, go to your prosthetist for an adjustment. If the breakdown is infected, you will need to go to your physician as well. Stop using the prosthesis; have crutches and a wheelchair for backup.
- If you have a skin breakdown, don’t use a prosthesis. Put a clean dressing/band-aid on the area daily and see your doctor or prosthetist. Don’t “pad” a pressure area, as that creates additional pressure and will make it worse.
- A red spot that turns into an ulcer can mean weeks without being able to use your prosthesis. Stop using the prosthesis and call your prosthetist/doctor.
- If you have reduced or no sensation in your residual limb, check your limb more frequently during the day and don’t put it in hot water or expose it to the sun – it will burn and blister.
- Wash anything that makes skin contact (liners, socks, the inside of the socket, etc.) every day with mild soap and water and allow plenty of time to dry. Follow manufacturers’ instructions for care of liners. Unless specifically instructed, do not use anything containing alcohol or unknown chemicals.
- You should know the landmarks of when your socket fits correctly; if you don’t, ask your prosthetist to show you. If your socket is too big or too small, visit your prosthetist immediately.
- Make sure your shoe height is correct for your prosthesis or your alignment will be wrong, putting a strain on your residual limb and surrounding joints.
- Keep a “leg” bag handy with items you might need in an emergency (stump socks, pull socks or bandages, antibiotic ointment, antihistamine ointment, etc.).
- Remember – the fit of your prosthesis changes during the day, so add socks when needed.
- If you are having trouble with the prosthesis or liner, do not make your own adjustments or alter the prosthesis/ liner – call your prosthetist immediately.