Reflecting On Prosthetic Development

In July’s blog, we speak to Donald Mandra, a 56-year-old, car enthusiast, who has been wearing the Infinite Socket TF for four years. 

When I was 17, I lost my right leg above-the-knee. When I was referred to my Prosthetist for the first time, I never thought about the progress of prosthetics or the care I was going to be given. I actually dealt with my current prosthetists, Tony Tufano’s, Uncle who owned Mutual Orthopedics on Long Island. Back then, the sockets were made out of wood, with a hinge on the knee but I was young and didn’t want to let anything slow me down in my rehabilitation. Comfort wasn’t necessarily the most important thing for me either. Now that I’m older I feel things catching up a little bit, and I have a chance to reflect on what’s important to me now, and how prosthetic technology has developed over the last 39 years. 

It would be fair to say that after my amputation, rehabilitation was learned through trial and error. My experience with Mutual Orthopedics has spanned 30 plus years, and I have always received great care, but when I started dealing with Tony, it was clear that he wanted what was best for the patient, but the technology was not there to match. Every time I fell, I learned something new; learning how to balance, how to utilize what I had to the best of its ability. The problem with conventional sockets was around the brim. Even with a softer inner liner, the comfort was never there, and I was receiving sores around the groin.

When I first saw the Infinite Socket TF on a news article on TV in 2014, I noticed that it was adjustable and had a soft brim. I informed my prosthetist Tony who investigated further, and within months he brought me into the office to be fitted with the socket. It actually fits pretty well out the box; I don’t remember any adjustments to my initial fitting, but one thing was noticeable; the comfort around the brim was immediate. I didn’t find myself having to take it off, or even wanting to take it off. I thought to myself, I can wear this all day and all night and it doesn’t give me any issues. Utilizing it increased my activity level as it didn’t create those sores around my groin anymore. Now that I can reflect, comfort should be the benchmark, as I went from being confident, but in pain, to not feeling like I have any limitations any more. 

As with all new technology, there were areas where the socket was breaking, predominantly the brim, and the tensioning device. What made the experience so seamless, however, was that for every part that broke, I informed my prosthetist, who informed LIM’s customer service, and they would ship the replacement part to be fit, all within three days. It was as though they never broke as I’d never been without the component for very long. I’ve actually been on the first Infinite Socket I purchased for 4 years now, and can’t imagine I’d ever go back to a conventional socket again. I’m now extremely excited to get my new Infinite Socket and a new knee. I had a trial with the Ottobock Genium knee and didn’t want to give it back. The combination has been working great for me especially as I spend a lot of my time working on the yard and working on a ‘67 Corvette.

One thing I have noticed is that there is still a lot of uncertainty around the socket on social media. People talk about the bulk of the socket, but in my opinion, it’s only marginally thicker, and that’s by the struts. I have no issues with the bulk and don’t really notice it as I’m comfortable. The weight is hard to quantify when you are wearing it, as the dynamic fit allows for a snug feeling around my residual limb that can be changed when I need it. As I have mentioned, comfort should be the benchmark, and I just wish everyone had the opportunity to try it. 

LIM Innovations now offers the Infinite Socket TF to candidates up to 300lbs. If you do have any questions surrounding the socket, please reach out on Facebook, or call us on 844-888-8546 and we will be happy to answer your questions.

Jill Takes Action To Regain Ability

Jill exhibiting strength and poise in her Infinite Socket.

Jill, from Pennsylvania, recounts how she persevered through years of surgeries and rehabilitation to finally regain her active lifestyle with the Infinite Socket TF.

“I’m an energetic person. I’m out and about every day doing as much activity as possible.  I love to get myself into anything active, whether it’s outdoor activities or competitive sports–I’ve always been that way.  Then, in 2009, I received a stress fracture to my left foot. The exact moment it happened is unclear, though we suspect it may have happened when I tripped in a parking lot one evening.  Surgery was needed to fix it, and the doctor did a full fusion on my foot. The fusion and all the hardware in my foot ultimately came apart, though I didn’t realize it at the time.  A few years later I couldn’t take the pain anymore and went to have a doctor look at it. In 2013, they tried to reconstruct it. The reconstruction did not go well, and infection set in.  All the hardware in my foot was removed to allow it to heal, but a year later the pain was worse, and my foot was deformed. By the end of 2016, I’d had twelve surgeries to try to save the foot to no avail.  In December of 2016, I became a below knee amputee.  

I got myself a prosthesis and was walking.  However, I was still having trouble and couldn’t figure out why I was in so much pain.  It turns out there was osteomyelitis in my tibia, and in 2017 I opted for a shorter amputation.  A year from then, the pain in my knee from osteomyelitis was still persistent. In April of 2018, I became an above the knee amputee and encountered a whole new set of challenges.  

Below-the-knee sockets had been simple for me.  I had a traditional transtibial socket, and within three months I was out jumping rope and other activities of that nature.  However, when I got my traditional above-the-knee socket, it was the most uncomfortable thing I had experienced in my entire life.  When I first put it on, my reaction was ‘you have got to be kidding me.’ It was limited, heavy and restrictive.  The brim was incredibly awkward in the crotch area and so bulky.  It made me feel really bad. I tried my best but felt that I could only be as good as the socket I had to work with, and the conventional did not work for me.  For many months it sat against my wall, and I was non-weight-bearing for an entire year. The rashes and the rubbing made the socket unwearable, and for months I’d go in once a week for adjustments and band-aid solutions to try and make it bearable.  If I do something I really full-on go for it, and I really tried to make it work. Even so, it just wasn’t usable, and I became really depressed.  

I decided I absolutely had to get walking to stop feeling bad for myself.  A support group I joined on Facebook connected me with LIM, and in April of 2019, I received my Infinite Socket TF.  This thing is absolutely amazing, and I only wish I’d found it sooner. There are so many positive things about the design that make such a difference.  It doesn’t dig into my thigh and groin area because of the low trim, and it’s lightweight as opposed to thick and heavy. The steps I’m taking aren’t restricted as they were in the conventional socket.  The word “breathable” comes to mind; I don’t feel as if my limb is encased in something hard and unnatural. Sitting is also much easier as I can loosen and tighten my socket with the ratchet strap at the top, which is also great for volume fluctuation.  The difference between the Infinite Socket and my old traditional socket is night and day. I’ve done more in the past few weeks than I’ve done in the past year. It made me feel good about myself again.” 

 

Clinician Spotlight: Patrick Kelley of Oakland O&P

The main draw of this industry is being able to get somebody up and walking again after they’ve had some sort of traumatic experience in their life.  Whether it be lower limb loss due to trauma or a disease, an ability is taken away from them. I like the sense of giving that back to patients.

 

Patrick, on the right, in front of Oakland O&P.

In 2002, I was fresh out of the military off of active duty Marine Corps and looking for a career that would be interesting and challenging. After making some phone calls, I ended up shadowing an orthotics and prosthetics company. From there, I started learning the industry from the fabrication side while working in the lab.  Eventually I ended up going to Northwestern, first for orthotics and then for prosthetics. Ultimately, I decided prosthetics was the way to go.

The main draw of this industry is being able to get somebody up and walking again after they’ve had some sort of traumatic experience in their life.  Whether it be lower limb loss due to trauma or a disease, an ability is taken away from them. I like the sense of giving that back to patients. Oakland Orthopedic Appliances is opening a new office location, which will allow for more patients to be reached.  We are aiming to target patient populations as needed, and up north is an underserved area.

Once patients are in the office, a lot of initial encounters really serve to lay groundwork for an ongoing relationship in addition to the assessment of the current clinical situation.  It’s worthwhile to get to know the patient, what their goals are for the future, how they see themselves as a prosthetic user. Really understanding how realistic the patient’s goals are and managing expectations while doing everything possible to get them there is so important.  In the prosthetics industry, your patients aren’t one time patients–you’re building a pretty intimate and long-lasting relationship together. That relationship is crucial in order to properly advocate for the patient’s needs. There’s a lot of conversations that need to be had in order to figure out what patient and practitioner feel would result in the optimal outcome, from choosing socket type to selecting the suspension and components.  

For the patients I’ve fit with LIM’s Infinite Sockets, I’ve been very happy with the outcomes.  I’ve had a great experience working with LIM from the beginning, and was a huge fan of the Infinite TF from the get-go.  Then there’s the transtibial socket which went through a redesign, and it has been vastly improved. It’s more aesthetically pleasing and less bulky; I have a few patients now on the new design who really love it.  The Infinite Socket is a great option to provide in our area and makes us stand out as providing a niche service. I can stand by the product. In general, technology in the prosthetics industry has advanced so much.  There’s new devices coming out every month to do different things or do to optimize current functions. The socket technologies and new materials being explored have incredible potential. LIM has been a part of that growth and is doing innovative design work.  

Premier Partner Q&A: Anthony Tufano of Mutual Orthopedics

Anthony Tufano, CP, is the president of Mutual Orthopedics.  He strives to achieve an optimal outcome for every individual patient by combining new technologies with the traditions that have made his long-standing practice a success.

 

Infinite Socket, Mutual Orthopedics
Mutual Orthopedics CP Anthony Tufano with Infinite Socket TF patient

What brought you into the Orthotics and Prosthetics industry?

My practice is third generation.  First was my great-uncle in 1957, then my father, and now myself.  What is now Mutual Orthopedics was officially founded by my father in 1978, and I took over in 2002.  It is one of the oldest companies in the Long Island area. Some of our patients have been with us for forty years.  We have expanded to two offices, one in Brooklyn and one in Long Island, with a sizable prosthetics and orthotics laboratory at the Long Island location.

 

How have you seen the industry change over the course of your career in prosthetics?

The uptake in technology alone has changed the way we practice.  Today, we have access to a whole slew of technology that we did not have previously. We as prosthetists can make people much more comfortable than we could years ago. A while ago, everyone had a standard prosthesis.  That was the challenge back then. It was a lot easier to run the business before, but the technology wasn’t there. Currently, the struggles of operating a practice are related to the changing environment of health care, rather than technological limitations.  Prosthetists are now better able to understand patient needs and fulfill many more of their dreams due to those advancements. As a prosthetist, you want to make your patients more comfortable than they were when they came in. You want them to be able to do things they haven’t been able to do before and to maximize the potential that they have.  The best thing for me to see is a patient coming back after they’ve gotten their prosthesis with parts worn out because they’ve been using it so much.

 

Mutual Orthopedics, Infinite Socket TT-S
Mutual Orthopedics CP Anthony Tufano with Infinite Socket TT-S patient

Can you describe the working relationship you’ve had with LIM Innovations?

I have a long-standing patient who has been with Mutual Orthopedics since the 80s.  About three years ago, he came to me wanting to be fit with the Infinite Socket. After meeting with Geoff, a representative from LIM, we set the process in motion and got the patient fitted. The Infinite Socket is fun to fit, and getting it just right for the patient is a great experience.  Once the fit is flawless, it’s a slam dunk. The appeal of working with LIM is they evolve with you and listen to the input of the prosthetist. It is a collaborative process. Like any product, it has the occasional pitfall now and then, but LIM works efficiently with the clinician to find the optimal resolution.

What would you say are the benefits of the Infinite Socket versus a conventional socket?

In my opinion, the beauty of the Infinite Socket is the adjustability.  It allows for the socket to evolve on a continuous basis along with the patient’s residual limb.  I can get patients to the next level of comfort by tweaking and adjusting to accommodate fluctuations in volume.  The comfort of sitting that the Infinite Socket provides is a huge factor for patients as well. The flexible struts are a draw as well; having something that isn’t rigid when a patient is ambulating on it is a big deal. The Infinite Socket permits a dynamic fitting as opposed to a static one. I love the product.