Category Archives: Prosthetics

Carol’s new socket saved her from surgery!

After many years of living with pain and limited mobility, Carol came to George for a second opinion.

George and Carol first met in May of 2021. She lives with Bilateral Symes Amputations and was experiencing significant knee pain. Doctors were recommending bilateral knee replacement surgery to possibly ease her pain and she was hesitant.

Prosthetic solutions for increased mobility.

George observed that Carol’s pain was exacerbated by the alignment of her bi-lateral Symes prostheses and the knee flexion contractures she had developed. The construction of new sockets with the correct alignment enabled Carol to have her foot flat on the ground. She now has added stability while ambulating and has less pain in her knees. Over approximately 10 appointments with George that included measurements, adaptations and adjustments, she was satisfied with the fit and function and was able to take her prostheses home.

It took her whole life to find the help she needed.

Congenital amputees are one of the most difficult population of patients to work with. A prosthetist needs the experience to recognize that the anatomy in regard to bone structure, nerve innervation, muscular presence and function is often abnormal. As lifelong amputees, congenital patients are very tuned in to how they feel their prosthesis should function, and it is our job to help them reach those goals with the proper device.

Learn more about Practitioner George and his congenital limb experience.

View on YouTube

Resources and Reading for Congenital Limb Patients and Families

Syme Amputation, what is it?

https://www.footcaremd.org/conditions-treatments/injections-and-other-treatments/syme-amputation

Why some people choose not to wear a prosthesis:

https://www.armdynamics.com/upper-limb-library/why-do-some-people-choose-not-to-wear-a-prosthesis

Congenital Differences resources – blogs – podcasts

National and state resources:

https://new-horizons.org/cmtamp.html

Parents of children with limb loss resources:

https://www.armdynamics.com/upper-limb-library/resources-for-parents-of-children-with-upper-limb-differences-or-limb-loss

Lucky Fin Project (kids):

Helping those with limb loss find a prosthetist

Amputees and those with congenital disorders who wear a prosthetic device typically have a long-term relationship with their prosthetist. If you have never worn a prosthesis, this is an outline of what you should expect during your journey.

Are you ready for a prosthesis?

Obtaining a prosthesis is usually a long term process. You need to prepare your muscles so they are in the right shape to utilize your new device. This usually means working with a physical therapist and other members of your care team to educate you about day-to-day living with a prosthesis. Having care team members that communicate is extremely important for a successful outcome with your prosthetic device.

If you decide having a prosthesis is the path you want to take, you will want to find a prosthetist to collaborate with on your care team. Your physician will provide the referral to be seen at our facility. The next step is for us to evaluate the best course of action for your daily living and future goals.

What is the best way to learn more about getting a prosthesis?

Before you can see a prosthetist, your doctor will need to:

  • Document your current condition
  • Diagnose your K-Level
  • Collaborate among the members of your care team

After the appropriate device has been decided upon, you will continue your PT while your prosthesis is manufactured. During the fitting process, over multiple visits, your prosthetist fine tune your device socket and provide the training you need to get the most out of your new prosthesis.

Step 1: Documenting your current condition

Your doctor will complete an evaluation checklist. This is when you should ask questions. This information will be the basis of the report being sent to your insurance company which ultimately determines the affordability of your prosthetic device.

  • Physical Exam
  • History of Amputation
  • Functional Deficits
  • Functional Level
  • Motivation to use prosthesis
  • Describe the condition of the residual limb
  • Patient’s past experience with prosthesis

If a replacement prosthesis is needed, describe the condition of current prosthesis or component and your recommendation based on your functional level evaluation.

Step 2: Diagnose your K-level

Your doctor will confirm your K-level which determines the type of device your insurance will approve. The K-level is based on your daily activities and current physical condition. it is possible over time that you can graduate to a higher K-Level if you continue to progress in your abilities.

Learn more about K-levels.

Step 3: Team Collaboration = Improved Prosthetic Care

On your first visit, options will be discussed to find the prosthetic configuration that allows you to get back to your daily activities and meet your future goals.

In addition to your doctor, your care team will consist of physical therapists and your prosthetist. Cohesive care during your rehabilitation will help you stay on track with your short and long-term goals to better improve your outcomes.

The team collaboration is a transparent process – the goal is patient education through communication with all members of the team. Collective input creates a clear plan which leads to higher patient satisfaction with improved functional results. After your final fitting, your prosthetic devices will need adjustments over time, so you will likely check in with your prosthetist once or twice a year.

“I believe that providing a prosthesis is just the beginning of my responsibility as a prosthetic provider, I am also involved in the education and follow up care of my patients”, says George. He is always eager to learn new methods and philosophies and share for the benefit of the team as well as the success of the patients’ prosthetic experience.

Read more about George Villarruel’s experience.

Patient Resources

Every patient is unique, physically and psychologically and we have the experience and compassion to guide them through this journey. We have put together a list of resources of organizations and articles to help you and your family members.

Check out our patient and family resources.

Certification Boards

The American Board for Certification in Orthotics, Prosthetics & Pedorthotics (ABC)

abcop.org
info@abcop.org
703-836-7114

The Board of Certification/Accreditation, International (BOC)

bocusa.org

Orthotics and Prosthetics Patient Care – Our offices are open.

Collier Orthotics and Prosthetics in association with Laurence Orthotics and Prosthetics logo

As an essential health care service provider, our offices remain open with a full staff of trained, licensed, bonded and insured practitioners who are ready to provide on-going care for those in need of mobility devices and for in-patient hospital calls 7 days a week, evening and holidays.

Providing Orthotics and Prosthetics care for seniors, pediatric patients, and those with special needs is the heart of what we do.

Our Practitioners and staff can assist those that are in need of orthotic and prosthetic devices to improve or maintain their mobility for all Activities of Daily Living (ADL’s) such as personal care, cooking, walking, exercise, essential transportation to the grocery store and pharmacy, safety, reassurance and especially with those tasks one may have difficulty in accomplishing during this period of Sheltering in Place.

We are here for you. If you need an appointment, please do not hesitate to call. Nothing is more important than the health and safety of our patients and staff. We have taken precautions based on state and federal mandates to provide a safe and comfortable environment for our patients and staff. We follow all social distancing guidelines and ask you to please remain 6 feet from any other patients and staff.

Orthotic and Prosthetic services remain an option to those at risk of mobility and we will do everything in our power to support our patients, staff members and community in every way possible to keep them safe and cared for by continuing services for improved mobility during these times.

Please rest assured that we are monitoring the COVID-19 situation very closely at all our locations.

We will continue to keep our Management, Practitioners, and Office Staff Employees well-informed on a daily basis about the virus and best practices to ensure the health and safety of all of our clients and employees. The following precautions are being taken to combat this changing situation:

  • Limiting the number of people in our facility at any given time. If you require assistance, we ask that you limit caregivers/companions to one support person only for your visit.
  • Reducing patient appointments to comply with social distancing in waiting rooms
  • All patients, caregivers/companions, and staff are required to wear a mask. The mask must remain over your nose and mouth throughout your entire visit to our office.
  • We ask that patient family members remain in vehicle at the time of patient appointment
  • Pediatric patient can be accompanied by an adult during their appointment
  • All patients entering the clinic will sanitize or wash their hands on the way in and out.
  • We will continue to disinfect all equipment and surfaces after each treatment.
  • We will be modifying treatment to accommodate your specific needs.
  • We ask you to help our efforts by staying home if you feel sick or are at risk.

Those defined as at risk are:

· The elderly
· Those with heart or lung disorders
– Diabetes
– Immunocompromised

We are doing our best to take the proper precautions and modifications to meet the needs of our patients under these unusual circumstances. Make sure you are doing your best to protect yourself, and if you have any questions or concerns, please visit www.cdc.gov/coronavirus.

Our compassionate and professional staff and practitioners have been serving the community since 1988 for Collier and 1946 for Laurence. We are committed to offering the same legendary service which we are known for, especially during this unprecedented COVID-19 crisis.

If you have any questions, or are in need of services, please contact us by email below or call 916-979-9729.

Prosthetic Case Study – Trans Tibial Amputee

Mikhaila Rutherford is 26 years old and, and has a new articulating ankle. This allows her to be more ambulatory and ready to enjoy her new career in nursing without the hassles and limitations of her old and worn out prosthetic device.

Four years ago, Mikhaila came to our lead prosthetic practitioner with some challenges:

  1. She would be challenging to fit due to multiple surgeries to resolve her subluxating patella (knee cap).
  2. A short trans tibial residual limb.
  3. Her current foot did not allow for any flexibility when walking on slopes of any kind.

George was able to get approval through the insurance for the best possible device for Mikhaila. Watch the video to see how she demonstrates her new prosthesis with an articulating ankle.

Mikhaila was fit with an Alps AKDT locking liner and Patellar Tendon Bearing Supra Patellar Supra Condylar (PTB SCSP) socket design to help stabilize her knee in the medial lateral plane. For her last fitting, she was provided a foot with an articulating hydraulic ankle which can accommodate going up and down sloped terrain.

Mikhaila can now get back to daily living with a lot more mobility when hiking and being outdoors. We look forward to hearing about her new career as a nurse when she comes back for a check up.

Mikhaila has been a patient of George Villarruel at Collier O and P. If you would like to see more of our patient success stories, visit our patient outcomes page.

Prosthetics Hip Flexion Case Study

hip flexion case study prosthetics

By simply adding a flexion plate to his existing alignment (purple arrow) the patient can now stand on his prosthesis with greater stability and confidence.

Although this is a dramatic depiction of a transfemoral patient with a significant hip flexion contracture, it is something many above knee amputees and their prosthetist deal with to various degrees. A Thomas test would show that this patient has a contracture of approximately 35 to 40 degrees.

The picture on the left shows the weight line or TKA line, bisecting the socket with the center of his mechanical knee so far in front of the line that weight bearing on this alignment would certainly cause the patient to feel unstable and possibly collapse. Even if the patient could stand on this alignment it would create a lordosis or arching of his lower back. He would be in pain in no time as his lordosis compensates for the lack of hip flexion aligned onto this prosthesis.

The weight line on the picture on the right shows it bisecting the socket and going slightly anterior to the center of his mechanical knee and down to the middle of his foot creating an inherently stable alignment from which the patient can feel safe ambulating on.

George is an American Board Certified Prosthetist with over 25 years of experience focused solely in the practice of prosthetics. As the Director of Prosthetics for Collier, he is responsible for lower and upper extremity prosthetic patient care. His experience ranges from infancy to geriatrics.

Do you have a question? Please contact us below.