What diseases can be caused by long-term wear of inappropriate artificial limbs? How to prevent and treat them?

When the prosthesis is in use, it is treated as an organ of the human body and becomes an integral part of the whole. Improper assembly and use of prosthetic limbs will not only cause problems with the residual limb itself, but sometimes also cause problems with certain other parts. Long-term wearing of inappropriate prostheses may generally cause the following diseases:

1. Skin friction injury at the weight-bearing part of the residual limb

It is more common on the bony protrusions of the residual limb. The surface of the skin will initially become red, and then blisters and skin abrasions may develop. Long-term use of inappropriate calf prostheses can cause bursae at the fibular head (due to long-term friction between the socket wall and the skin at the bony protrusion, forming a mass). When redness, swelling, heat, and pain appear, it is called bursitis. We should focus on prevention for this type of problem, pay attention to the skin damage of the residual limb at all times, discover it in time, find the cause in time, and solve it in time. This type of problem is mostly caused by an inappropriate socket for the residual limb. Sometimes it may also be caused by improper wearing. It may also be caused by muscle atrophy of the residual limb and bony protrusions that are too obvious. Generally, it is necessary to ask a prosthetic technician to adjust the socket to solve the problem. A small number of amputees have bone spurs at the end of the residual limb bones, which often cause local pain and skin friction injuries and require surgical removal.

2. Skin diseases of residual limbs

Folliculitis caused by bacterial infection or psoriasis caused by various fungi is mostly due to the failure to clean and sanitize the residual limbs and prosthetic sockets. We should also focus on prevention of such problems, and do a good job in cleaning the residual limb, residual limb socks, and socket. If skin disease is found, the prosthesis must be stopped and treated promptly.

3. Muscle atrophy and blood supply disorder of residual limbs

Some muscles in the residual limb no longer move after being severed, and the prosthetic limb is often put under pressure. Therefore, after long-term use of the prosthetic limb, the muscles of the residual limb will become increasingly atrophied. Muscle atrophy will cause the blood circulation of the residual limb to deteriorate, and the residual limb will be cold and easily cause residual limb pain and phantom limb pain. To prevent muscle atrophy, amputees should pay attention to regular phantom limb movement exercises. Generally, amputees retain the sense of phantom limbs (see question 4). During phantom limb movement exercises, thigh amputees can practice imaginary movements of continuously extending and bending the knees, and each time they extend or bend the knees, they must continue to exert force for more than 10 seconds; patients with lower leg amputees can practice imaginary movements of lifting the instep and pushing down with force. In addition, patients with lower leg amputations should try their best to adjust the residual limb socket to full weight bearing or full contact. People who use calf prostheses with knee hinges and upper thigh straps should also be careful not to tie the middle strap of the upper thigh strap too tightly to avoid affecting the blood supply of the residual limb.

4. Lymphatic stagnation inflammation of soft tissue at the end of the residual limb

Most of the modern lower limb prosthetic sockets are sealed. If the residual limb and the socket can fully contact, there will generally be no problem. If there is a gap between the end of the residual limb and the bottom of the socket, the residual limb should be lifted once. As the prosthetic limb moves downward, the gap in the socket becomes larger, and a negative pressure occurs, which is equivalent to cupping in traditional Chinese medicine treatment. Over time, the soft tissue at the end of the residual limb will become red, swollen, and tender, which is called lymphatic stagnation inflammation. Prevention is also the first priority for this type of problem, requiring all closed sockets of thigh or calf prostheses to have full contact with the residual limb. If full contact cannot be achieved, do not force a closed socket. For patients who have developed stagnant inflammation, it is recommended to stop using the prosthetic limb in time and wrap it with an elastic bandage (see question 16). If necessary, they can cooperate with heat compress or some physical therapy.

5. Scoliosis and low back pain

The length of the lower limb prosthesis is often inappropriate. If it is too long or too short, it will cause the amputee to tilt the pelvis and lumbar scoliosis when standing. Over time, it will cause low back pain. It should be discovered early and ask a prosthetic technician to help adjust it as soon as possible. Generally, the healthy limb and the prosthetic limb are required to be of equal length. The thigh prosthesis can be shorter and should not exceed 1 cm.