Lower Extremities

1. Children tend to do well with lower-limb prostheses, often requiring little or no formal gait training.

2. Limb-volume changes occur following amputa­tion and can be controlled by rigid dressings in the postoperative period (145).

3. When fitting an ankle disarticulation prosthesis, the prosthetists should strive to create a prosthesis that permits near full weight bearing on the distal end of the child's residuum. This will ensure that the

Figure 13.25 Individual with transtibial amputation and removable, rigid dressing. Note strap used to maintain compression on limb.

Figure 13.26 Angulation deformity accommodated by prothesis.

distal end of the residuum and the heel pad remain toughened. An end-bearing residuum of this length is beneficial for limited ambulation without the prosthesis (eg, using the bathroom in the middle of the night), as well as long-term fitting.

4. The surface area of the distal residuum will remain fairly consistent throughout the child's life; therefore, the child is encouraged to maintain a rea­sonable weight, so as not to lose the ability for distal end bearing.

5. Prosthetic fittings may be affected by angular deformities as the alignment of the device must be biomechanically appropriate and not necessarily the most cosmetic. Most of the angulation defor­mities can be accommodated in a prosthesis; how­ever, it is not possible to provide a device that is advantageous to appropriate gait mechanics and satisfies the cosmetic expectations. The accom­modation of angular deformity is illustrated in Figure 13.26.

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