Hesperian Health Guides

Chapter 67: Artificial Legs

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HealthWiki > Disabled Village Children > Chapter 67: Artificial Legs


Artificial legs can be (and often are) made at home or in village shops. How well they work and how natural they look depend on many things, including costs, skills, and materials available.

Below the Knee
Boy with 1 leg and 1 stump holding crutches, boy walking with artificial leg holding flower.
Even a simple artificial limb can make a big difference.

The most common leg amputation is below the knee. A leg that has been amputated halfway between the knee and ankle works best for walking with an artificial limb. Here are some examples of artificial limbs, from simple to more complex.

WITH THE KNEE BENT

HAND-HELD POLE LEGS ‘SAWED-OFF CRUTCH’ LEG
Boy using hand held pole leg on which his stump rests.
padding
plastic or wood leg support
canvas or leather sling for knee
The torso and below of a boy using a sawed off crutch leg.
leather or canvas bands
padding
block of wood or piece of plastic curved to fit leg
prop
sawed-off crutch
CAUTION! Limbs like these 3 are quick and easy to make, but they cause knee contractures. As a result, the knee cannot be easily straightened to fit a better, more useful limb. Bent-knee limbs should only be for temporary or emergency use. Do exercises every day to keep the knee straight and strong.


WITH THE KNEE STRAIGHT

BAMBOO AND PLASTER LEG PLASTIC PIPE LEG WITH FOOT
Artificial leg made of bamboo and plaster that ends in a pole, and artificial leg made of plastic pipe with foot attached.
bamboo
plastic pipe (PVC)



These limbs are better because the knee has full range of motion. Walking is easier and more natural. However, the person’s weight must be supported evenly over the entire stump, not only at the end of the stump.

Positions for FITTING A LIMB

Stump below the knee folded backward, stump sligthly angled back, stump facing straight.
BAD
will only work with a bent-knee limb
DIFFICULT
knee does not straighten fully
GOOD
knee straightens completely

Exercises to strengthen and straighten the leg

Waist down drawing of body with normal leg and stump below the knee.
AVOID CONTRACTURES
Contractures here and here need to be straightened before a standard limb can be fitted.

From the time a leg has been amputated until a limb is fitted, daily exercises are needed to keep the hip and knee muscles strong and to avoid contractures. If weakness and contractures already exist, these should be corrected as much as possible before a limb is fitted. Exercises are discussed in "Prevention of Contractures".

How soon can an artificial limb be fitted?

Adult hands sustain small child with one bamboo and plaster leg.

Children born without a foot or part of a leg (or legs) can be fitted with an artificial limb as early as 10 or 12 months of age.

A child whose foot has been cut off can and should be fitted with a temporary limb as soon as the wound has healed. However, be very careful not to injure or put any pressure on the new scars or end of the stump.

Note: On a very young or fat child, it may be difficult to fasten the limb firmly to the knee (the bones may not stick out enough). Straps to a waistband and even over the shoulder may be needed.


Temporary limbs—when to use them and why

Because a stump usually shrinks and changes shape in the first weeks after a limb is fitted, it is often wise first to fit a low-cost, temporary limb. This is especially true if the amputation is new or the stump is swollen. A better-looking, more permanent limb can be made after 4 to 6 weeks, or when swelling is gone.

Preparing the stump

In the first weeks or months after an amputation, the stump tends to swell up. The swelling may in time lead to a club-shaped, deformed stump, which is difficult to fit with an artificial limb. For this reason, it is important to wrap the stump with elastic bandage from the time the leg is cut off until a limb is fitted, or at least until there is no more sign of swelling. Instructions for wrapping the stump are in "Care of the Amputated Limb".

BAD SHAPE
Below the knee stump that is swollen.
If the stump is swollen or badly shaped, before fitting a limb, wrap it for several days (or weeks) to reduce swelling and improve shape.
Below the knee stump that is bandaged, below the knee stump that is not swollen.
Wrap it to above the knee.
GOOD SHAPE

Note: When the person is not wearing the artificial leg, he should also wear an elastic bandage to control the stump shape


Before starting to make an artificial limb, STUDY THE PERSON’S LEG.

A good fit of the socket on the stump and at the knee is one of the most important —and difficult—parts of limb making. It helps to have an understanding of the bones and muscles in the leg.


FRONT VIEW
Front view of a human leg from above the knee to the foot, arrows and letter "x" note characteristics.
Avoid pressure on bony bumps.
Put pressure on kneecap tendon.
Put pressure on muscle areas.
Avoid pressure on shin bone.
SIDE VIEW
DVC Ch67 Page 627-2.png
A GOOD SOCKET,
does not press on bony bumps just under the skin.
presses on against muscles
presses in firmly just below the kneecap. (The main weight bearing is here.)
does not press over shin bone.
leaves enough space at stump tip so that tip will not be injured if the stump settles a little deeper into the socket.


Before beginning, study the person’s knee and stump carefully. Note the positions of the kneecap, the bony bumps on the sides of the knee, and the shin bone.


MEASUREMENTS YOU MAY NEED FOR A BELOW-KNEE LIMB
(Copy this chart and use it to record your measurements.)
distance around knee just below kneecap and every 5 cm. around the stump
measuring distance between knee and stump
length from mid-knee to bone end length from mid-knee to bone end
measurement of foot, knee to stump and knee to foot to make an artificial limb
length of foot
shoe size
length from mid-knee to heel of good leg

Note: For the plaster and bamboo limb, only lengthwise measurements are needed.


Note: The artificial limb should be the same length or just a little shorter than the other leg.



This page was updated:19 Jan 2018