Post-ERTL Surgery & Pre-Prosthetic fitting regime

APPROXIMATELY TWO WEEKS POST-SURGERY:

  • Usually stitches are out or will be soon, and you have a good start on healing.
  • Begin weekly progress visits here to visually examine residual-limb, record volume, and discuss your individual regimen.
  • I usually demonstrate a number of exercises that will prepare your overall body and residual-limb for prosthetic fitting. It is best to assure that you use correct form, to prevent injury. You may wish to have a physiotherapist or personal trainer work with you on these exercises.
  • Post-Operative swelling is natural, and is part of the healing process. Excessive swelling can cause greater discomfort, impede healing, or, could be a sign of complication. To allow a more natural process of swelling reduction & healing, I will fit a Hypobaric Cushion & Compression Interface (HCI). This is an elastic type “sock” that you roll on your residual-limb (I have found this system to be more effective than the conventional “shrinker” or “Ace wrap”). I recommend a gradual wearing schedule to allow skin to acclimate to the enclosed environment – the first three days wear from 1-3 hours (this can be 1-3 hrs. straight, or 1 hr. on, 1 hr. off, etc). Increase one hour every day or as you feel appropriate (it is important to inspect your skin and report any irritations, concerns/problems you may have). You will eventually keep it on most of your waking hours. This is the best way we have found to reduce and control post-operative swelling as well as protection from injury such as bumping. Make sure to clean the inner surface of the HCI per instructions.
  • You can begin gentle compression over the end your residual-limb by using a hand towel. This can be on bare skin or over the HCI. Fold the towel in 1/2 or 1/3 rds length-wise. Grasp each end and sling it over your residual-limb from front to back direction – directly over and under your kneecap. Pull gently to the point that discomfort “smarts” – hold for 5 seconds. Release SLOWLY and do not lose contact with your skin. You may gradually increase the number of repetitions to 25 or more. When you are able to pull with all your strength, and it does not hurt, you are ready for standing “end-bearing” exercise.
  • I will give you a folder that contains all this information and your end-bearing log. There will also be a QUESTION & ANSWER page for you to write questions you may have while at home. Bring this folder with you to all your appointments until you leave with your Definitive Prosthesis.

–     Sound Nutrition is essential to healing. I encourage you to drink clean water daily – about ½ your bodyweight in ounces (a person weighing 130 pounds would drink about 65 ounces of water every day – about 7 cups). Three-quarters of your brain is water, muscles are 70% water, blood is 82% water, and bones are 25% water. This basic biochemistry emphasizes that plain ol’ water is the most important component of your body! I also encourage eating healthily. Optimal bodily function cannot occur without daily ingestion of a precise mix of 59 nutrients. Healing after surgery, as well overall physical and mental health can be greatly improved by practicing sound nutrition. It is well accepted in the general medical community, that the food we eat does not contain the proper amount of disease preventing vitamins, minerals, trace elements, antioxidants, amino acids that our bodies need to maintain a defense against the ever increasingly powerful germs that we are faced with. This is especially important after any surgery.

EXERCISES:

  • While seated in a chair that is firmly supportive, sit in such a manner that you would have both feet comfortably flat on the floor – thighs horizontal – legs vertical; lightly contract muscles in your residual-limb(s) as if you were going to keep your heels on the floor and raise the front part of your feet and toes up toward your shins as high as you are comfortably able – do this slowly at first and hold for 3 seconds. DO NOT contract muscles to the point of PAIN (I usually say, “to the point of smarting”). Do one set of 5 repetitions two times a day (It is best to perform these at the same time each day – morning/evening). Gradually increase intensity of muscle contraction and number of sets/repetitions (to 3 sets of 15 repetitions).
  • Reverse the exercise described above, lifting just your heels off the floor as high as is comfortable for the same number of repetitions, holding each for a count of 3.
  • Assume the sitting position described above, and tilt your feet inward/under, like you were rolling your foot/ankle over the outside edge of your foot/ankle (this is called inversion).
  • Then do the opposite – tilt your foot/ankle outward, as if you were going to walk on the inside of your feet as they are tilted outward (this is called eversion).
  • The next exercise is to imagine turning your feet outward, like a duck walks; then the opposite of that – turn your foot inward toeing in.
  • Keep your overall body limber and strong by doing floor exercises to maintain knee, hip, shoulders, and back range of motion (ROM) & strength. See instruction sheets. It is best to do the stretching exercises every day.

 FOUR WEEKS POST-SURGERY

Begin standing end-bearing exercises by pressing the end of your residual-limb onto a weight scale. Place a bathroom type weight scale on a stool and press the end of your residual-limb onto the scale to the point that the pressure “smarts”. It is important to feel the pressure under the tibia – the larger main bone, directly under your kneecap. DO NOT bear weight under the fibula – the smaller bone on the outside of your leg (you may not have this bone, I will let you know if that is the case). You may do this exercise with your HCI on or off, and/or use a folded towel or equal for added cushion. Using the “end-bearing log sheets, at least once per week record the date and weight you are able to bear (you may record amounts more often). The objective is to eventually progress to no cushion other than the HCI. As you record, you will observe how you are able to increase the amount you can bear –many have been able to bear 100% of bodyweight in 5-10 months. It is not necessary that you bear 100% as a condition to begin the fitting. Each case is different.

  • Continue ROM & muscle strengthening exercises.
  • Follow the nutritional guidelines discussed above

ABOUT 8 WEEKS POST-SURGERY

  • Begin Preparatory Prosthetic fitting
  • Continue all exercises including end-bearing
  • Follow the nutritional guidelines discussed above

GENERAL NOTE

The Ertl Reconstructive Primary & Secondary Amputation Surgery provides the most biological, physiological result known today. Each person presents a different set of circumstances to this Rehabilitation Process – differences in overall body type, residual-limb length/size/shape/complications, physical capability, and emotional/mental condition. The program you will follow is general in nature, yet will be customized to your individual needs. What you learn of another persons experience may not be the same as yours. The surgery is a highly specialized, and the prosthetic rehabilitation process is also specialized. It can be fairly simple if you are healthy and in good physical and mental condition. Any complications will typically extend the process. Please discuss with me any questions, concerns, problems you have or perceive.

GENERAL DON’Ts

  • Let your residual-limb(s) hang down too long when you are sitting causing swelling in the end of your residual-limb – keep your leg(s) supported horizontally or higher
  • Be lazy & not exercise muscles & all your body
  • Too much end-bearing to the degree of pain – this could cause injury &  delay your progress
  • Ignore sound nutrition