How can BK-Short get the best possible performing prosthesis? The short answer, each step mentioned in this webspace is an important part of the puzzle, and will help compensate for the short residual. Together, these steps will help advance your prosthesis design, comfort, and activity level.
First, we start with the socket and liner, which is the most important part and most difficult to accomplish. Get a well fitted high-top socket, with a higher back and a narrow collar. Do not settle for anything less than well-fitted and comfortable. This will allow a better grip of the prosthesis by your short residual, which will help you drive that prosthesis, with minimal discomfort and best performance. Also, use Tri-lamination liners and make sure that you have two of the same liners to alternate between, and that each liner has the same good fitting, a half inch overhang, and at least a 2 inch stump extension heel, with a perfect sink-in matched fitting inside the socket. This is what replaces a surgery to extend your residual or the need for using a thigh corset. Inside the extension of the liner, try to use a hard gel pad for added springy performance, and cover with hard foam material. Then, choose your comfort level of socks, either the French sheath and 3-8-ply socks combination for a snug fit, or the Silipos BK gel socks and 3-5-ply socks combination for a snug fit, or one set of each, so you can switch between them for relief.
Second, choose a carbon fiber-type foot that will be attached directly to that socket. Never use a foot with a tube shaped pylon. Either Flex-Foot or Silhouette will be the best option for BK-Short today, in my opinion. They are made by different manufactures, but both are similar in functionality and benefits. Either one will be long and lightweight carbon fiber, which will flex and store energy when you step in, then give that energy back to you when you step off. When selecting either foot, it is important to make sure to select a less firm, softer grade, or less active option. This will help soften the suspension while allowing you to turn your short residuals into an advantage, by harnessing the extra energy that comes with the extra length of the carbon fiber.
Third, when it is time for alignment, make sure that your completed leg has the right height, and your prosthetist has a scale to measure that. Try using the Tube Clamp alignment mechanism, it will provide the most benefits. There are some special considerations for BK-Short, including keeping the foot pointing straight forward, a slightly softer heel, and a slightly resistant foot roll, all of which can be accomplished via proper alignment. My current prosthetists and I usually joke about my special micro adjustment needs, and how much difference the slightest adjustment can make for my walk. So, be patient, adjust over multiple sessions so that you can take it home for a trial in between. Alignment is not hard to achieve, but it is key to making sure that you are walking well and taking advantage of what you have.
Fourth, you need suspension sleeves in order to keep that leg on, especially during activities. I have predominantly used a Juzo sleeve for many years, for walking and other standard activities. They are made of decent elastic materials and are washable and inexpensive, which is good because they only last about 3-6 months. I have also used different types of gel sleeves for many years. They are flexible but have a stronger hold than Juzo, and most importantly, protect your liner from getting wet. I use gel sleeves for playing sports, or riding motorcycles and jet ski, for firm grip, but not for riding bicycles, because it is less flexible during the ongoing motion of pedaling. Please note that all prosthesis components as described above are water safe, except for the liner. So, while I take my prosthesis off during pool laps and diving, I use gel sleeves in showers and swimming in the sea or the ocean, because you have to walk on the beach before you get to the water. Aqua shoes are definitely recommended for walking pool side and on the beach. It will support walking and make activities much less wobbly, especially for BK-Short. As for the foot shell, you need to drill 4-6 quarter inch holes in it, in order for water to drain out, otherwise, the water will stay in the foot shell and will become rotten.
Fifth, don’t go cheap on shoes. It is like a Mercedes with bad tires. A good pair of shoes will provide support and help you walk better. They need to be lightweight, comfortable and have wide and grippy soles, which will help advance your walk and also help with your balance. I am addicted to NB-860, they tremendously improve my walk and maneuverability. Clarks and Skechers also have many good options, and help me step into a range of casual and less casual wear. Also, adding a good shoe insert to the good leg only is beneficial. Especially when your good leg and foot are now doing more work than usual, including unusual twisting and pressures. Change your shoes and insert every 3-6 months, as different parts will break down internally, which will impact your spine, hip, and pelvic floor, not to mention comfort, which is key to healthy walking.
Sixth, walking for BK-Short is very different, because unlike people with longer residuals, you are not operating your prosthesis with intent and leverage. Instead, your walk is like a swing and balance dance. So, make sure you have all your gears ready for it, including proper fitting, the right foot, a sleeve to hold that leg on, and a good pair of shoes with an insert. Now, you are good to go. Also, be aware that each step will place weight on your residual skin, at the rate of body weight divided by the number of square inches in your residual. So be kind to your residual. Try to wash with warm water nightly, and apply some lotion so that you are fresh and ready for the next day. Finally, when you have an irritated spot on your residual, you can use a thin silicone nipple cover for a few days to prevent further irritation. When your hair follicles are infected, take a rest. If you can’t, then use Dr Scholl’s Corn Cushion and some Neosporin in the donut hole to expedite healing and prevent infection. Remember, neglecting your residual frequently can lead to more pain, sores, and infections.
Seventh, spinal misalignment, hip rotation, and pelvic floor dysfunction are the direct result of walking with a limp, with short and long term impacts. Given that you are BK-Short, you will have at least a slight limp in the best case. While over the years I stayed active, I did not realize this until I got older, and started to suffer all kinds of indirect effects, from headaches as a result of neck misalignment, to chest pain as a result of mid back misalignment, to hips and knee pain as a result of hip rotation, etc. It is all connected. Interestingly, when the hips are rotated, you will also feel as if your knees and hips are problematic. This is because one leg will be longer than the other as a result, depending on which direction your hips are rotated. As for the pelvic floor issues, there can be several, because that complex network of muscles and nerves inside are trying to overcompensate. So, the key here is to be aware and proactive, follow up regularly with a physical therapist and a pelvic floor specialist, and include all your PT exercises in your weekly workout routines.
Finally, having multiple prostheses, multiple liners, and multiple sock combinations is a good thing, so you can switch for relief. Be aware that every prosthesis and liner will have a different fitting and pressure points, even with identical fittings and components. Also, if you have the extra funds, you may be eager to try other expensive components. While this is also a good thing, most sophisticated and expensive feet are also heavier, for obvious reasons. So, try to stick with lighter components only. When it comes to leverage and weight, it is just simple mathematics, how lengthy and heavy of a prosthesis can you move with your short residuals. Also, your weight divided by the number of square inches in your residuals represents the pressure you apply to your residual skin, with each pressing step. So, make decisions that are kind to your skin and your body. Good luck and best wishes!