Amputation/prosthetic foot or leg

Amputees have enormous demands when it comes to the properties of shoes. Even at the beginning of rehabilitation, having the right shoes has a significant impact on the individual’s later gait pattern. The kyBoot stands out from all of the other shoe models on the market thanks to its air-cushion sole. If the amputee struggles to roll over the ankle in normal shoes, this completely disappears with the kyBoot.

The soft, springy soles absorb impact on all surfaces and enable the prosthetic foot to gently use the rollover motion. This saves a lot of energy and relieves stress on the residual limb. The hips and back are also relieved, which often leads to increased quality of life.

Definition

Amputation is the removal of a body extremity.

An amputation above the ankle would be described as a major amputation.

The term minor amputation denotes amputations below the ankle region (i.e. up to and including the Chopart amputation).

Border zone amputation is a collective term used in German-speaking countries to refer to the combination of a minor amputation at the border to vital tissue, necrosectomy or debridement.

Causes

Most planned limb amputations are necessary as a consequence of arterial occlusion (peripheral arterial occlusive disease). The indication is usually established in stage IV, when extensive tissue necrosis or infected gangrene with pending sepsis develops and vascular surgery measures are not an option or have been exhausted. In exceptional cases the indication is also established in stage III when existing chronic pain cannot be managed and the patient’s quality of life is so restricted that the amputation is the ‘lesser evil’. The amputation level depends on the quality of circulation, which is determined by means of angiography, and the most effective prosthetic fitting option.

Diabetic gangrene is the second most common indication (see diabetes mellitus). In contrast to arterial occlusive disease, the aim here is to carry out what’s known as a ‘border zone amputation’. This means amputating at the most distal location possible, right in the area that is only just still healthy. These are therefore often amputations of the toes, the forefoot (amputation/disarticulation in the Chopart or Lisfranc joint) or the hindfoot (Pirogoff amputation). This approach, which used to be frowned upon and called ‘salami slicing’, has become widely accepted since the 1990s because of improvements in wound management, systemic antibiotic treatment and diabetes control. Nevertheless, many transtibial (lower leg) or transfemoral (thigh) amputations still have to be performed ‘ultima ratio’ as the final option.

Amputations due to accident injuries are rare compared to the first two indications.

Malignant tumours very rarely require a limb to be amputated. Usually these are bone or soft tissue tumours (sarcomas).
There has been a significant increase in amputations in recent years due to MRSA bacteria.

Possible consequences

• Phantom sensations
• Phantom pain
• Postoperative pain
• Residual limb pain
• Neuroma pain
• Wound healing problems, both superficial and deep
• Deep wound infection
• Residual limb necrosis
• Residual limb oedema
• Contractures
• Skin diseases on the residual limb
• Anxiety and depression

Conventional therapy

Aftercare following an amputation primarily covers three areas:

• Prosthetic fitting
• Administration of medications
• Physiotherapy
• Walking rehabilitation

Alternative forms of treatment such as acupuncture or mirror box therapy are used with great success as well.

The kybun principle of operation – being proactive

The kyBoot offers a unique walking experience for customers with prosthetic legs:

• Learning the physiological gait after an amputation is much easier with the kyBoot thanks to the soft, springy soles, as the kyBoot does not require the typical heel impact of other shoes and enables the wearer to feel contact with the ground.
• This relieves the strain on the stump in the prosthetic.
• The prosthesis holds better, i.e. it is not pushed away from the residual limb as much.
• The soft, elastic sole compensates for surface irregularities.
• The toes rarely get caught on the ground in the kyBoot so you stumble much less often.
• You can tread forward confidently on the prosthesis with an easy rollover.
• Balance while standing and walking is significantly improved.
• The legs no longer feel so heavy after walking.
• You can walk more confidently, more relaxed and save more energy than in conventional shoes. Your gait is also improved.
• Getting up from a chair or the toilet etc. or getting out of the car is much easier than with other shoes. We also shouldn’t forget the safety factor. The kyBoot has a far wider stepping surface, which reduces the risk of slipping.
• The kyBoot is extremely slip-resistant on all dry and wet surfaces, even in snowy conditions and on wet stone floors.

Initial reactions

Specific initial reactions when wearing prosthetic legs

You may find the first steps you take in the kyBoot somewhat irritating. This is particularly true for customers who previously always wore hard shoes. This will only have a negligible effect for beginners learning how to walk again. Experience has shown that the body gets used to this within a short period of time . Be patient, it’ll be worth it.

Click here for the general initial reactions experienced by kyBounder and kyBoot beginners: Initial reactions

kybun exercises

For information about the special kyBoot exercises or the basic kyBounder exercises , please click here: kybun exercises

Application tips

• Take small steps in your kyBoot shoes at first.
• Be sure to maintain an upright body posture without cramping up!
• Keep your gaze forward while keeping the shoulders loose.
• We recommend a second generation kyBoot model(Comfort or SlimFit sole). These models have a somewhat wider sole in the area of the midfoot, providing added stability.
  Seek advice from your local kyBoot expert.
• Try to consciously perceive the feeling of the roll-off phases. Venture out onto different surfaces. You will subconsciously gain more confidence when walking.
  After a while, you will hardly pay any attention to your steps, which will allow you to relax when walking.
• If the second generation kyBoot model is too unstable for you, we recommend the kyBounder. You can choose the thickness you are comfortable with (the thicker, the less stable, the more intensive the training). You can also hold on to a fixed object.
• Precise movements are essential, especially if you suffer from joint pain or osteoarthritis. Pay attention to exact movements and be sure to take a break in case of fatigue or weakness. Lateral/medial rolling of the ankle joint on the soft, elastic material has to be corrected so that the load is applied to the leg with proper axial alignment and so that strain on the back is kept to a minimum. Read more under ‘Lateral/medial rolling of the ankle joint’.
• Take your time! The kyBoot and the kyBounder are intensive ‘training devices’ and pose a major challenge for the body. It may take a few months before you can walk in the kyBoot or stand on the kyBounder for several hours in a row. The duration of use is highly individual and depends on numerous factors. It also varies from day to day. Listen to your body and accept your personal limits.
• Contact a kybun dealer you trust if you have further questions, feel unstable or if there is no alleviation of pain when using the kyBoot even though you are following the tips.