Well, most of the hard work is done.  We have a socket that’s pretty cozy for my leg.  That’s the part that takes the real skill.  People love to carry on about how lucky I am to be an amputee in the age of all the world’s greatest technology.  Let me tell you something friends… technology doesn’t mean shit.  The highest technology that the earth can offer is still a set of experienced hands and the brain that’s attached to them.  You can put some of the coolest, most sophisticated, ultra network capable, computerized machinery available in the world (and I’ve actually walked on some of the most cutting edge stuff) under a crappy socket, and I’ll still look like a gimp.  Get me a good socket, made by hand, adjusted by feel, honed by instinct and fired by heart… and I could make a broomstick walk like prince.

Yesterday was all about the socket.  John and I started around 9:30 in the morning.  Monday afternoon after casting my leg, he spent the day creating a model, modifying it, and then creating a check socket made out of clear plastic.  Tuesday morning he mounted it on my current hardware (a Freedom Innovations Thrive foot with a Delta Twist shock for all you ampu-geeks who want to know what I use.)

Then it was fit, walk, adjust, walk, modify, walk, tweak, walk, modify, walk for about 4 hours.  We stopped for lunch, got to know a little more about one another, and went back to it afterwards.  I should have worn a pedometer.  We put on some serious mileage doing laps around the building, up and down stairs and slopes, anywhere we could.  By 5:30 I was just about out of quarters, but we weren’t there yet.  John didn’t want to stop until we were pretty sure we had the socket dialed in.  I got back to the hotel sometime before 7… spent.  I wasn’t quite sure what my leg would do once I gave it the night off.

It’s pretty grueling work.  You can’t just say “It hurts” then sit down when you have something that isn’t quite right.  You have to walk it, describe where it hurts, and what the quality of the hurt is.  Is it nerve pain, or mechanical?  Bone, skin or muscle?  Then you have to figure out where the pain is, and where it’s coming from.  Sounds a little easier than it is because the nerves in the residual limb are kind of a jumbled up mess.  When doctors amputate a limb they cut the nerves just kind of stuff them up in there like Atlantic City Boardwalk wiring, figuring they don’t really go anywhere anymore, so…  Ok, my guys probably did a better job than that, but it’s still a little weird.  A touch on one place on the leg creates sensation in another.  So it’s pretty difficult to nail down where any one pain point might be.

We’re also trying to make the leg with a seal-in liner.  The liner is the big gel sock like affair that goes on my residual limb before putting it into the socket.  Typically, use a sleeve over the socket to block out air.  As I walk a little one way relief valve allows air to be pushed out of the socket as I load it, but doesn’t allow back in.  The sleeve not only serves to keep the leg on kind of like a Chinese finger puzzle, but it keeps air from entering the system (usually).  The idea is that there is a slight vacuum created by the expulsion of air without new air being introduced.

A seal-in liner incorporates a gasket on the outside of the liner between the socket wall and the liner (it looks kind of phallic).  So rather than using a sleeve on the outside of the socket to create a vacuum, the seal closes air out from just inside the socket.  The idea is that this should create a stronger hold, free up a little flexibility by eliminating the sleeve, and be a little more reliable.  To one-up the suspension, we’ll incorporate a vacuum assist pump to enhance the leg’s staying power. (ya, just try to get this paragraph past a spam filter!)

Fortunately our hard work seemed to pay off.  I got up walked pretty darn comfortably this morning.  The new socket shape seems like a radical departure from the old socket.  It can a little like getting a new pair of ski boots.  You go and try them on all day, bring home the ones that fit and are supposed to make you ski like a rock star, only to get into them the next day and make your feet feel like rocks, sans star, instead.  No such trouble today.

Today was all about getting the new hardware to play with me.  John got an Ossur Vari-Flex foot with Evo.  This is a pretty cool ass looking foot, that’s light weight, and has a vacuum pump built into it.  So the idea is that with each stride I take, the little tiny mechanical pump pulls a little bit of air from the socket.  So after walking a few feet that socket will fit my leg tighter than a Sumo wrestling team in a Cessna 182.

The biggest benefit from this is increased proprioception.  In other words, I’ll be able to feel more accurately where my leg is on the ground, or in the air.  I’ve played with elevated vacuum suspension before.  The difference in feel is significant.  It’s like going from a set of heavy winter gloves to some really fine leather driving gloves.

All that cool stuff aside… we couldn’t get the foot tuned in today.  It was another day of walk, adjust, walk, adjust, walk, adjust.  Basically there are four set screws that hold a pipe onto my leg, and another four screws that hold the foot onto that pipe.  It’s kind of like those Christmas tree stands that let your tree fall over at 3 in the morning after you finished cleaning the living room for the family to come over the next day.  You loosen one screw a quarter turn, and tighten the opposite screw the same and it moves the pipe one way, then you have to do the same or opposite to that to the screws in the foot.  Every little turn does something to change how the foot hits the ground, loads the spring, then unloads the spring to help propel me forward.

The trouble is, we couldn’t get rid of this brutally fatiguing post terminal release (that’s what she said… come on, yo know you thought that).  It’s that thing where you have a ruler sticking out over the edge of desk, and you hit the part that is on the desk and the ruler makes that cartoon “thuwangggg” sound.  Cool if you’re trying to kill a detention… sucky if it’s a spring on the end of your leg that’s strong enough to send you forward in a full sprint, but instead is unloading behind you.

So we called Ossur and asked them to overnight us the foot in the next size up, to see if the spring is just getting overloaded.  We have most of the day tomorrow to try to get it right.  If that doesn’t pan out, I’ve still got a good socket to put some miles on that works just fine with my current, slightly high milage foot.  There are plenty of other foot options out there, so I’m not worried about what I’ll eventually put under me.  We’ll see how tomorrow goes, then it’s back on a plane that they won’t let me jump out of to head home.