Positioning your residual limb while relaxing

After a leg amputation, it is very important to keep your residual limb positioned correctly to prevent complications such as muscle contracture. Proper positioning can also help you maintain a full range of motion in your remaining joints, and promote good blood circulation.

In a straight position

Whenever possible, avoid putting your residual limb in a flexed (bent) position. For example, do not support your limb on the handle of a crutch, hang it over the side of a bed or keep the knee joint flexed when sitting on a bed. Keeping the knee or hip joint flexed for long periods may disturb blood circulation and cause muscle contracture.

For below-knee amputations, keep your residual limb supported and the knee straight when seated. In a wheelchair, you can use an “amputee board,” and on a regular chair you may use a second chair of the same height to support your residual limb.

For both below-knee and above-knee amputees, lying flat on your stomach stretches the muscles at the front of your hips, which prevents contractures from developing after being seated for too long. You may want to spend 15 to 20 minutes in this position several times per day, to help prevent contracture complications from developing.

In an elevated position

Resting your residual limb in an elevated position can reduce pain and swelling. You may want to strive to keep your limb straight, especially when resting it on something like a cushion where it may inadvertently bend. A piece of foam cut to size and in the right shape can work well to elevate and support the residual limb while keeping it straight.

Desensitizing the residual limb

After amputation, the skin on your residual limb will be sensitive to the touch, and eventually, when the prosthesis is fitted and you are starting to walk, it will be subjected to forces it was never intended to cope with. To develop a tolerance for these forces you may need to desensitise your residual limb. Please note that for some people, desensitisation techniques like those suggested here may also decrease phantom pain. Talk with your prosthetist or other members of your medical team for suggestions on how to perform desensitizing exercises on your residual limb.

Scar mobilization

Sometimes as your body heals, scar tissue adheres to the soft tissues and bone beneath it. This can cause skin problems and pain when you are wearing a prosthesis. Ask your medical or rehabilitation team for suggestions about at-home scar mobilization techniques that may be helpful to you.

Inspection of the residual limb

Other skin problems can make using a prosthesis uncomfortable or, in some cases, even impossible. Regularly inspecting your residual limb can help you identify skin problems early, before they become severe.

• Use a mirror to check your residual limb from every angle.
• In the beginning, check your residual limb whenever you change your dressing or take off your prosthesis.
• Later, one daily inspection after washing your residual limb should be enough.

NOTE: if you lost a limb due to vascular disease such as diabetes, proper care of your residual limb, including regular inspections, is even more important, as skin breakdown could lead to another amputation.

Inspection of the socket-liner interface

You will want to clean your socket daily, ideally with a cleaning solution recommended by your prosthetist.

Your residual limb must fit snugly but comfortably in the socket. If the socket becomes loose, or if there are pressure areas, your skin might get damaged and your gait will be affected. Talk to your prosthetist if you experience changes in how your socket is fitting.

The importance of controlling your weight

During rehabilitation and beyond, it is important to eat as healthily as possible and keep your weight stable. Maintaining a consistent, healthy weight is important for everybody, but for people who have prosthetic limbs it is even more important for the following reasons:

• To maintain the proper fit of the prosthetic socket attached to your residual limb,
• To reduce the energy required to use your prosthesis,
• To prevent or reduce secondary conditions, such as back pain, and
• To manage the risk of medical conditions such as diabetes and high blood pressure

Suggested instructions for donning a liner

If you have difficulties putting on, or donning your liner or do not know exactly how to do it, you may find these tips helpful:

1. Make sure that the inside of the liner is clean, dry, and contains nothing that may cause skin irritation.
2. Roll your liner inside out and hold it as shown in this illustration picture. Your goal is to create a surface as flat as possible.
3. Place the liner flat at the end of the residual limb. Make sure that the liner is as close to the residual limb as possible. Avoid trapping air at the far (distal) end of your residual limb.
4. Push the liner carefully over the end of the residual limb, making sure there are no creases. Then roll the liner completely upwards onto your residual limb. Be careful not to damage the liner with your fingernails. It is important that throughout this process, you roll and do not pull on the liner.
5. Gently pat the liner. Avoid "plucking" the liner as this can cause increased tension on the liner edge and underlying skin (this can create water blisters, welts, or similar symptoms). If there are wrinkles when tightening, please unroll your liner and repeat the donning process.
6. If you are using a non-textile liner, such as Iceross® Original, you may use special pull-on sprays that make it easier to unroll the liner and put on. Apply the spray to the OUTER SIDE of the liner, roll it over and then roll it up the residual limb. Then, after rolling the liner up, wipe off the remaining spray. If you choose to use a spray, make sure that the agent is not harmful to the liner or the silicone of the liner. For this reason, it is best to use only sprays recommended by the manufacturer of your liner, such as the  Iceross Clean & Simple Dressing Spray by Össur,  or ask your prosthetist for their recommendation on which spray to use.

Your prosthesis, silicone liner and residual limb require consistent care and maintenance to prevent breakdown or injury. Poor hygiene can lead to skin irritations and injuries. This can cause infections and other issues that may impair or even preclude a person from wearing their prosthesis.

Regularly cleaning your residual limb, liner and prosthetic socket can reduce the risk of germination and protect your sensitive skin from inflammation and infection. Good hygiene also protects the lifespan of your devices. Here are some recommended procedures for regular care of your residual limb, liner and prosthesis.

Residual limb care

By wearing a prosthesis, the natural properties and functions of the skin are disturbed at the sites stressed by the prosthetic restoration. Additionally, the pressure and friction exerted on the skin by sockets and liners affects the skin‘s ability to regulate temperature. The combination of increased perspiration and stress on skin eventually leads to irritation and bacteria formation. It is important that you cleanse and care for the skin on your residual limb daily.

1. Clean your residual limb daily with a mild soap (pH neutral) or a special cleansing lotion.
2. Apply a moisturizing cream to prevent the residual limb from drying out and to promote the regeneration of the skin. To avoid excessive perspiration in the liner, you should use the cream in the evening, preferably at bedtime.

Liner care

The liner wraps around your sensitive residual limb and comes in direct contact with bacteria. Therefore, you should clean the liner after each wear or daily, by hand, and at least once a week in the washing machine.   

For Handwashing:

1. Roll the liner off of your residual limb.
2. Turn the liner inside-out so that the silicone that is typically on the inside is outside.
3. Thoroughly wash the silicone side with a mild (pH neutral) soap or with a special liner cleaner.
4. Rinse off the soap entirely so there is no residue.
5. Dry the liner inside and out with a towel.
6. Turn the liner back its normal form so the silicone is on the inside, and to the outside (silicone inside) and clean the outside with a damp cloth.
7. Hang up the liner to dry completely. Never put it on directly on a heater and avoid direct sunlight.

For Machine Washing:

1. Place the liner in a laundry bag.
2. If the manufacturer's specifications of your products allow, machine wash your liner in warm or hot (104oF) water.
3. Use a mild detergent and choose the gentlest cycle your machine offers.
4. Dry the liner inside and out with a towel.
5. Turn the liner back its normal form so the silicone is on the inside, and to the outside (silicone inside) and clean the outside with a damp cloth.
6. Hang up the liner to dry completely. Never put it on directly on a heater and avoid direct sunlight.

Tip: having a second liner allows you to change the liner daily, making daily cleaning much easier and allowing for adequate drying time. If you do not currently have a backup liner, ask your prosthetist for advice.

Prosthesis care⁠—socket & textile components

Thanks to the innovation of prosthetic liners, the sensitive skin of your residual limb is unlikely to ever come in contact with your prosthetic socket. However, it is still very important to clean your socket at least once a week.

If your residual limb does sit directly within the socket without a liner interface, such as if you are using vacuum suction, you should clean your socket daily to maintain optimal limb health.

1. Clean your prosthetic socket with water and pH neutral soap and then leave it to dry.
2. Disinfect the socket with an alcohol spray.

Other textile components of your prosthesis should be washed at least 2-3 times a week. As long as the manufacturer's specifications of your products do not contradict this, you can If the manufacturer's specifications of your products allow, machine wash your liner in warm or hot (104 F). Use a mild detergent and choose the gentlest cycle your machine offers.

wash these textiles in the washing machine at 40 degrees, with a mild detergent and a low spin number.