Painful prosthesis


Not living your best life even after your amputation? It could have something to do with the treatment protocol used. Heinrich Grimsehl provides some insights

An amputation is traumatic. You must deal with the change in body image and your new level of mobility or disability, depending on your point of view. You must deal with the tremendous sense of loss, similar to losing a close relative.

Looking around, you might see amputees going for gold. You see senior amputees living a normal life. You see younger amputees doing weird and wonderful things with prostheses. You even see animals on artificial limbs living normal lives.

But, for you, this is not happening. Your prosthesis causes you daily pain and discomfort, and you don’t know why? If this is the case, maybe I can assist you with a problem-solving check list.

Disclaimer: Please bear in mind that the following does not constitute any treatment protocols or treatment advice. Furthermore, it does not reflect negatively on any treatment that you might have received. I have no knowledge of you as a patient or your circumstances.

But, the following might help you to pinpoint what went wrong, and how to fix it, because not all prosthesis and treatment protocols are created equal. The following mostly applies to first-time amputees or patients who’ve had stump revisions. You can answer the following “Yes” or “No”:

  • Did a healthcare practitioner refer you to your current prosthetist?
  • Did your prosthetist insist on a prescription from a healthcare practitioner?
  • Did your prosthetist speak to the previous prosthetist who might have treated you?
  • Were you explained, in detail, what outcomes to expect once your treatment was complete?
  • Was your residual limb (stump) measured and coned with an elastic bandage for at least three weeks?
  • Were regular stump measurements taken?
  • Did your prosthetist ask the referring healthcare practitioner if they can start the coning process before they did?
  • Did you have a trial silicone liner wearing period before you were cast for the limb?
  • Were you informed on how to wash your stump and the liner down to the very last detail?
  • Did you receive an initial test prosthesis consisting of an adjustable see-through socket (looking like glass) that can be fully adjusted with a bit of heat?
  • Were your wounds healed a 100 percent before the prosthetic fitting started?
  • Did you wear the “glass” test socket for at least a couple of weeks to see if it is comfortable and if your stump still reduces in size?
  • Was your prosthetic alignment assessed and optimized with every consultation?
  • Was a fully adjustable final socket manufactured that can be reduced in size at will and that can be adjusted for bony prominences?
  • Was your treatment protocol longer than five months before the prosthesis was complete?
  • Did you receive extensive gait training by a person qualified to do so? For example, a physiotherapist.

If your answer is no to more than one of these questions, maybe you should have a look at the drawing board. It might just produce surprising solutions to your problems.


Heinrich Grimsehl is a prosthetist in private practice and a member of the South African Orthotic and Prosthetic Association (SAOPA). email:

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