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1407 E. Michigan Ave., Jackson 517-784-1142 770 Riverside Ave., Suite 101, Adrian 517-263-3310
CHAPTER XII - Facts For Consideration
WOODEN FEET SUBSTITUTED BY RUBBER ONES. - Artificial legs, manufactured with wooden articulating feet, are more or less troublesome and expensive to keep in order, and are deficient in supplying the requisite propulsive power in walking, it is therefore often deemed advisable to remove them and substitute rubber ones. We have devised methods by which this can be done, whether the legs be constructed of wood, leather, or metal. Our charge is $20.00 in each case. We guarantee the attachment to be strong and lasting. A foot of any size or shape to meet the wishes of the wearer can be put on, and the leg can be made longer or shorter, as may be desired.

A WAY TO TEST THE RUBBER FOOT. - The attachment of a rubber foot to an old artificial leg is often done to test its merits. It gives an admirable opportunity for the wearer to try the rubber foot and ascertain for himself the advantages it has over those he has worn.

An experiment of this sort can only be successful when the socket of the old artificial leg fits correctly; if it does not, the leg cannot be worn comfortably and satisfactorily, no matter what kind of a foot it may have.

A cabinet maker, carpenter, or other mechanic, be his skill in his own line what it may, should not be expected to connect a rubber foot to an artificial leg with assurance of satisfactory results. The alignment, the set of the foot, the angle at which it should be placed relative to the shaft, are important factors and must be thoroughly understood and their relations to each other comprehended, or the results will be disappointing. This knowledge can only come from experience; we therefore dissuade persons from buying rubber feet and having them put on their artificial legs by home mechanics. We therefore insist that artificial legs can be sent to us for such work, and for which we make no extra charge.

Ease and comfort in wearing an artificial leg depend almost entirely upon the manner in which the socket receives the stump. No matter how correctly the leg may be constructed, or with what nicety the parts operate, it is worthless if it causes pain, abrades the stump, or interferes with the circulation.

FITTING - AN ART. - The fitting of an artificial leg is an art, only acquired by thought and the experience of years. A thorough knowledge of the anatomy of the stump, the effects of pressure on various points, the manner in which interference with the circulation or the displacement of tissues on the stump can be obviated must be understood, or the fitter is not qualified to be intrusted with such work.

There are a great many artificial limb manufacturers in the world, but there are a very few fitters.

ONLY ONE WAY TO FIT. - There is but one way in which a leg can be made to fit correctly, and that is to excavate a block of wood until it has the proper size and shape to receive the stump, so that pressure will be placed where it can be endured, there must be absolute freedom from contact on the blood vessels and exposed nerve areas.

A leg that puts pressure uniformly on the stump is not a comfortable one to wear, for there are many places on every stump that cannot bear any pressure whatever. There are other places that can endure any amount of pressure; a socket to be comfortable must, therefore, be made so as to apply pressure only where it can be endured.

WHEN PLASTER CASTS ARE USELESS. - A plaster cast of a stump and a plaster cast of the inside of a socket that fits the stump correctly are no more alike than the last on which the shoe is built is like the foot on which the shoe is worn. It is absurd to assume that a serviceable, comfortable socket can be made by molding a plastic material, such as leather, felt, or wax, on the cast of a stump or by molding it on the stump itself. Sockets so made are always irritating and cause pain and suffering. It is likewise an error to assume that a block of wood can be cut out to the contours of a plaster cast of a stump and fit the stump comfortably. If it were so, the fitting of an artificial leg would be reduced to a mechanical operation which could be conducted by inexperienced and inexpensive persons. If the work could be done in this way, the cost of an artificial leg might be considerably lessened.

MACHINE FITTING A FAILURE. - The irregular form turning lathe, with which all mechanics are familiar, carves a stick of wood to the exact shape of the model. Axe handles, gun stocks, shoe lasts, and many other articles are made in this way. A machine of this kind has been modified so as to excavate a block of wood so it will have the exact shape of a plaster mold of a stump. A socket for an artificial leg made in this way must be greatly modified by hand before it can be worn with comfort.

When we are reminded that the stump is bone covered with muscles, fat, blood vessels, nerves, tendons, and skin; that these coverings are not of uniform thickness: that they are soft, yielding, and easily displaced: that more pressure can be applied on the least sensitive parts, and that where the nerves and blood vessels are the most numerous less pressure can be endured, we will readily see that a socket, to fit properly and not injure the stump, must be fitted by persons skilled in the work, who know the location of the large blood vessels, the character and disposition of the nerves, and who are keenly alive to the necessity of avoiding pressure on the vascular parts. The skilled fitter does not always need the presence of the person who is to wear the leg he is fitting. Circumferences and diagrams of the stump will guide him in doing more accurate work than is possible for an incompetent fitter, though he can be supplied with plaster casts, or fits directly to the stump.

WHEN CASTS ARE NECESSARY. - Plaster casts are desirable in some cases. They convey contours, locate irregularities, prominences, and tender spots on abnormal stumps, or on those that reach to the knees, ankle joints or insteps, and in such cases are quite necessary, but, generally speaking, stumps that extend to any point between the articulations do not require to be reproduced in plaster.

WOOD SOCKETS THE BEST. - The advantages of wood sockets are many. Wood is light and firm, retaining the shape it receives from the skillful fitter. No matter what conditions may exist - the tender spots of a stump are always protected, weight is applied where it can be endured, and when the socket is highly polished there is absolutely no friction. A stump may move, slip, and slide without becoming blistered or abraded.

WEIGHT. - The weight of an artificial leg varies from one to seven pounds, according to the size and the severity of the labor it is to perform. We have made artificial legs for infants that weighed less than a pound, and we have been obliged to make them seven or eight pounds in weight in order to be strong enough for active, three-hundred-pound persons. The only way to obtain strength is by the employment and proper disposition of suitable material. A small leg is not as heavy as a large one, and a strong leg must be heavier than a frail one.

RUBBER FOOT NOT HEAVY. - A leg with a rubber foot can be made from six to sixteen ounces lighter than the ordinary artificial leg with articulating ankle. The lessening of weight is chiefly caused by the absence of the metallic ankle connection.

The notions of those wearing artificial legs are varied, therefore they cannot be used as guides. One man says, make my leg as light as you can, even at the sacrifice of strength; I would rather have a light leg and renew it more frequently than to carry a heavy one. Another will say, do not make my leg too light; I have worn light and heavy ones, and I find that I can walk more steadily and step more naturally with a leg of moderate weight. The leg should act as a pendulum; the moment it is lifted from the ground it should swing forward of its own weight and not depend upon energy imparted by the stump. Still another will say, I do not care what the leg weighs so long as it is made strong: strength is the desideratum. If it weighs a pound or two more I will not object to it, as I can soon get used to that, but it must be strong and last a long time. I cannot afford to take chances on the leg breaking. The utmost diversity of opinion, therefore, exists on this subject.

The greatest demand, however, is for the lightest leg, consistent with strength.

For light, delicate women, weighing less than a hundred pounds, a full-length leg weighing three pounds without attachments is as light as it is prudent to produce. So light a leg with ample sustaining strength is almost a marvel. We know of nothing calculated to withstand equivalent strains that weighs so little. A leg weighing six pounds for a large, heavy person, who is likely to subject it to severe use, is not excessive, and should not be objected to.

Let us think, for a moment, of the weight of other instruments that are made to stand similar strains. The weight of the bicycle has been reduced from sixty to nineteen pounds, and it is generally conceded that a nineteen-pound bicycle is as light as prudence will allow. Persons marvel at a bicycle weighing so little, yet the nineteen-pound bicycle has no more work to perform and is not subjected to any more strains than an artificial leg weighing from three to six pounds. The bicycle, like the leg, has only to support the weight of the rider and resist such strains as may occasionally be brought upon it.

In constructing a leg it is essential to make it strong enough to sustain the weight of the wearer and not break under such sudden strains as it is likely to receive at times. If one slips and recovers himself with his artificial leg, some part receives a strain that is much greater than the weight of the wearer. In ascending or descending stairs the strains on the leg are greater than in walking. A leg should be made strong enough to meet these demands, and, in addition, must have a margin of strength that will enable the wearer to carry such articles and lift such weights as his vocation requires. No matter how crippled one may be, or what his station in life is, nor how delicate, there will be times when he will thoughtlessly lift, carry, push, or pull some weighty object. Should the leg break under any of these conditions, the maker would unquestionably be severely censured.

It is not wise to build an artificial leg so close to the danger line, especially for delicate persons, that when those persons become healthier, stronger, and heavier the leg will break. Conditions do not remain the same. "The weak of to-day are the strong of to-morrow." The light person frequently becomes heavy, and the careful limb maker, if he guards his reputation, will keep well on the side of safety.

The average weight of a substantial artificial leg, suitable for a thigh amputation, worn by a man weighing one hundred and fifty pounds, engaged in an ordinary occupation, may be placed at five pounds, less for a below-knee or foot amputation.

It is possible to localize the weight of a leg weighing six pounds so that it will feel lighter than one weighing half as much, improperly adjusted. Inadequate means of attaching the leg to the body will make it feel heavy. A heavy lower part, with a light thigh piece, produces an apparently heavy leg, because the weight is distant from the stump and the frail thigh piece does not hold it in place securely. On the other hand, a strong, substantial thigh piece, which properly holds the leg in place, will lessen the apparent weight considerably.

ODOR. - The contention that rubber emits a disagreeable odor is untrue. Sponge rubber has no more odor than wood; moreover, the rubber foot is incased with an air-tight material. Even if the rubber had a disagreeable odor - which it has not - it would not be possible for it to escape. On the other hand, the ankle joints of articulating feet have to be oiled very frequently, and the oil in times becomes rancid. No refined person can possibly tolerate such an odor.

TEMPERATURE. - The rubber foot will not alter its consistency on account of changes in temperature. Properly vulcanized rubber, such as is used in the manufacture of our rubber feet, will not lose its elasticity in any temperature the human body is capable of enduring. It requires 280 degrees of heat (Fahrenheit) to produce a change in rubber, and as there is no habitable place on the earth with a temperature half of that, the rubber foot is never in danger from heat; no human being could live in a temperature intense enough to harden pure rubber.

THE MASS OF LIMB WEARERS ARE OF SMALL MEANS. - The greater number of wearers of artificial limbs are in limited circumstances. It is exceptional to find a wealthy person in need of one. The wage-earner, the laborer, the man who works in the mill, the engineer, fireman, brakeman, or the miner, the private in the army, those whose occupations place them in jeopardy and who are exposed to the dangers that destroy life or mutilate the body, these make the greatest number of limb wearers. This being so, it is the more important that artificial limbs should be durable and as inexpensive to wear as possible. The first cost, the purchase of the limb, should be the only important item to be provided for. An artificial leg constructed with delicate machinery, or parts subject to friction, may be attractive to look at, but is ill-suited to the wants of the man who has to support himself and his family by daily toil. The loss of time in having repairs made, the cost of repairs, and the danger of breaking down at critical times, are serious matters, and the careful man will take them into consideration before making his selection.

We do not know an artificial leg with an ankle joint that is now made, that has ever been made, or, perhaps, ever will be made, that will not cost from five to twenty-five dollars a year to keep in repair. The delicacy with which an ankle joint must be constructed in order to be light and small enough for its narrow limits, and the immense strain that it must resist at times, are conditions incompatible with durable mechanism.

The fast that persons walk, run, and perform all kinds of labor on artificial legs with rubber feet without ankle motion is evidence that the ankle mechanism is unnecessary. Men, women, and children with rubber feet run, walk, skate, and dance. Work, regarded not many years ago as impossible, is now being daily performed with facility. The farmer follows his plow on a rubber foot, the blacksmith works at his forge, the sailor climbs his rigging, the builder erects houses, and persons of every vocation attend to their affairs with as little concern and hindrance, operating on one or a pair of our rubber feet, accomplishing as much as their associates who are in possession of all their natural limbs.

HOW LONG WILL A LEG LAST? - The question is frequently asked, "How long will an artificial leg last?" There is but one reply: it depends upon the care the leg receives. We have patrons who are still wearing artificial legs that were made for them twenty-five years ago, and the legs still appear to be in fair condition. These are exceptional cases and should not be referred to, any more than should the experiences of those who, through abuse and carelessness, destroy their artificial limbs in an unexpectedly short time. An average made of the frequency with which our patrons renew their substitutes, fixes the period at about eight years. This does not imply that a leg will not last longer. Necessity by no means occasions all renewals; wearers want new legs much the same as they want new coats, before the old ones are completely gone. Wearers become as proud of their artificial limbs as they do of articles of fine apparel; those financially able frequently supply themselves with several, so as to have a reserve for emergencies. Accidents are as likely to occur to the substitutes as to the real ones. Men have been run over by vehicles and have had their artificial legs crushed instead of their natural ones. When accidents of this kind occur, the limbs must be sent to the manufacturer for repairs. The wearer who is fortunate enough to have a duplicate which he can put on is at a great advantage. Taking all these facts into consideration, and fixing the average life of an artificial leg at eight years is certainly estimating on a fair basis.

SHOES AND STOCKINGS. - All artificial feet should be dressed with stockings and shoes, as are natural ones. The wear and tear on shoes and stockings, when the feet are articulate at the ankles, are enormous and have been a source of complaint. This annoyance is removed by the use of rubber feet, for shoes on rubber feet look and wear like those worn on the natural, as the wrinkling at the toes and other parts is nearly identical in both. We have heard patrons say that in five years their rubber feet have saved them in the cost of stockings and shoes enough to buy a new leg.

HOW SOON AFTER AMPUTATION SHOULD AN ARTIFICIAL LEG BE APPLIED? - As soon as the stump is thoroughly healed and the patient has regained sufficient strength to go about on crutches, it is time for him to consider the matter of procuring an artificial leg. Before procuring one some attention should be given to the preparation of the stump.

TREATMENT OF STUMPS. - Tight bandages should be worn from the moment the stump is healed until the artificial leg is applied. Bandages are inexpensive and can be frequently renewed. A very good and perhaps more convenient substitute is the stump corset; this is made as follows: A piece of substantial leather is molded upon a form made to the dimensions and contours of the stump, it is lined with suitable material, strengthened in the lower section with rawhide; after being applied it is laced as tightly as can be endured. In addition to compressing the stump and bringing about a reduction, it becomes a means of protection, for, should the wearer fall and land on the amputated side, he would strike on the end of the corset and not on the end of his stump. These corsets are suitable for amputations at any point. Cut L 1 represents one with suitable straps for leg amputation and Cut L 2 represents one for a thigh stump.

The knee and hip joints should be moved very frequently, and the stump rubbed vigorously in order to maintain mobility.

No matter what means are employed to reduce a stump before an artificial leg is applied, it is doubtful if all the changes can be brought about. As a rule stumps become smaller from wearing artificial legs. The pressure received from the socket has a tendency to force absorption and solidify the tissues. The extent of this emaciation cannot be conjectured. Some stumps do not change even when artificial legs are worn for years. On the other hand, we know many cases where the stumps have grown larger. The matter is governed by the disposition of the wearer, his occupation and his activities.

If a stump reduces after an artificial leg is worn, some compensative adjustment must be employed, lining the socket with thick material as leather, felt, or cloth, or by wearing a number of socks on the stump, one drawn over the other is the most convenient way, but in case of great shrinkage, so much so that such fillings are objectionable, it will be necessary to remove the socket from the leg and substitute a new and smaller one. We do this work for our customers at small expense, but new measurements and diagrams are required and the entire leg must be sent to us.

If the stump is one that will yield to pressure it will not only become smaller under the influence of the bandage or corset, but must grow still less by the use of the artificial leg. Under such circumstances, it is an important economical question to determine whether it may not be wiser to immediately apply a leg and change the socket, should it become necessary, than waste time in bandages or shrinking corsets.

THE GAIN IN APPLYING A LEG IMMEDIATELY. - The immediate use of an artificial leg enables the wearer to dispense with crutches at the earliest possible moment, to gain the freedom of his arms, attend to his vocation, and take healthy and vigorous exercise. The cost of a new socket to fit a reduced stump is insignificant when the advantages of wearing an artificial leg during the interval the stump is changing are taken into account.

Walking on crutches is dangerous, a slip or fall may seriously injure a stump. An artificial leg is the best protective device for the stump.

The single exception to the wisdom of early applications is in amputations which result from malignant diseases.

DANGERS IN DELAY. - If a stump is permitted to go for six months without performing its share of work, it will become weak, nervous, and disordered, and circulation will become sluggish. It is much more difficult to use an artificial leg on a stump that has been permitted to get into this condition than if applied immediately after it has healed.

We have applied artificial legs within a month after amputation with good results, although this time is exceptionally brief. It is impossible to indicate the exact length of time that should elapse between the amputation and the application; it is safe, however, to say that a limb can be judiciously applied as soon as the wound is healed, even if there be tenderness on the amputated surface. It is well to remember, in this connection, that with rare exceptions the end of the stump bears no pressure whatever.

It is a common error to assume that a stump will become hard and tough in time. Nothing can harden or toughen it except use, and there is no better way to toughen a stump than to use a leg. The hands of a laborer are strong and hard because he uses them in performing his work. Those of a person not accustomed to manual labor are soft, tender, and delicate, and become easily blistered because they have not been disciplined. Exactly the same principle is applicable to stumps.

Surgeons are at variance in their views on this topic. Some advise an early application, others insist on their patients waiting an unreasonable length of time. The surgeon who has studied the subject in all its bearing invariably agrees with the advice given above.

CORK LEGS. - The term "cork leg" has long and frequently been used to designate an artificial leg. The prevailing impression is that there is or has been an artificial leg made principally of cork. This is an error and should be corrected. Cork is known to every mechanic as a very friable substance, on account of which it has not strength enough to form any part of the supporting structure of an artificial leg.

The origin of the term "cork leg" is not known. It has, however, been said by credible authority, that the term originated from the fact that years ago very good artificial legs were made in Cork, Ireland, which were called Cork legs, the same as legs made in London are called London legs, those made in New York are called New York legs, etc.

There have been many doggerels written in which the word cork is used to designate an artificial leg.

Thomas Hood, in his Golden Legend, "Miss Kilmansegg and Her Precious Leg," speaks of cork and wooden legs, neither of which was good enough for the fastidious Countess:

"She couldn’t, she shouldn’t, she wouldn’t have wood, Nor a leg of cork if she never stood! And she swore an oath, or something as good, The proxy leg should be golden!"

It is evident that at the time the above was written, many years ago, the term 'cork leg' was misunderstood the same as it is now.

Comment from follow-up survey
Everyone was very nice to me and very helpful. I am very satisfied with the Orthotics. My foot Dr. made the comment that the Orthotics were nicely done. I was always treated with respect.