With recent technological advances, there are exciting improvements in the design and creation of artificial limbs.  This is formally described in a recent article by Dr. Saff and his prosthetist colleague, Kevin Garrison, in Case In Point magazine, searchable at www.dorlandhealth.com.  With a properly fitting prosthetic, especially those involving the legs, there is a remarkably decreased risk of developing musculoskeletal and remaining limb stump pain at the attachment site of the prosthetic. Strong, durable, yet lightweight materials used to create the prosthetic limb, coupled with automatic vacuum suspension and microprocessor technologies, allow for normal walking and balance with movement both at the artificial knee and ankle joint.  Upper extremity prosthetics now allow all-finger natural proportionally controlled motion.  The art is to balance the proper biomechanics to achieve the “perfect fit”, which varies from patient to patient and unique to every prosthetic. The “one size fits all” non-custom prosthetics, though well intended, can actually be a destructive force.

In pain management, we see such minor incidents such as a toe nail injury or infection lead to gait abnormalities, resulting in chronic lower back, hip, and knee pain.  In time, this can eventually translate up to the cervical spine and musculoskeletal system as a whole.  Needless to say, an improperly fitted or aligned lower extremity prosthetic can be a catalyst to the development of these pain syndromes.  Lumbar and cervical disk degeneration with resultant scoliosis, nerve impingement, and spinal stenosis, need to be addressed at the spinal source of pain but also by addressing issues involving the prosthetic.  To attempt to treat the patient otherwise is futile and frustrating both for the patient and clinician. Prosthetics are very complicated devices but can restore an active lifestyle when fitted properly, as discussed in Kevin Garrison’s book “It’s Just a Matter of Balance: You Can’t Put a Straight Leg on a Crooked Man”