Amputation; Artificial limbs; Orthopedics; Surgery, Military
The foot should also point slightly outwards, as in the normal
standing position.
_To ascertain whether the limb is built so as to ensure equilibrium_,
a thread is stretched against its side so as to pass through the axes
of the knee and ankle joints, if this cuts the ischial bearing point
at its centre the equilibrium of the patient is assured. Equilibrium
will be better still if the cord lies entirely behind the ischial
bearing point, leaving in front of it the greater part of the thigh
piece. The best method of ascertaining if the foot is properly mounted
is to hold the limb in front of one by the thigh piece, with the knee
bent at a right angle; it can then be seen whether the foot turns
outwards at the correct angle.
It is not necessary to say anything more about the shape of the thigh
piece (page 17).
The metal bolt which transfixes the knee must not allow any play; the
hole through which it passes must be lined with hard wood or leather.
The indiarubber sole should be reinforced with several layers of
canvas incorporated in the rubber, as the latter if not so reinforced
perishes and cracks.
The appliance must further be examined after it is applied. The level
of the iliac spines must be compared: the spine on the side of the
amputation should be 2 cm. below that of the sound side.
Examine the position of the point of the foot. Make the patient sit
down, see if the knees are on the same horizontal plane; if the
sound knee is the higher the leg piece is too short. The foot being
fixed in the equinus position the patient must wear boots while the
examination is being carried out.
B. _Mechanism of walking._--In walking, a step being taken with the
artificial leg, the toe of the foot is the last to leave the ground,
the heel being raised and the knee straight. The limb is swung forward
and raised by flexion of the hip: active flexion of the knee is
impossible, but passive flexion occurs, owing to the weight of the leg
piece, as the thigh is raised.
At this moment the leg piece is vertical, forming an angle with the
thigh, from this position it must pass into one in which it is oblique
forwards and downwards, in a straight line with the thigh, _so that
the knee may be fully extended when weight is again borne by the limb_
as the foot meets the ground. If at this moment the knee is flexed the
limb will double up under the weight of the body.
The first contact of the limb with the ground should be at the heel
with, as we have already said, the knee extended. Afterwards as the
limb, which at first points obliquely forward and downwards, passes
into the vertical position in which it must be at the period when it
bears the whole of the weight, this complete extension becomes locked
and transforms the limb into a rigid column.
Public-domain text, read in full here on John Shaqi.
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