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Racial and Ethnic Differences

Among US Adults With Diabetes

Michael Jordan

Opens Clinic In NC To Serve The Uninsured

Health & Fitness

Lower Risk of Type II Diabetes with Exercising

Main Story





A Publication for Amputees For many amputees asking for help can be hard to do. The reality of missing a limb becomes harsh and can lead to some difficult emotions. Emotions like sadness, anger, grief, self-doubt and self-worth. Many amputees feel like a burden and accepting help can fuel this even more as helping them to appointments or normal everyday things can be time consuming. Some feel the lost of their independence to such things places a burden on family members or friends if they ask for help. I have spoken with numerous amputees about this subject. It helps speaking with another amputee, someone who has been through what your now experiencing. An amputee who is successful and living life free of the emotional turmoil that most new amputees face. Finding the answers to your questions as a new amputees can be hard, especially when your not even sure what questions to ask.

A Publication For Amputees

Ampnation Magazine publishes unbiased journalism that seeks to “empower and inform” amputees and those affected by limb loss. The magazine’s audience is primarily amputees and their families and is provided free electronically (digital) to anyone who subscribes at and there is a hard copy available for purchase as well. Each issue covers health topics, well-being, better outcomes of amputees living and thriving, O&P News, Vascular News, Tech and products & services.

One the biggest misconceptions about peer support is that it mainly exist to help people with emotional difficulties in coping with their situation. Peer support also offers valuable information, practical tips about things only an amputee would know, how things work & go together and ways to adapt to limb loss. Hope is the biggest one that I find amputees get from interacting with a peer. Seeing another amputee living life is the most powerful tool of peer groups or peer support. There are many pathways on the journey to being free from the emotional chains of amputation. You will learn that there is no best or right way to cope - there are many pathways to recovery from amputation. Living a full life. Although peer support is critical for a new amputee to help adjust to their new normal. I have seen too many hospitals and doctors not understand the importance of peer support and set new amputees up for failure by not recognizing this one simple step in the emotional recovery of a person who has undergone amputation. Connecting with a peer visitor or peer support allows the new amputee talk with someone who actually understands what they are going through, who will listen and share realities. Seeing what others like you have already experienced is what the peer experience is all about, building a connection, putting the puzzle pieces together mentally. Learning that everybody’s story is your story and your story is everybody’s story to some extent. The amputee will discover our story is what makes us different also unites us in our struggle to be free from the emotional chains. Being an amputee is what you make it. It really is that simple, yes everyone is different and is in a situation with health issues. But when it all comes down to it your in control of your life and path. I have been very blessed to meet some incredible people in my lifetime, some amputees and some not. You know what separates the able people from the amputees - noting! That’s right, nothing. These awesome and incredible people all have the same-thing;

Purpose - Grit - Motivation - Positive Attitude Editor’s Message Sean Harrison 1

Spartan staff and SGX Coaches will be on hand to answer all questions about Spartan and what to expect on race day, as well as provide expert tips on how to crush Spartan obstacles like a pro. Anyone 14 years and up will have time to practice on the obstacles. People of all ages are welcome. It’s free. Bring friends, family, and strangers and encourage them to sign up for the race if they haven’t!

My Story

It was a crisp winter day when six-year-old Kacey McCallister lost both of his legs, forever altering the course of his life. This unthinkable trial could have broken him, but from that day forward he chose to rise above his circumstances and learn to live without limits. For those struggling to find hope in the depths of physical, spiritual, or emotional trials, this incredible story of one man’s unbreakable courage will inspire and motivate readers to not only survive but thrive amidst life’s challenges. A true testament to the power of the human spirit, When Life Gets You Down, Rise Up! The book now on Amazon.



Page 18 The Para Spartan Team


Page 12 O&P News Hope To Walk

Page 5 Better Outcomes Michael Jordan

Page 15 TECH News Apps that help you

Page 6 Correspondence Headline News

Page 16 O&A Finding The Best Foot For You

Page 8 Vascular & Ortho News How skin cells from foot soles could help amputees

Page 17 Health & Fitness Healthy Benefits of Exercise Page The Para Spartan Team Making History

Feature Contacts

Better Outcomes - Correspondence - Vascular & Orthopedic - Prosthetic & Orthotic - Q&A - If would like be involved with Amp Nation Magazine please send inquires to: 3

Better Outcomes Michael Jordan opens clinic in North Carolina to serve the uninsured Michael Jordan opened a clinic in Charlotte, North Carolina on Thursday to serve people who are uninsured and under-insured. The NBA legend and Charlotte Hornets owner cut the ribbon at the grand opening of the Michael Jordan Family Medical Clinic. Two years ago, Jordan made a $7 million donation to Novant Health to build the state-of-theart facility in Charlotte’s west side, as well as a second facility that has yet to open. In his speech, Jordan praised his hometown of Charlotte, and said the clinic is about making an “impact” that will be paid forward in the city. “The money is not an issue for me, it’s the If you are having trouble getting the affordable commitment to be able to make a difference and medical care you need, you can count on Novant make an impact...” he said. Health Michael Jordan Family Medical Clinic to provide you with the quality care you deserve, The clinic has 12 exam rooms, an x-ray room with or without insurance. and a physical therapy space. It was built on Freedom Drive, because a study showed that Services include primary and preventative care, there was a lack of primary care providers in physical therapy, behavioral health and social the area. Another study, conducted in 2014 by support. Harvard University and UC Berkeley, ranked Charlotte 50th out of 50 large cities for social The Michael Jordan Family Clinic is open from 8 mobility when it came to economic mobility for a.m. to 5 p.m. Monday through Friday. children born into poverty, according to Novant Health. The clinic serves patients of all ages, which means you and your family can continue seeing But Novant Health executives say it’s about more them throughout all stages of your lives. than the physical health of people living in West Charlotte. “Care is helping to improve other Must meet low income guidelines. drivers of health like access to food, housing, education and employment,” said Jesse Cureton, Services include: the EVP and chief consumer officer for Novant Annual wellness visits for adults and children Health. Medicare annual checkups Sick-child appointments A social worker will be staffed at the clinic to Immunizations for adults and children, inconnect patients to other resources for patients cluding flu shots with little or no insurance. The clinic will also School, camp and sports physicals offer additional comprehensive care, including Ear washes behavioral health and social support services, Treatment of minor injuries and illnesses, to more directly address health equity gaps and including fevers and burns social determinants of health in the community. Management of chronic illnesses such as high blood pressure, high cholesterol, diabe“It’s just so great to have when you don’t have tes, weight concerns, acid reflux, arthritis and insurance and you don’t know what to do,” said osteoporosis Sharelle Blake, a patient at the clinic. “So this is Sexually transmitted disease (STD) testing a huge blessing for the Camp Green neighborMinor procedures, including stitches (sutures) hood.” and joint injections Women’s health services, including Pap tests, birth control consultations, pelvic exams and care for gynecologic concerns Hearing and vision screenings

Electrocardiograms (EKGs; used to examine heart function) Spirometry (lung function tests) On-site lab tests On-site X-rays The Novant Health Michael Jordan Family Medical Clinic is open to everyone, regardless of ability to pay. The clinic also accepts most major insurance plans, including Medicare and Medicaid, should you wish to use insurance. Address: 3149 Freedom Dr Charlotte, NC - 28208 Phone: (980) 302-9405 Office Hours - Monday 8:00 AM - 5:00 PM - Tuesday 8:00 AM - 5:00 PM - Wednesday 8:00 AM - 5:00 PM - Thursday 8:00 AM - 5:00 PM - Friday 8:00 AM - 5:00 PM - Saturday closed - Sunday closed First published on October 18, 2019 / 5:04 PM © 2019 CBS Interactive Inc. All Rights Reserved.


Correspondence Advanced Treatments Help Hard-to-Heal Diabetic Foot Ulcers—and Improve Lives

Teen Born Without Leg Donates Hundreds of Barbies with Prosthetic Legs to Local Hospital

Breakthrough treatments making the difference.


Advanced therapies for foot wounds are saving limbs, restoring mobility and improving the lives of many people living with diabetes who suffer from non-healing foot ulcers.

A New York teen who’s lived with a prosthetic leg her entire life was thrilled when she learned Mattel had created a special Barbie for people just like her — and wanted to ensure others would be able to get their hands on it, too.

For many Americans living with diabetes, impaired healing of foot wounds can be a tremendous problem, making these advanced treatments extremely important.

Chloe Newman, 18, donated more than 400 Barbie dolls that feature prosthetic legs to Shriners Hospitals for Children in Springfield, Massachusetts, where she has received treatment for years, the hospital said in a press release.

Foot ulcers develop in about 15 percent of the 25 million Americans living with diabetes. These ulcers can lead to serious complications, such as infection and amputation, and can also decrease the patient’s quality of life. Diabetic foot ulcers are costly, too. About 20 percent of the estimated $174 million spent annually on diabetes treatment in the United States deals with lower extremity care. In fact, non-healing ulcers and infection in the lower extremities are the top reasons for hospitalization among people with diabetes. Today’s advanced treatment of diabetic foot ulcers include innovative technologies that stimulate healing. These breakthroughs are critical in diabetic foot care because poor circulation, nerve damage and impaired immune responses—problems that people living with diabetes are at higher risk of having—make it difficult for a patient’s foot ulcer to heal.

News, Opinion & Information

CHLOE NEWMAN improved today. Surgeons now use plastic surgery grafting techniques that were once reserved for other parts of the body, such as in facial reconstruction. Grafting involves taking healthy skin from another area of the body and placing it over the ulcer. The success rate of all the advanced therapies for diabetic foot wounds is high, providing substantial improvement over treatments of the previous decade.

“I think [the patients] would feel better about themselves,” she told NBC affiliate WWLP. “That they would see, ‘Wow, they are making a Barbie like me, so why should I be ashamed of myself if there’s now toys like me?’ ” Chloe, of Mechanicville, N.Y., has Amniotic Band Syndrome, a rare condition that causes strands of the amniotic sac to separate and entangle fingers, toes, limbs and other parts of the fetus, according to Benioff Children’s Hospitals. As a result, she was born without her right leg.

“If you’re out shopping, if you see five [dolls]. Get them and I’ll reimburse you,” the post reportedly read. The mother-daughter team hit their goal within 24 hours, but kept receiving dolls — including 200 Fifteen years ago, doctors would clean out the wound, apply an antiseptic and an antimicrobial from Mattel. agent, put a bandage on the wound and hope for Their haul of more than 400 Barbies — plus the One groundbreaking approach that promotes additional dolls from Mattel — were delivered the best. healing is the use of bio-engineered skin substion Monday, where they will “serve as tools in tutes. Surgeons place these advanced biologics, That picture is dramatically different today. therapeutic education and medical play for kids which are made either from living or nonliving Because of the advance technologies and NPWT, facing amputation to help explain their situation,” tissue, over the wound to accelerate growth of the release said. patients are having less complicated surgeries, healthy skin. Additional dolls will be dispersed among the hossaving their limbs and getting back to living sooner than ever before. Another advanced wound-healing technology is negative pressure wound therapy (NPWT). Time away from work, lengthy hospitalizations This consists of a wound dressing, an air-tight and major surgery add significantly to the film placed over the wound and a drainage tube economic burden of diabetes. For that reason, connected to a suction device that draws excess the advantages of advanced therapies extend fluid. The suction enables healthy new tissue to beyond improved medical results to include grow. better outcomes related to work, cost and lifestyle outcomes. NPWT makes it far more likely that a graft will survive. Today, foot and ankle surgeons rarely In light of these complications and the fact do a skin graft without using NPWT before and that the prevalence of diabetes is rapidly rising, after the grafting procedure. advanced therapies for diabetic foot ulcers will play an even more important role in the future. 5 Skin grafting for foot ulcers is also greatly

pital’s 16 other Pediatric Orthotics and Prosthetics Services locations across the country. “The whole point was to give back to Shriners because we’ve received so much,” Cindy Newman told CNN.


Low-carb Diet This is considered as one of the highly effective ways to lower blood sugar levels. A study from the University of Copenhagen showed that those who ate more protein and fewer carbs had an improved regulation of blood sugar levels. The study was participated in by people who suffer from Type 2 diabetes.

without diabetes. Prior studies have identified persistent disparities in readmission risk among black and Hispanic adults with diabetes, which seemed to correlate with underlying social determinants of health. Nevertheless, none of these studies assessed the association with race A spokesperson for Mattel did not immediately separately from other important risk factors for respond to PEOPLE’s request for comment. readmission, such as age, co-morbidity, economMattel introduced the Fashionistas line in February — which included not only a Barbie with a According to DMSc Thure Krarup, senior con- ic status, reasons for hospitalization, and site of care. Hence, our understanding of individual and prosthetic limbs, but a doll in a wheelchair — to sultant at the Department of Endocrinology at reflect differently able bodies, Good Morning Bispebjerg Hospital, “The purpose of our study hospital factors contributing to these disparities remains uncertain and is an essential first step America reported. was to investigate the effects of the diet within developing policy and practice interventions out ‘interference’ from a weight loss. For that “For 60 years, Barbie has been a reflection of reason, the patients were asked to maintain their aimed at improving health outcomes for all people culture and fashion and that is key to the brand’s weight. Our study confirms the assumption that with diabetes. continued relevance,” Kim Culmone, Global a diet with a reduced carbohydrate content can Head of Design for Barbie, told GMA. “As we improve patients’ ability to regulate their blood Published: October 11, 2019. doi:10.1001/jamadesign Barbie for the next generation, we are sugar levels -- without the patients concurrently networkopen.2019.13249 Open Access: This is an open access article disfocused on evolving to remain the most diverse losing weight.” tributed under the terms of the CC-BY License. © doll line in the marketplace.” 2019 Rodriguez-Gutierrez R et al. JAMA Network Some low-carb foods you can incorporate into your diet include eggs, fish, lean meat, and leafy Open. Corresponding Author: Rozalina G. McCoy, MD, greens. You could also go for nuts and seeds. MS, Division of Community Internal Medicine, Berries and apples are great too. If you need to Department of Medicine, Mayo Clinic, 200 First take some dairy products, go for unsweetened St SW, Rochester, MN 55905 (mccoy.rozalina@ ones. Author Contributions: Dr McCoy had full access On a final note, make sure that in conjunction to all of the data in the study and takes responsiwith these foods, you also keep yourself active. bility for the integrity of the data and the accuracy Being physically active also helps in regulating of the data analysis. your blood sugar.

Type 2 Diabetes: New Study Racial and Ethnic Differences Reveals One Chinese Plant Ex- in 30-Day Hospital Readmistract Lowers Blood Sugar sions Among US Adults With Diabetes Patients of Type 2 diabetes would often find themselves measuring their blood sugar levels. This is because improper monitoring of the same could prove very costly to one’s health. Fortunately, there is now an existing supplement, which could help in lowering the blood sugar levels. Berberine Extract According to Express, berberine, a Chinese herb extract, was used by the Chinese for centuries. Because of this, researchers conducted a study and ascertained that people with diabetes benefited from berberine. It lowered their blood sugar levels and also promoted the breakdown of carbohydrates.

Are there differences in hospital readmission rates among racial and ethnic minorities with diabetes, and if so, what are the individual-level and hospital-level factors associated with these differences? In this study, black patients with diabetes had a significantly higher risk of readmission than members of other racial/ethnic groups. This increased risk was most pronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals. These findings reinforce the importance of identifying and addressing the many reasons for persistent racial/ethnic differences in health care quality and outcomes.

Aside from this, it helps in reducing blood sugar spikes that normally occur after a meal. The percentage that was reduced was at 30%, a huge drop from the regular value. What’s more, researchers have ascertained that the efficacy of berberine can be likened to the blood sugar-lowering drugs.

Diabetes is among the most prevalent and costly chronic diseases in the United States, costing $327 billion annually and accounting for 1 of every 7 dollars spent on health care in the United States. Diabetes disproportionately affects racial/ ethnic minorities, who also have worse diabetes-related health outcomes (ie, microvascular While you could use berberine extract to help in and macrovascular outcomes) and mortality. lowering your blood sugar, there are other things Hospitalizations contribute substantially to the cost and burden of diabetes care, as people with that you can do. Below are some of the things diabetes are more likely to be hospitalized and you must not forget if you want to lower your experience unplanned readmissions than people blood sugar.


Vascular& Ortho

How skin cells from foot soles could help relieve amputees of stump injury

Imperial scientists aim to re-engineer stump skin for more comfortable prosthetics People who have had limbs removed often use

false arms and legs, known as prosthetics, to improve mobility and independence - but 75 per cent of prosthetic-wearing amputees encounter problems like skin tears, ulceration, and blisters. To address this, Imperial scientists want to re-engineer stump skin to become resistant to rubbing, by making it thicker and better at bearing weight and mechanical force.

Skin on our arms and legs, however, is not designed to bear weight, or to have hard materials rubbing against it. We found ourselves asking why the skin underfoot doesn’t break down when we move around or wear shoes; and whether we can isolate that property and somehow incorporate it into stump skin. Top and bottom comparison images showing that layers of foot sole (plantar) skin are much thicker than body skin.

Dr Claire Higgins and Dr Colin Boyle, from Imperial’s Department of Bioengineering, want to use the thick, tough skin from the sole of the foot as a template for sturdier stump skin. They hope this will reduce rubbing and pain from prosthetics.

That’s quite the challenge! What’s next for you?

What does your new study show?

You’d be forgiven for thinking that thick plantar skin develops as an adaptation to pressure as we grow up, but its thickness is in fact genetic. This we already knew, but we wanted to see if we could find out how that works practically: what One issue is that they rub against skin which isn’t makes sole skin so tough? equipped to deal with rubbing or supporting the too much weight. Stump skin breaks down, We used computational models to analyze the causing blistering and ulceration, which can lead make-up of sole skin and how it behaves differto infection and a lot of pain. ently to regular skin under pressure. We found that the outermost layer of sole skin, the stratum The problems can mean that amputees often find corneum, plays the biggest role in protecting more relief from taking off their prosthetics than skin from tears and blisters. This layer is much they do from wearing them. We want to help thicker in sole skin than other skin types. change that.


their stumps.

We now know that stump skin needs thicker collagen fibres, thicker bundles of collagen, and different types of keratin to behave as sole skin does - so now we need to work out how to do this!

What issues are you trying to address?

The bottom of the foot is covered in what’s known as plantar skin. This skin is unique to the soles of our feet, and is particularly thick and padded, which helps it to stay intact when it bears our weight and rubs against shoes.

These factors all contribute to plantar skin that is tougher and more resistant to injury - characteristics that amputees could really find useful for

We hope our paper will help define exactly what we’re aiming for when we think of tougher stump skin.

Caroline Brogan spoke to Dr Higgins to find out why her team’s work could improve the lives of amputees.

Why did you look to sole skin to help stump skin?

Similarly, we found that collagen is arranged in much thicker ‘bundles’ in plantar skin, and that the collagen fibres themselves are thicker.

How will your findings help you toughen up stump skin?

They are lead authors of a new paper, published in Science Advances, that looks at what makes sole skin so hardy.

Many amputees use prosthetics to try to emulate the freedom of movement and independence that able-bodied people have. Prosthetic hands, for example, can let amputees pick up objects, and prosthetic legs can help them walk again. For this reason, prosthetics are invaluable - but they’re also fraught with problems.


We found that thicker skin did not protect sole skin from ulceration. Instead, we found that the biggest factor in protecting sole skin from ulceration is the way strong structural proteins, called keratin and collagen, are arranged. We found that the epidermis, which is the next layer down from the stratum corneum, contains far more keratin, as well as different types of keratin, than in other skin, which helps sole skin to resist

It’s a big challenge logistically to translate to patients, but scientifically we have already defined several potential avenues which we hope will be fruitful - the main ones being incorporating genetic material into stump skin to help it grow thicker, and using sole skin-inspired skin grafts. All skin has the potential to grow in different ways, so we could even manipulate the genetic material that’s already in stump skin to change its make-up. For example, we could inject cells called fibroblasts which trigger the production of collagen and alter the type of keratin produced, making skin layers thicker over time. Alternatively, we could take plantar skin cells and grow them into thick layers in the lab, which would then be grafted onto stumps. We don’t yet know how helpful these approaches will be, so we’re keeping our minds open and exploring all avenues. Side by side comparison images showing difference in load bearing between foot sole (plantar) and body skin.

Could you say this is a new area

of research entirely? Our approach to improving amputees’ lives is rather different than most. Most researchers look at how to improve the prosthetics themselves,

so our work on improving the interface between problems. person and technology is quite unique. Although diabetes has no cure, you can take Perhaps our work will inspire more scientists to steps to manage your diabetes with medication think outside the box to improve stump skin and and lifestyle changes. make the lives of amputees as normal as possible. Symptoms of type 2 diabetes “Morphology and composition play distinct and complementary roles in the tolerance of plantar skin to mechanical load” by Colin J. Boyle, Magdalena Plotczyk, Sergi Fayos Villalta, Sharad Patel, Shehan Hettiaratchy, Spyros D. Masouros, Marc A. Masen, Claire A. Higgins, published in Science Advances. This work was funded by the Engineering and Physical Sciences Research Council (EPSRC) Source: Imperial College London Journal reference: Boyle, C.J., et al. (2019) Morphology and composition play distinct and complementary roles in the tolerance of plantar skin to mechanical load. Science Advances. aay0244.

V&O ing more to lose weight, can help you prevent or delay type 2 diabetes and related health problems. Asking your health care team about steps you can take to prevent type 2 is key.

Although people with diabetes usually have Set a weight loss goal. If you are overweight, symptoms, too often those symptoms are igset a weight loss goal that you can reach. Try nored or dismissed. Some symptoms of diabetes to lose at least 5 to 10 percent of your current include: weight. For example, if you weigh 200 pounds, a 10 percent weight loss goal means that you will Increased thirst and urination try to lose 20 pounds. Increased hunger Follow a healthy eating plan for weight loss. Feeling tired Research shows that you can prevent or delay Blurred vision type 2 by losing weight by following a reNumbness or tingling in the feet or hands duced-calorie eating plan and being more active Sores that do not heal each day. Losing weight without trying Move more. Start slowly and add more activity until you get to at least 30 minutes of physical Causes activity, like a brisk walk, five days a week.

You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes. A family history of diabetes, high blood pressure, overweight or obesity, and being inacLifestyle changes key to delay- tive can increase your chances of developing the disease. Women who have a history of gestationing or preventing type 2 diaal diabetes, which can develop during pregnancy, betes are also at increased risk. Source: National Institute of Diabetes and Diges- It is more common in African Americans, Alastive and Kidney Diseases ka Natives, American Indians, Asian Americans, Hispanic/Latinos, Native Hawaiians, and Pacific In the U.S., about 10 percent of the population Islanders. has type 2 diabetes. Even more surprising? Nearly one in four people living with diabetes don’t A primary care provider will often diagnose and even know they have it. treat type 2 diabetes. However, they may refer you to a diabetes specialist called an endocrinolThese and other facts are included in a new reogist. port from the National Institute of Diabetes and Complications Digestive and Kidney Diseases (NIDDK). The third “Diabetes in America” report, released last High blood glucose levels can have a severe summer, has information for everyone. effect on the body. Issues can include: Do you think you or a family member could have type 2 diabetes? Read our overview below for information and lifestyle tips from the report and MedlinePlus. Overview Diabetes is a serious disease that occurs when your blood glucose, also called blood sugar, is too high. Having too much glucose in your blood affects how your body uses food for energy and growth.

Heart disease and stroke Kidney disease Vision problems Foot problems Nerve damage Sexual and bladder problems Gum disease and other dental problems Prevention There is good news for people at risk for type 2 diabetes. You can prevent or delay the disease with healthy lifestyle changes, according to findings from the NIDDK-supported Diabetes Prevention Program research study. That includes people with prediabetes, a condition where your blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.

With type 2 diabetes, your body doesn’t make enough insulin, or use insulin effectively. Insulin—a hormone made by the pancreas—helps glucose move from your blood into your cells, where it is used for energy. Without enough insulin, not enough glucose reaches your cells, leaving glucose in your blood. Over time, having too much glucose in your blood can cause health Taking small steps, such as eating less and mov-


V&O VEST external stent demonstrates low event and disease rates in two prospective trials Clinical data presented at the 2019 European Cardio-Thoracic Surgery (EACTS) annual meeting (3-5 October, Lisbon, Portugal), from two prospective trials of the VEST external stent for vein grafts during coronary artery bypass surgery (CABG), showed low major adverse cardiac and cerebrovascular events (MACCE) rates up to three years, excellent patency rates and a significant reduction in the progression of vein graft disease. David Taggart (John Radcliffe Hospital, Oxford, UK) presented the results of the VEST III trial at the late breaking clinical trials session. VEST III is a randomized controlled trial that enrolled 184 patients in 14 centres across Germany, Austria, Israel and the UK. At two years, the trial met its primary and secondary endpoints, showing superior perfect patency rates (Fitzgibbon I) of externally stented vein grafts compared to the control group (66.4% vs 53.6%, p value = 0.02) and a highly significant reduction of 25% (p value <0.001) in both intimal area and thickness assessed by intravascular ultrasound (IVUS). “The results of the VEST III trial confirm our previous observations regarding the bio-mechanical effects of external stenting,” said Taggart. “This is another milestone in our ongoing efforts to improve coronary surgery and patients’ quality of life. As the principle investigator of the first-in-human VEST I trial in 2011, and someone who has closely followed the evolution of this technology in the last 10 years, it is very satisfying to see how the combined effort of surgeons, scientists and innovators has led to a technology with high clinical impact.” Luca Weltert (European Hospital, Rome, Italy) presented interim results from a led all comers study that evaluated angiographic and clinical outcomes in 51 patients. The majority of patients underwent off pump CABG (77%) and all vein grafts were supported with the VEST external stent. CT angiography was performed at one year and patients were prospectively followed every six months for MACCE. Although the average age of the study cohort was 73.5, with 32% of patients having had a prior primary coronary intervention (PCI), at average follow-up of 3 years, MACCE rates were 2% with only one patient requiring revascularisation to a de-novo coronary lesion. At one year, CT angiography demonstrated 100% patency of the VEST externally supported vein grafts. “It is very encouraging to see that “real world” data supports the evidence from randomized 9 trials,” said Prof. Luca Weltert. “Very often,

we see big gaps between clinical results of randomized cohorts, which are highly selective in nature, and the results in our day to day practice. Our interim follow-up data shows that at 3 years, clinical and angiographic results are superior compared to those observed in published randomised trials.”

Type of diabetes suggests different treatment algorithm for chronic limb-threatening ischemia

• Had less complete wound healing at six months (41 vs 49 vs 61%) • Required more major amputations at three years (23 vs 11 vs 8%). Interestingly, further breakdown of treatment strategy revealed that those insulin-dependent diabetics treated initially with an endovascular strategy had significantly increased rates of amputation, re-intervention and non-healing compared to non-diabetics; however, if treated initially with surgical bypass, only decreased wound healing at six months was significant.

“Overall, this study demonstrates the importance of distinguishing between diabetes type, as each of the three cohorts presented with differing degrees of disease and comorbid conditions that harbor varying degrees of limb-based and OUTCOMES AFTER FIRST-TIME LOWER patient-based risk.” Dr. Schermerhorn notes. EXTREMITY REVASCULARIZATION FOR CHRONIC LIMB-THREATENING ISCHEMIA “Although insulin dependence is associated with the greatest risk of adverse outcomes, these data BETWEEN PATIENTS WITH AND WITHsuggest that these adversities may be most mitOUT DIABETES. Journal of Vascular Surgery, igated by initial bypass, provided the patient is April 2018. appropriately selected and anatomically suitable CHICAGO, Illinois, April 2018 – A new Harvard for such treatment.” research study suggests that vascular surgeons should consider insulin dependency when deter- The systemic nature of diabetes presents sigmining treatment for chronic limb-threatening nificant challenges to those treating diabetic patients suffering from chronic limb-threatening ischemia in patients with diabetes. ischemia. The diabetic may have coronary and Many previous studies have documented worse renal disease, making invasive surgeries risky. In addition to peripheral artery occlusions, healing outcomes for diabetics compared to those without the disease. Less well known, however, is can be obfuscated by small vessel disease as well the differing outcomes for patients dependent on as a diminished capacity to fight infection. The presence of neuropathy often results in delayed insulin for treatment versus those treated with diagnosis as an infected foot ulcer may go unnooral medications. ticed for days. As reported in the April 2018 edition of the The authors point out their study is limited by Journal of Vascular Surgery, researchers from its retrospective nature, single-center data, and the Beth Israel Deaconess Medical Center at Harvard Medical School, led by vascular surgeon inability to precisely define disease onset and severity. Dr. Marc Schermerhorn, studied the outcomes of 1,294 limbs re-vascularized at their institution (2005-2014) for chronic limb-threatening isch- As different as diabetics treated with insulin emia. Patients were categorized by the presence versus oral medications may be, better understanding of their differential outcomes suggests of insulin-dependent (n=703), non-insulin this should be considered when planning a dependent (n=262), and non-diabetic (n=329) status. Treatments included both bypass grafting limb-salvage strategy. (n=646) and angioplasty/stenting (n=648). To download the complete article (open source Significant findings on presentation revealed that link available from March 21 - May 31), goto: those with insulin-dependent diabetes (compared to non-insulin dependent diabetes and patients without diabetes): This is an older study but one worth re-visiting because of the nature of patients and diabetes.

• Were younger (69 vs 73 vs 77 years old) • Had more tissue loss (89 vs 77 vs 67%) • Suffered higher incidences of coronary and end-stage renal disease

Six Diabetes-Related Vascular Complications - And How To Avoid Them

People who live with diabetes know they have a Although peri-operative morbidity and mortali- lot of health management to do – monitor their ty was similar, long-term outcomes revealed that blood sugar, stay alert for eye problems and monitor for foot infections. insulin-dependent diabetics:

But some may not understand that many of the most common complications of diabetes stem from one primary issue: the havoc that high blood sugar, also called hyperglycemia, causes for the body’s blood vessels. Because blood brings oxygen to every living cell in the body, when blood vessels aren’t working properly, the body suffers. “Diabetes is one of the strongest risk factors for any form of vascular disease, both symptomatic and asymptomatic,” explained Dr. Gregory Moneta, a member of the Society for Vascular Surgery (SVS) and professor and chief of vascular surgery at Oregon Health and Science University Knight Cardiovascular Institute. “Those with diabetes should have regular doctor visits and tests, and may need to see specialists such as ophthalmologists, vascular surgeons and podiatrists for checkups.”

Foot ulcers and peripheral neuropathy. While diabetic foot ulcers can be a result or complication of PAD, they can also be caused by peripheral neuropathy, or lack of sensation in the feet, which is also caused by diabetes. These patients would not feel pain if they get an open sore on their foot. Sores that are left untreated are dangerous for those with diabetes.

Heart attack. Patients with diabetes are at higher risk of heart attack as diabetes also affects the arteries supplying blood to the heart. Patients with diabetes and heart disease may not have typical symptoms of heart disease like What to do: Ulcers can be prevented with fre- exercise or activity induced chest pain (angina) quent foot checks and proper diabetic footwear. warning of a heart attack. Diabetics with foot ulcers should be evaluated by What to do: Prevention is the best course of action. Maintain weight, blood sugar and cholesterol levels, and report chest pain, exercise intolerance or shortness of breath to a doctor. Follow the doctor’s advice to reduce cholesterol levels. Renovascular conditions. Diabetes affects the blood vessels of the kidneys and can lead to kidney failure and the need for dialysis or a kidney transplant. Kidney failure may have no symptoms until it is advanced and not reversible.

In conjunction with National Diabetes Awareness Month in November, here is how six vascular complications are aggravated by diabetes: Diabetic eye disease. Diabetes’ effect on the vascular system is what causes diabetic eye disease. The tiny blood vessels in the retina become swollen, which blocks the oxygen supply to the retina. If the condition becomes severe, it can cause blindness.

What to do: Prevention again is the best course of action. Good blood sugar and blood pressure control can reduce the risk of diabetes-associated kidney failure. See a doctor regularly for blood tests, which can detect kidney failure in its early stages. Early on, kidney problems may be treatable with medications that could prevent kidney failure and the need for dialysis.

What to do: Be alert for changes in vision. Have a dilated eye exam at least annually. Peripheral artery (or arterial) disease, also known as PAD, occurs when plaque builds up in the arteries and reduces blood flow to the feet and legs. Fairly common among elderly Americans, PAD is even more likely among those with diabetes, which increases plaque buildup. An early indicator can be intermittent claudication, which is leg pain that comes on with walking and goes away with rest.

join a support group or ask a physician for advice. Try, stop-smoking or call 1-800-QUIT-NOW (1-800784-8669).

Learn more about diabetes and vascular disease, or visit the Society for Vascular Surgery Patient Resources website.

an amputation prevention or limb salvage team that includes a vascular surgeon and a podiatrist.

Smoking complications. Cigarette smoking damages everyone’s blood vessels, but for those with diabetes, there is a significant What to do: A daily walk is often the first increase in risk. Tobacco smoke causes inflamprescription, as long as there are no other health mation, which causes plaque buildup. Smoking problems, such as an ulcer on the foot. Walking also damages blood vessel walls and contributes increases blood flow to the legs and feet and also to bad cholesterol numbers. can eventually decrease leg pain. Before starting to exercise, be sure to discuss it with a physician. What to do: It can be hard to quit smoking, Patients who have PAD symptoms should have but for diabetics it is a must. Those who cannot regular checkups with a vascular surgeon. quit on their own can call a smokers’ hot-line,


O& P News

Electrical brain implants enable patient to have ‘mind control’ of motorized prosthetic arms

In a set of proof-of-concept experiments, Johns Hopkins researchers have implanted electrodes in both sides of the brain of a person who is mostly paralyzed — with minimal sensation in his hands — to enable him to have some “mind control” of motorized prosthetic arms. Most efforts to create such “brain-machine interfaces” have focused on one hemisphere of the brain with far fewer electrodes, but the Johns Hopkins team used both brain hemispheres to control two limbs. Researchers say these efforts are believed to be the first demonstrations of success with bilateral sensorimotor intracortical implants, or brain-machine interfaces designed to power movement — but also to sense touch — in people with high spinal cord injuries. “It may sound like science fiction, but at this point, our studies have added substantially to evidence that it is possible to use both sides of the brain to control two prosthetic limbs at the same time,” Celnik adds. Celnik and his colleagues are expected to present their findings in four poster presentations during the 2019 annual meeting of the Society for Neuroscience, which will be held in Chicago Oct. 19–23. For the studies, the Johns Hopkins scientists implanted in January six electrodes the size of large ants into both hemispheres — four on one side and two on the other — of the brain of a person who is quadriplegic but whose spinal cord is not completely severed. The 10-hour surgery, performed by the Johns Hopkins team, was done by opening the patient’s skull, placing the electrodes and connecting them via thin wires to a complex computer system In prior efforts to implant such devices, four electrodes were placed on only one side of the brain. The Johns Hopkins team implanted six electrodes bilaterally in an effort to deliver more stimulation to the brain.

“At this point, we’ve found that the subject can control both limbs to perform simple reaching movements in a coordinated manner,” says researcher Gabriela Cantarero, Ph.D., assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. The Johns Hopkins scientists say the electrodes can remain implanted in the brain for up to five years, with minimal risk of brain or skin scarring. However, like any surgery, there is risk of infections or bleeding. The team’s next steps are to test more complex bilateral movements and improve the connection between touch sense and motor control. For more details about the study, visit the Johns Hopkins physical medicine and rehabilitation website here. The researchers will present the following abstracts during the Society for Neuroscience conference: Oct. 21, 8 a.m. — “Human brain-machine interface using bilateral sensorimotor intracortical implants” (abstract 315.13) Oct. 21, 8 a.m. — “Modulation of M1 and S1 neurons to action observation, imagery and execution for brain-machine interface training: evidence from human cortical recordings” (abstract 315.09) Oct. 22, 8 a.m. — “Intracortical microstimulation of bilateral human finger areas of S1 enabled by MRI, fMRI and intra-operative ECoG mapping” (abstract 486.09) Oct. 22, 2019 a.m. — Neural responses in human primary somatosensory cortex to vibrotactile stimulation suggest more overlap in afferent representations of individual digits than sensory perceptions elicited by ICMS (abstract 486.11)

The Johns Hopkins Department of Physical Medicine and Rehabilitation (PM&R), in collaboThe implants were positioned in motor and sensory areas of the brain ration with the Johns Hopkins to record, send electrical pulses to and “stimulate” areas of the brain University Applied Physics Labresponsible for motor control and the sensation of touch. oratory and the Department of Over the past nine months, the researchers tested the subject’s ability to Neurology and Neurosurgery, perform an increasingly complex series of reaching movements in both Source: has been awarded a grant by the limbs, shoulders and fingers at the same time, in the same direction, as Johns Hopkins Medicine Defense Advanced Research well as in opposite directions with and without the use of a computer Projects Agency (DARPA) to conduct a clinical trial focused on recording model. The team tracked the patient’s accuracy in reaching computand stimulating the brain of a person with tetraplegia. erized targets using a prosthetic limb built in virtual reality as well as with a real motorized prosthetic limb. Hope to Walk brings freedom and hope by designing and delivering lowcost prosthetic legs to those in developing nations who cannot afford them. The scientist also performed tests stimulating the brain and determined where the patient could “feel” the sensations triggered by sensors in the prosthetic limbs. The scientists report that the patient was able to discriminate sensations from all fingers that had sensors attached (four on the right and two on the left) with 100% accuracy.

“Touch is an integral part of movement, so it’s important that action commands are paired with the ability to sense the limb to improve the accuracy of movements,” says Celnik. 11

The World Health Organization estimates that there are 35-40 million people who need prosthetic or assistive devices. Unfortunately, many of these people are not able to afford traditional prosthetic legs due to poverty and the high cost of materials, which ranges in the thousands of dollars, since the majority of them make less than $2.50 per day. Based in Blacksburg, Virginia, Hope To Walk is a young non-profit with a plan to make an impact for amputees. Phil Johnson, CPO, was in Guatemala over 15 years ago to fit a young child with a prosthetic leg and saw these

O& P difficulties first hand. The next morning, 15 families of children with amputations were asking him for help. Phil saw the problem was cost and lack of people trained to help. He knew there had to be a better way, so he started working on a low-cost prosthetic system that could be deployed in any nation. In 2014 Phil met a first-year medical student, Michael Mabry, who shared a passion for lifting others back to their feet. They traveled to Honduras where they saw 64 amputee patients in just a few days and they then began perfecting Phil’s prototype prosthetic leg. Their first patient, Carlos, hopped into the clinic on crutches and 90 minutes later took his first unassisted steps in two years with a leg that cost less than $100. Since then, Hope To Walk has fit over 500 below-knee patients in Honduras, Guatemala, Haiti and Vietnam and is currently training locals in these nations to manufacture and install prosthetics on their own people. Hope to Walk has designed a below-knee prosthetic leg that cost about $150, compared to common prosthetics that cost north of $5,000. To meet this incredible need we partner with missionary clinics across the globe and equip locals to manufacture and fit prosthetics, allowing them to “Give the Gift of Walking” to as many people as possible. When you join our efforts, you give the world’s poor the opportunity to walk, support their families, and lead productive lives. Hope To Walk is looking for prosthetists, doctors, physical therapists and other health professionals to help make their vision a reality – that all amputees who have the hope to walk will receive a prosthesis regardless of their ability to pay. Contact for more information or visit their Facebook page ( hopetowalk) or website (

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Join us and begin your journey now: https:// Address 429 W Lockeford St. Lodi, CA 95240 12 (855) PFT-FORM

Better Outcomes Without Wheelchair-Accessible Home, Boy is Unable to Leave Hospital; So Shaq Buys Family a New House

amputation of his right leg. Arnold Schwarzenegger once described “FLEX” as one of the greatest bodybuilders he had ever seen. Ronnie Coleman, who won the Mr. Olympia title 8 times in a row has stated that “FLEX” was the best bodybuilder he competed against.

First published on October 18, 2019 / 12:48 PM © 2019 CBS Interactive Inc. All Rights Reserved.

My generation grew watch him and others as they were the reason a lot of us got into lifting weights. I wish and hope for a speedy recovery for Flex, and hope to see a story that leads to a Better Come.

A 12-year-old Atlanta boy who was shot in August has been recovering in the hospital ever since. But when he’s released, he will have a new house to come home to – thanks to Shaquille O’Neal. This paralyzed little boy was unable to return home from the hospital because his house was not wheelchair-accessible—so basketball legend Shaquille O’Neal simply bought the boy and his family a brand new home.

Isaiah Payton, 12, was paralyzed in a shooting, and his mother has now quit her job in order to take care of him.

the efforts to help Payton’s family, WXIA reports.

This is not the first time O’Neal has stepped in to better the life of a teen in need. He recently bought 10 new pairs of shoes for a Georgia boy. Isaiah Payton was struck by a bullet during a high Thirteen-year-old Zach Keith already wears a school football game at Lakewood Stadium in size 18 shoe, which was difficult for his mom to Atlanta on August 16. Payton was paralyzed in afford. the shooting and another 15-year-old boy was hit in the leg, according to CBS Atlanta. O’Neal wears a size 22 shoe and went through the same thing as a teen. “Mom couldn’t afford A 15-year-old boy has been arrested in connecshoes. The kid had big feet. I just kind of remition to the shooting, CBS Atlanta reports. Payton’s nisced about how that used to be me, my mom mother, Allison Woods, said she quit her job to and my dad,” O’Neal told CBS Atlanta affiliate take care of her son, and she was looking for a WGCL-TV. handicap accessible home. The NBA star stepped up to make sure the family has what they need. When Shaq learned that Payton couldn’t leave the hospital because he didn’t have a home equipped for his new disabilities, he decided to find a house for the family. “I was watching the story and it’s just sad. It could have been any one of us. It could have been my son,” O’Neal told WXIA reporter Francesca Amiker. “It could’ve been your cousin and she was living in a one-bedroom house with her two boys so we found her a one-bedroom house in College Park. Nice area. I’m going to get her some ring cameras on me. We’re going to give her some furniture, TVs and pay her rent off for a year and help her get on her feet.” O’Neal was just one of the community residents who was particularly heartbroken by the incident—so when he saw an opportunity to help the family, he immediately stepped up to the plate. Roby Lynch, the CEO of Papa John’s, and Jeff Smith, the chairman of the board of Papa John’s, are also helping O’Neal get this new house up and running for the family. O’Neal recently became a director on the Papa John’s board. Mayor Keisha Lance Bottoms and the City of 13 Atlanta Fire Department are also supporting

How a Wheelchair-bound Amputee came to the Streets of Modesto The story of how a wheel-chair bound amputee ended up on the streets of Modesto for over a year is slowly emerging. Alan Davis, whose right leg was amputated at Sutter Hospital in Sacramento sometime in April of 2018, was sent to the Modesto Specialty Hospital in May of that same year, when there was no space for him in Sacramento rehab facilities. Davis arrived at the Modesto hospital on May 9 and stayed until May 25. He was then transferred to a skilled nursing facility nearby. After a stay of about 4 months, Davis left the nursing facility on September 25. He then stayed at a local motel for three days, after which he became homeless. Acquiring more specific information about how and why he came and went is difficult because of personal privacy laws.

On Sept 22, 2019, just under a year later, after an outreach worker alerted volunteers to Davis’s perilous condition—his one leg was infected and his clothing badly soiled—Frank Ploof, Homeless Coordinator for the Modesto Outdoor Emergency Shelter (MOES), found Davis in Modesto on H Street, between 17th and 18th Streets. Legendary Body Builder Flex A nurse-volunteer examined Davis’s leg and Wheeler Underwent Emergency recommended he see a doctor. Ploof summoned an ambulance and Davis was taken to Memorial Surgery According to a press release October 20, 2019 / Hospital. -- LAS VEGAS – Even after the long process of establishing Davis’s medical history, Ploof finds himself still dealing Kenneth “Flex” Wheeler is an American IFBB with bureaucratic obstacles. Davis often can’t professional bodybuilder. He won the Arnold remember specific details about where he’s been, Classic a then-record four times and was once and sometimes makes questionable claims about described by Arnold Schwarzenegger as one his past. At one point he told Ploof that he has of the greatest bodybuilders he had ever seen. fifty-four children, but doesn’t know any of them. Ronnie Coleman has stated that Wheeler was the best bodybuilder he competed against. More to come on this story as we are still following the progress of Frank Ploof. To Kenneth “FLEX” Wheeler, the legendary/iconic Be continued! professional bodybuilder and 4 time winner of the Arnold Classic, underwent emergency surgery last week which required the partial


Mobile app launched to optimize wound imaging and assessment WoundVision, the manufacturer of the industry’s first long-wave infrared thermography (LWIT) solution for mitigating risk associated wound measurement and assessment with hospital-acquired pressure injuries (HAPIs) • Seamless EMR integration into existing and other wounds, has announced the expanclinical workflows sion of its product offering with the debut of the Scout Mobile app. “In a market that is saturated with mobile wound photography apps and other single-caBuilt to streamline and simplify wound pability products, Scout Mobile ties all of documentation, Scout Mobile is said to be an our solutions together, positioning us as the enterprise mobile wound management app that industry’s only full-service wound imaging and standardises wound photography, measurement, documentation solution,” said James G. Spahn, and assessment across the entire healthcare co-founder and CEO of WoundVision. continuum. With multi-platform support for both iOS and Android smartphones and tablets, He added: “Until now, there has never been a the HIPPA-compliant solution also eliminates solutions provider capable of solving a hospital the inaccuracies of paper rulers and fulfills or health system’s HAPI problem and stanminimum documentation requirements while dardising wound documentation while seamseamlessly integrating into electronic medical lessly integrating both into the EMR. And with record (EMR) workflows. more and more healthcare systems looking to standardize across the continuum of care, we’ve With the addition of a mobile app to their exist- created a scalable solution that minimizes variaing Scout product suite, WoundVision becomes tion in care and outcomes across the healthcare the industry’s first and only full-service provider enterprise, no matter its size or setting.” of wound imaging and documentation solutions. Positioned as the healthcare industry’s oneThe burden of pressure injuries and other stop-shop for all digital wound management wounds on the US healthcare system is imneeds, this solution is comprised of the Scout mense. According to the Agency for Healthcare multi-modal imaging device (photographic Research and Quality (AHRQ), pressure injuries and thermographic), the Scout Software, EMR were the only Hospital-Acquired Condition integration and now the Scout Mobile app. (HACs) to increase between 2014 and 2017. Providers now have access to a complete range of solutions that includes: According to US National Institutes of Health, chronic wounds affect 6.5 million people in • The industry’s only anatomical and phys- the USA. With the healthcare industry shifting iological imaging solution to identify deep towards pay-for-performance and value-based tissue pressure injury (DTPI) present on care, WoundVision’s full-service wound imaging admission (POA) and documentation solution will help providers • A mobile imaging app for wound phoof all sizes and needs mitigate risk associated tography, measurement and assessment with HACs, standardize wound assessment and across the entire continuum of care streamline EMR workflows to create a better • An enterprise software solution that patient experience across all care settings. standardises all POA documentation and

Diabetes Management Simplified All the tools and support you need to balance your life

Dario Health Corp. is a leading global digital therapeutics company revolutionizing the management of chronic conditions. The Dario All-In-One Smart Glucose Meter is specially designed to fit your lifestyle in the digital age. This sleek, complete glucose monitoring solution includes a simple-to-use glucose meter, a disposable test strip cartridge holding 25 test strips, and lancing device – and easily fits in your pocket. Using the technology and mobility of your smartphone, the Dario connects to your mobile device and logs your blood glucose measurements, allow you to share your results with caregivers and doctors – no matter where you are on the globe. Why You’ll Love the Dario Smart Glucose Meter • • • • •

Connects directly to your Smartphone – no need for extra cables or adapters Rapid results – receive your blood glucose reading within 6 seconds Accurate – Dario accuracy meets ISO standards with only a small blood sample Pocket-Size Meter – easily fits into your purse or pocket, no need for a bulky pouch or case Battery free – the power comes from the SmartPhone. No need to carry extra batteries for your glucose meter

Each strips cartridge holds 25 disposable strips. Reloading your strips is simple, just pull out the old cartridge and insert a new one. The simple-to-use Dario Smart Glucose Meter automatically tracks your blood sugars with a tiny meter that plugs into your phone’s audio jack or lightning port. Blood glucose readings are directly tracked, charted, and analyzed for you. For more information visit: https://


People with lower limb-loss below the knee

need a prosthetic leg system but the number one question is how will I walk? That has a lot to do with the type of foot on your prosthetic leg. Every amputee needs a foot. But what type, which foot is best for you?

the foot will be.

Q& A

New devices open the door to new opportunities and activities for people who need a prosthetic foot. A broad selection of feet, including many that simulate the dynamic action of an Finding anatomical foot, can help you meet your activity goals. There are even feet specifically designed for running.

The Best Foot For

Q: What are some of the basics when considering a type of foot? A: Designing prosthetic foot systems is challenging. It’s very difficult to reproduce the complex workings of the human foot and ankle. Ideally the foot will be light because its weight is added to the rest of the leg prosthesis. If the foot is too heavy, the suspension system may be affected and with it the connection to the socket and your limb. A good prosthetic foot should also be strong, as it will be taking on huge force and torque as you walk and run. Feet must also be small enough to fit within a foot shell, a cosmetic covering for the prosthetic foot, and thus fit within a shoe. Being light, strong, and small, and yet functional and durable is the challenge. Early designs for prosthetic feet were often a solid piece of wood. A similar design, the SACH (solid-ankle-cushioned-heel) is still in use because of its sturdy function, especially useful for individuals with lower activity levels. A SACH foot typically has a rigid inner structure (wood or plastic) surrounded by a compressible foam cosmetic shell. Today’s more sophisticated feet, which add more functions, are secured inside a cosmetic shell. Most people never see their prosthetic foot without this exterior shell. The cosmetic shell, which stretches around the foot prosthesis and is held in place, serves two purposes: • It makes your foot prosthesis look like an anatomical foot. • It fills the space in your shoe. Q: What inside the foot-shell? A: What’s inside the shell can vary dramatically. Prosthetic feet are designed to meet the needs that fit your lifestyle and activity level. Here are some factors to consider.

Q: What should you consider for foot to meet your needs? A: Depends on your level of limb loss. If you still have part of your foot, you probably will need a custom prosthesis that is molded to fit in a shoe. If you experienced an amputation involving the ankle, including ankle-disarticulation, Symes, Chopart, Pirogoff or Boyd surgery, you’ll need a specialized low-profile foot. For an You amputation above the ankle, a standard prosthetic foot can meet your needs. You should consider multi-axial capability as well as shock absorption. For above-knee amputees, keep in mind that the higher the limb loss, the less control you will have of the prosthesis and the more you will need stability in your prosthetic foot. Your activity level. K-Levels Manufacturers categorize prosthetic feet by the user’s activity level. Selecting a prosthesis that matches your activity level will maximize your mobility and your quality of life. The wrong prosthesis can actually make walking more difficult or less stable for you.

Comfort. A prosthetic foot has to feel good for you to meet your activity goals. Comfort allows you to be more active, and the function of your prosthetic foot directly affects comfort. Function. Prosthetic feet are designed to mimic a human foot at a specific activity level. For people who cannot walk, the function is largely cosmetic. For those who are most active, a prosthetic foot must mimic a normal foot during the act of walking. It must act as a shock absorber as you strike your heel to the ground, adapt to uneven terrain, provide a smooth rollover from heel to toe, and provide a rigid lever for propelling forward when you finish your step (“toe-off ”). Multi-axial motion. Some prosthetic feet are designed to mimic the ankle, which allows the foot to move in multiple planes. Multi-axial capability in a foot allows you to raise and lower the forefoot; move the forefoot to the left and right; and roll the foot slightly to the inside and to the outside. Multi-axial motion is needed to walk comfortably and confidently on uneven ground, when your foot must adapt to whatever it encounters.

If a practitioner or therapist has not yet identified your activity level, here are some very basic indications. If you’re on the border between two activity levels, consider products designed for both levels. Activity Level 0 If you cannot walk, you may still want a prosthetic foot for your own sense of well-being or to feel more confident in social settings. Because it will not support your weight or help you walk, it doesn’t need any features that aid mobility. Activity Level 1 For those with the most limited mobility, prosthetic feet designed for maximum stability help maintain balance when standing or taking short, cautious steps at minimal speed on level floors. With safety as a priority, opt for these characteristics in a prosthetic foot: Lightweight A secure stance area upon heel contact that allows you to safely shift your weight onto the foot Allows walking without bending the knee

Activity Level 2 To walk for a limited time and limited speed and Energy storage. A foot made with carbon fiber be able to negotiate obstacles like curbs or unfor energy storage literally gives you a spring in your step. The carbon fiber acts as a spring, com- even ground, you would benefit from a prosthetpressing as you apply weight and propelling you ic foot that offers stability and comfort, meaning it protects the joints and residual-limb tissue. forward as your foot rolls, returning energy to Materials. The materials in a prosthetic foot Look for a prosthetic foot that features: your step as the spring releases. Some prostheses differ by activity level. Wood, plastic and foam are usually found in feet designed for individuals have one spring in the heel and a second spring Shock absorption at heel strike who have low activity levels and require stability. in the forefoot: just what you need for walking A light rollover during walking at various speeds, running, climbing hills or Carbon fiber feet meet the functional needs for A dynamic transition from standing into descending stairs with a secure, confident stride. shock absorption and energy efficiency, and are swing phase (taking a step) With carbon fiber, the longer the spring, the Moderate multi-axial functionality, if you 15 lightweight as well. more energy it can store and the more responsive


Nutrition, Exercise & Healthy Living Tips for Amputees

The new findings suggest that exercising before breakfast had ‘profound’ and ‘positive’ effects on health. Image credit: George Rudy

Health benefits of exercise can be increased by working out before breakfast, study suggests Source: University of Bath

According to a new study, published in the Journal of Clinical Endocrinology and Metabolism, health scientists at the Universities of Bath and Birmingham found that by changing the timing of when you eat and exercise, people can better control their blood sugar levels. The six-week study, which involved thirty men classified as obese or overweight and compared results from two intervention groups (who ate breakfast before / after exercise) and a control group (who made no lifestyle changes), found that people who performed exercise before breakfast burned double the amount of fat than the group who exercised after breakfast. They found that increased fat use is mainly due to lower insulin levels during exercise when people have fasted overnight, which means that they can use more of the fat from their fat tissue and the fat within their muscles as a fuel. To test proof-of-principle the initial study involved only men, but future studies will look to translate these findings for different groups including


which is all the more remarkable given that both exercise groups lost a similar amount of weight and both gained a similar amount of fitness. The only difference was the timing of the food intake.”

Whilst this did not lead to any differences for weight loss over six weeks, it did have ‘profound and positive’ effects on their health because their bodies were better able to respond to insulin, keeping blood sugar levels under control and Over the six-week trial, the scientists found potentially lowering the risk of diabetes and that the muscles from the group who exerheart disease. cised before breakfast were more responsive to insulin compared to the group who exercised Building on emerging evidence that the timing after breakfast, in spite of identical training of meals in relation to exercise can shift how sessions and matched food intake. The muscles effective exercise is, the team behind this study from those who exercised before breakfast also wanted to focus on the impact on the fat stores in muscles for individuals who either worked out showed greater increases in key proteins, specifically those involved in transporting glucose from before or after eating and the effect this had on the bloodstream to the muscles. insulin response to feeding. Dr Javier Gonzalez of the Department for Health For the insulin response to feeding after the 6-week study, remarkably, the group who exerat the University of Bath explained: cised after breakfast were in fact no better than the control group. “Our results suggest that changing the timing of when you eat in relation to when you exercise can bring about profound and positive changes to your overall health. We found that the men in the study who exercised before breakfast burned double the amount of fat than the group who exercised after. Importantly, whilst this didn’t have any effect on weight loss, it did dramatically improve their overall health. The group who exercised before breakfast increased their ability to respond to insulin,

Co-author Dr Gareth Wallis of the University of Birmingham added: “This work suggests that performing exercise in the overnight-fasted state can increase the health benefits of exercise for individuals, without changing the intensity, duration or perception of their effort. We now need to explore the longer-term effects of this type of exercise and whether women benefit in the same way as men.”


THE PARA SPARTANS The first Para Spartan Team to take on a Spartan Beast unassisted and finish. A grueling 11 hours task that took to 9,000 ft. elevation at Squaw Valley in Tahoe, California know as one of the toughest Spartan Races


What is a Spartan Race?

The Spartan United States National Series is obstacle course racing competition at its highest level. Spartan Race is the global leader in obstacle course races, with the right challenge for anyone - from first-time racers to elite athletes. Spartan Race is a series of obstacle races of varying distance and difficulty ranging from 3 miles to marathon distances. They are held in US and have been franchised to 30 countries including Canada, South Korea, Australia and several European countries. Spartan is on the road to becoming an Olympic sport and Para Spartan could become a Para-Olympic sport. In my biased opinion, I think obstacle course racing is the true test of athleticism as it requires full body strength, mental focus, endurance and grit. Simply put, Spartan Race is the world’s leading 17 obstacle race series and one of toughest out

there. It’s an event of pure primitive craziness that think you got it figured out “Bam!” Your doing you’ll never forget. burpees. Spartan Races are known for their tough terrain and obstacles. So, why would four people with disabilities want to do something like this? Maybe they don’t see missing limbs as a disabilities. maybe they are crazy or maybe they are just living life. I think every person that gets bitten by the “Spartan Bug” has one thing in common, they make you feel alive. As Joe De Sena would say, “We’re here to rip you from your comfort zone. If you need a road map for each step of the way, then maybe this race isn’t for you.” Comfort Zones are addictive and trap people (amputees) in a place where they lazy and uninspired to live this amazing thing called “Life.” Spartan Races are full of surprises. Just when you

They don’t tell you anything about your obstacles, including but not limited to, how tall, long, heavy any obstacle is or might be or which obstacles you will see at a specific race. Going through an amputation or having limb difference is pretty much the same, there is no road in the beginning unless your one of the lucky ones to have an amputee peer share some of their experience and explain to you the road that your on and what to expect. But that’s just it, you still have to experience it for yourself. Just like a Spartan race most doctors and medical professionals don’t (or are unable) tell you anything about the course ahead of you because they don’t know.

Why Do We Race?

This is a question that I think most Spartans get able body or not. I find that people when they find out I do these races they are wondering why, they typically say; you have nothing to prove, you are crazy and you have prosthetic leg. I attempt to explain Spartan Racing is not for everyone. You will know once you do your first race, it will either lite a fire inside of you or you’ll quite before you finish the race. As the editor of this magazine and the host of Amp Life Talk Radio - The Podcast, I am always curious about things (on the human side) related to amputees and those living with limb-loss or limb difference. If you were to look at the Spartan social media page you will see endless stories of why people race. I did a recent interview with a young lady who was involved in an auto accident with placed her in a wheelchair at the age 19. She had did a few Spartan races before her accident and she recalls the experience of those races, how she complained about training for them and how going through the race while able body and she like most people who go through a race thinking why am I doing this? Internal moaning about legs hurting or being in pain. But she recently did a Spartan race two years after her accident on the same date. Her perspective was completely different. She told how she felt so alive going through this race in a wheelchair now with the help of the OSCAR-MIKE foundation. She embraced every obstacle with a smile, never once

thinking about the pain or complaining about being tired. She was truly alive. But How? She was unable to use her legs, she was in a wheelchair now, why did she do this race? I think the better question is why not? While talking with her I got a scene of how sometimes we as people tend to forget how good life is, we forget how live life and find ourselves going through the motions of living without actually living. Mundane existence, is what most of us are doing.

athletes so they could compete on a level playing field. “[Adaptive athletes] should have the opportunity to purse, and they should have an opportunity to compete. Bottom line,” Walker said.

Dave Ganas and Erica Walker met and started talking about adaptive racers who wanted an opportunity to podium having a Spartan Race they could compete in but how? This was new Why do we race? This is a deep question and can territory for Spartan as well as the adaptive athonly be answered by the individual. But I think letes who wanted to compete at the highest level the one common factor is that Spartan races in Spartan Racing. Special rules had to be made make you feel something inside of you. to accommodate a team approach and an OPEN Heat for solo racers. What Is Para Spartan? First we must talk about a very special person, The Para Spartan Elite Heat was created and deEric Walker Erica, formerly the director of U.S. veloped for adaptive athletes to have an opporevents and operations for Spartan races, was tunity to compete as a team or a solo Elite(s) for chatting with an amputee, a friend and Spartan cash and podium 1st. 2nd & 3rd. place standings competitor who lost his leg in a roadside bomb among other adaptive Spartans with the first offiduring his deployment in Afghanistan a decade cial race last year. ago. The second annual Para Spartan Championships He voiced concerns about being able to podiwill be held in Laughlin, NV this November um and how that could never happen if racing on the 17th. 2019. They will have a team heat against able body racers and hoped for a race for (4 member team w/ a wheelchair member) adaptive racers. and an open heat for individuals. If you are interested in a Para Spartan event please visit: Walker went straight to the top and talked to articles/360009041613-What-is-the-ParaSpartan’s founder and CEO, Joe De Sena. He Spartan-Heat then gave her the green light to conceptualize a course specifically geared toward adaptive

As the only Para Spartan Team to accept this challenge it is clear that we are serious about competing, we are serious about being Spartans, we want to show America anything is possible no matter what your situation is. Get up off the couch and get outside. As an amputees this race was hard but not impossible. 18

Thoughts After The Race We crossed that finish line tired & cold, beat up but happy. We collected our medals and shirts, drove back to the cabin ordered in some pizza and sat around recalling moments from the race. Kacey signed a copy of his book for me after dinner. We all were tired and called it an early going to bed as most of us had to drive several hours back home to family. When I got home I decided to ask my teammates to answer some questions that I wanted to use for this story. I wanted to give each member to express their emotions and thoughts on this race. I simply ask: 1. Your hardest moment(s)? 2. Your thoughts from the race or about the race? 3. Your proud moment(s)? 4. Your feelings after the race? 5. What message you want to send? Dave Ganas “My hard moments are always being prepared to compete and spending the time away from my family.” “Finishing the Spartan World Championships in Tahoe definitely brings a sense of accomplishment. However, to see my teammates give it everything and still push themselves further until the finish line is a proud and marvelous thing to witness.” “To be a part of the team that works together almost seamlessly is an honor. crossing the finish line was a proud moment for me. Almost more than last year when I completed the beast at the World Championships both days.” “My message is to show and bring hope and support to others out there. To show them there is so much potential inside them. That they are not alone.”

despite all of that, I knew that this team was going to do something amazing we were going to finish a race that no other Para team had done. We were going to finish a race that others had decided not even to show up to. All of the other things were any sort of window dressing. There was going to be nothing that could stop our Para team from doing something great.” What was your hardest moment: “My hardest moment was not when my elbow decided it was time to stop holding weight, nor was it when my hands got so cold it felt like they were being electrocuted. I knew that those kinds of things were going to happen. I had prepared for and was ready for those challenges. The hardest part for me was the concerns I had for my team. As we got to the top of the first rise one of our teammates had a severe reaction to the altitude, and another one of our teammates were struggling with a health issue not related to the race at all. It was then that I wondered whether my greatest fear would happen. Would we not finish the race as a team? That to me was the hardest moment. But I saw the change. I saw the instant the team pulled together tighter than before and took on each obstacle as they came. After that there was no doubt in my mind we would finish the race.” Proudest moments; “One would definitely be when we pulled together as a team. Other

The weather played a big role is this race, it made things much harder. Kacey How did you get into spartan racing: “I was looking for a challenge. Marathons were too short and extremely boring. The longer distance races would not let me compete for “safety” reasons. Then I saw a video for spartan races and I knew I had to give it a try. I did not know if I could do it or not but I knew that I needed to try. The first race just about killed me. But I knew that if I could do one, I could try another one. A few supers latter and I knew it was time to try a beast. After completing my first trifecta I knew there was no chance I would stop doing spartan races. And every year since I have been striving to go faster harder and farther.” “Before the race stated I was excited. This was going to be an incredible race one way or another. Sure I was worried about the weather and how the chair was going to hold up. I was worried about nutrition and water and all 19 of those little things that go into a race that takes this long to do. But

The Grit Chair weighs about 65lbs. We carry this the entire race.





As a Para Spartan Team working together as a unit is important in accomplishing your goal for each race.

races that we have done we made sure it was about other people. Sure it was the training we had put in but it was also about the other people who could benefit from us and what we were doing. In Tahoe there was a different goal. We were doing something that had never been done before. Every step we took was to show the true possibilities. There were other smaller moments. Like Sean making it up the rope, and Dave and Pat pulling the chair sometimes with me in it over punishing terrain. The thing that I am most proud of though is the work that was put in every single person on this team. The race was just a showing of what we could do but the real work took much longer and was seen by almost nobody.” “After the race there was a sense of satisfaction. I was happy for sure but more than that I was content in the knowledge that we had done what we set out to do. We learned later that many were pulled off the mountain due to weather. We made

it past that point and finished the race one step at a time. There was nothing that could stop this amazing team.” “If anybody reading this or watching our race feels like they are not good enough then you need to stop listening. Stop listening to the doctors, family and especially yourself. We are not meant to sit on the couch wishing for a better life and complaining about the life we have been given we are meant to rise up over our challenges. Because are challenges are what makes us strong. If you think you can’t do this race then start with something else. But start. There is no reward Dave Ganas is the backbone of this for getting through this life in the easiest way, but oh what a reward team, a true captain, he carries & for truly living each and every day. pulls the chair over, up and through So go out there and LIVE.”

some of the roughest terrain.

Pat Toughest moment: “Negotiating grit chair and skipping water obstacles.” Thoughts from the race: “I’m always touched by those around us who are deeply affected by our actions.” Proud moment: “The moment when Sean overcame some altitude issues and killed the rope climb as I failed it. Good on ya, Sean.” “I feel now as I did that Saturday. We can do so much more. This is just the tip.”

During this race several racers were pulled from the course for hypothermia.

My message: “America, get off the couch - 4 Guys with 3 legs are doing something you’re not. Come out and join us!” 20

No matter how much pain your in you can always count on a beautiful view. Itâ&#x20AC;&#x2122;s all about perspective. Sean For me this race was a big moment in my life and as a Spartan. As someone who is new to Spartan racing with only a handful of race under my belt doing a beast was unthinkable at this stage in the game. My hardest moment(s): When I reached the top of the mountain/hill and felt the effects of altitude sickness (nausea, and lightheadedness) shook my foundation because I had never experienced anything like this in my life. And the last three miles of the race were brutal, as my knee in my socket had swollen on the lateral and medial sides. Every step was painful. My thoughts from the race or about the race: I feel a little like Pat, in some ways I wish we all could have participated in the water obstacles for the experience of it. It was a real eye opener

Spartan Races are about facing you fear, the Rope Climb has been one for me. But I trained hard to overcome it and this race I rang that bell! Adapt and overcome.


Kacey took on the water obstacles which meant getting wet is 17 degree weather. I know Pat wanted to do these as well but as a team one member can do the obstacle. to do a Beast, one of the toughest races Spartan has to offer. To be able to finish the race as a team, The Para Spartan Team! And I say this because no other Para Spartan has sacrificed as much as our team to promote Para Spartan we are the real deal. We didn’t make excuses when offer a challenge, we step up. We Spartan Up! My proud moment(s): Of course crossing that finish line and getting that medal placed over your head. Not letting my team down, sucking it up and completing this race. And of course climbing that rope and ringing that bell! Feelings after the race: As we all sat and had our pizza dinner in the cabin after the race, I felt accomplished and proud to be apart of something special, making history. This race was about facing my fear, the fear I didn’t voice out loud and never showed to my teammates or my wife. I had faced my fear(s) during this race, I share this with my wife Heather afterwards and welled up with tears as I told her about what we had just went through and how it felt to cross the line. I got very

Racing hurt is part of the game and I know Dave and Kacey both were in pain but saddled up any way. The downhills soon took a tole my prosthetic side with my knee swelling up, every step was painful for the last 3 miles.

Pat told me, “He feels now that we have done this, there is so much more we can do.”


emotional. On that day on those mountains I left that fear and found a new level of toughness and grit. What message you want to send: I want to say to anyone out there who is an amputee or even an able body person, your body is an amazing gift and it can do amazing things if you are willing to step outside of your comfort-zone. There really are no excuses getting up and becoming more active does not take much. You don’t have to do a Spartan race just move. And to those of you have been thinking about doing a Spartan, sign up, as Joe De Sena would say put some skin in the game, lay down the cash on registration for the race and book a hotel or flight, then you will committed or lose the cash. Kind of like booking a one-way flight.

“When I think of Grit, I just take a look at my teammate Kacey” Sean Harrison ed a Spartan Beast as a team following the rules. As you read earlier there were several teams of Para Spartans invited to do this event, the Tahoe Beast. To complete a Beast without any help from anyone. There were supposed to be a media coverage of the teams and some interviews lined up. To really put this out there, I remember thinking to myself awesome! Well as the event approached and I mean a few days before we were all suppose to show up the others teams backed out for whatever reason(s). I am sorry to sound like mean person but if you give your word to do something you do it, come hell or high water or death. Our team saw this as a great opportunity to


Para Spartan History After the race is when we learned or should I say I was aware that we had did something special. One word says it all “unassisted”. Randy Moss, yes the NFL football player and others typically people with some type of disability go through Spartan races assisted by either the Spartan Staff or outfits like OSCAR Mike, Enduring Warrior, etc. They typically helping them with the obstacles. Or like in Randy Moss situation get ride on a golf cart obstacle to obstacle. There are some solo adaptive racers who do Spartan events without any help. But on the Para Spartan Team level and rules no team has attempt-

promote the Para Spartan race, a chance to be apart of big race and show people what Para Spartan is all about. Here’s the thing, most people know who Dave and Kacey are as they have developed a pretty big following among Spartan world-wide. Every race I have been with my teammates at people from all over the globe come up to Kacey and Dave asking for pictures, one of things you have learn to do when your on a team with two “rock-stars” is take good pictures. So, our team has brought some attention to Para Spartan. As an Elite Para Spartan Team you must do the entire race without any help on the obstacles. Follow the rules for Para Spartan the entire race, no cutting corners. And for 11 hours we did just that. Compete as Elite Para Spartans.

As prosthetic user knowing when to care for your stump is vital to your health. What was disappointing to me and I think our team was that after the others backed out from the race it seemed like interest was lost. There was no media coverage at all. If it were not for Niki Verneuille who acts as our handler for Spartan but is not really employed by Spartan (yet) we would have been involved in anything. She saw us off in the morning of the race at 6a.m. in the freezing cold and held on to our personal belongs that we couldn’t take and made sure we had everything we needed before taking on this race. She was there waiting for us to come down the mountain after 11 hours, she arranged for the DJ to announce what we had done that day over the PA system as we crossed the finish line. She is truly amazing. We as a team are so thankful for her being there for us helping arrange all Don’t get me wrong I and my team are thankful for Spartan and what they of this and helping us with accommodations. have done for us but we really would appreciate the respect that the other Elites get when doing an event. Para Spartan will only become a big deal if Spartan treats it as such and the people who show up to compete at the big events as well as the little events. We (and I speak for my team) not here for fame and the spotlight unfortunately some others. We are here because we believe in what Para Spartan could be if the right people and energy is

Even though I failed this obstacle it made me proud to see Pat handle it like a Boss! focused on it. It could be a powerful motivating event to both adaptive and able body racers. I am thankful Spartan and the opportunities they have allowed us but I would like to see more from them in supporting Para Spartan on the same level as the able body Spartans. I am proud of my team for we have made history and I am looking forward to 2020 as I hear there are some good things coming. I encourage other adaptive people looking for something that to fill that void to take a look at Para Spartan.






Q& A

Finding The Best Foot For You

expect to walk on uneven ground

more expensive materials. Reimbursement by an insurance company or government program Activity Level 3 depends on specific codes. Before making a If you’re a person who can walk at varying speeds final selection, make sure the prosthetic foot of while also negotiating uneven terrain and similar your choice is covered. Insurance companies barriers, look for these features in a prosthetic often will cover a more expensive prosthesis if foot: it will enable you to increase your activity level, work a longer day or take fewer days off. A smooth rollover as the prosthetic foot transitions from heel strike to toe-off. Over the past decade, technology and research Good energy efficiency. have greatly expanded the functionality and Ability to adapt to uneven ground. aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Activity Level 4 Various models are designed for activities For the highest level of mobility, including ranging from walking, dancing and running walking for unlimited time and distance plus de- to cycling, golfing, swimming and even snow manding work, recreational or athletic activities, skiing. Heavier wood and steel materials have you need a prosthetic foot that can withstand been replaced over the years by lightweight shock, tension and torsion and that responds plastics, metal alloys and carbon-fiber composwhen you change walking speeds or start runites. Much like the human foot, many of today’s ning. (For certain activities, you might consider prosthetic feet can store and return some of the additional specialty feet for sports or swimming.) energy generated during walking. Other key attributes included toe and heel springs that alFor everyday use, look for a prosthetic foot with: low more natural movement at the ankle, shock • An easy rollover absorption, multi-axial rotation, adjustable heel • Good forefoot support heights, and waterproof materials. • Excellent energy efficiency. Consider a carbon-fiber foot with more stiffness for A number of factors must be considered when support and energy storage. selecting the right foot/feet for your lifestyle. • Ability to adapt to uneven ground These factors include your amputation level, age, weight, foot size, activity level, goals and Q: Why is your weight important? occupational needs. A: Prosthetic feet are designed for a specific weight range. To ensure that a prosthetic foot Structurally, prosthetic feet can be divided into performs well for you, choose one suited to your two groups: those with a rigid connection to the weight class. prosthetic shank (non-articulated) and those with a hinged ankle mechanism (articulated). In Q: Why is your height important? terms of function, prosthetic feet can be categoA: Your clearance. rized into the following groups: When you stand, a prosthesis fills the space between your residual limb and the floor. It is Solid Ankle Cushioned Heel (SACH) designed to add only the length needed to equal Elastic (flexible) Keel Foot your other leg. Most prosthetic feet are 2 to 7 Single-Axis Foot inches in height. Consequently, a limb loss near Multi-Axis Foot the ankle may limit your options to low-profile Dynamic-Response Foot prosthetic feet. Microprocessor Foot. Q: Is skin tone an issue? A: Your preferred shell. Shells can be ordered in colors to match skin tone, in a range of sizes and often with a split toe for wearing sandals. Low-end shells may lack detail, such as toes, and may be attached to the prosthetic foot. At the high end, the toes and skin colors are more realistic. If your activity level is 3 or 4, look for a foot with a shell that can be replaced if you wear it out dancing or playing tennis. Q: How much does a prosthetic cost? A: Price is tricky. The price of prosthetic feet generally rises with the activity level because additional func27 tionality translates to more structure and

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Profile for Ampnation Magazine

Vol. 1 Issue 5 November 2019