**9.1 Prosthetic considerations**

Syme's level of amputation needs to encompass on several objectives for prosthetic management. It should pay back for the missing foot along with ankle motion which provides propulsive energy during ambulation. Limb length discrepancy (LLD) should be considered before preparing of prosthesis has it needs to suspend during the swing phase of the individual during gait.

Essential socket fit will maintain fat pad beneath the distal end of the tibia and fibula. SA has many functional advantages but when suggested with prosthesis it has various cosmetic limitations depending upon the shape and nature of the limb being treated.

In Biomechanical aspect, the prosthesis must provide comfortable transition, minimize shear and provide comfort for gait.

#### **9.2 Types & parts**

Currently four types of basically designed prostheses are used for SA.

*The Canadian design or posterior door design*, also used for Chopart's amputation is the commonly used prosthesis for individuals with large or bulbous residual limbs. Disadvantages of this prosthesis is heavier in weight when considered as a cosmetic option.

*Medial door design* (**Figure 6**) is a commonly used prostheis. It has great suspension due to intimate construction nature of the socket. It consists of an expandable door made up of an elastic sleeve which improves cosmesis and helps in donning and doffing process.

*An expandable inner liner which is enclosed within the rigid outer shell*. It has a hidden-panel expandable wall which is used for small distal ends.

*Preparatory prosthesis which consists of a removable foam liner* (**Figure 7**) that interfaces with the external socket. This allows or has the ability to modify accordingly further allowing for atrophy during maturation process by using the patellar tendon to assist by unloading the limb. It is lightweight and easily adjustable hence considered as the one with great cosmesis. Proximal region at the level of patella tendon or below can be trimmed as the amputee progresses with limb maturation.

**Figure 6.** *Medial door design.*

**Figure 7.** *Rigid outer shell.*

A modified Jones compression dressing is used postoperatively to control edema and to help shape the stump [7].
