How to Choose a Prosthetic Foot

1. Arm yourself with knowledge. Read my previous blog “Everything You Need to Know About Prosthetic Feet.”  Once you understand what the different types of feet are meant to do, you will really be able to communicate effectively with your team. For those of you who have ever watched my live show, you know how much I am pro -communication between clinicians and patients!  So go and familiarize yourself with the different classifications of prosthetic feet and make sure to download my quick reference “Cheat Sheet” that you can take with you to your next appointment.

2. Make a list of activities that you do on a daily basis. And yes, begin with getting out of bed!  Think of all the things you do around your house.  Walking to your kitchen, making breakfast, using the bathroom/shower/toilet, making your bed and other household chores. Do you go through a garage or front door to leave your home?  Steps/stairs/ramps?

   What are your work requirements?  Desk job or on your feet and moving around?  Smooth indoor walking surfaces or out on a contract site or going from place to place to visit clients?

   Are you zipping around trying to keep up with your kids/grandkids/beautiful neighbor’s kiddos?  Do you like to walk your dog (or very precocious hamster?)

   Don’t worry, if you’re getting a little cross eyed with everything I am throwing out at you, I have created a “Cheat Sheet Worksheet” for you to fill out to make it easy to keep track of everything.  And yes, you should take this to your next appointment as well!

3. Once you’ve made a list of these activities, think about HOW you used to do them prior to your amputation. Were you completely independent?  Did you need a mobility aide such as a walker, wheelchair, crutches?  Then compare with how you are performing these activities right now.  In making these comparisons, you can see where you have maybe been able to return to full function and where you are still looking to make improvement.  There is a place on the Cheat Sheet worksheet to keep track of this.

   Other things to consider are any future home modifications you may be planning or car modifications?  This will help you think about the areas in your life where you will have a lot of adaptive support (most likely your home) and where you will not (out in the community).

And then we get to the fun part (’bout time Cosi!).

4. Write a list of your goals. It could be something grand like opening a business, learning Mick Jagger’s moves, or training that hamster to walk on a leash.  But most likely, you’ll want to start with the basics.  How will you get around in your home?  Do you want to be able to achieve the same level of independence with mobility that you had prior to amputation?  Or is your amputation going to allow you to have more potential with mobility?  How do you want to negotiate your work environment?  This is where a conversation with your Physical Therapist is absolutely crucial.  While we do not have a crystal ball to help us predict the future, we will be able to reasonably predict what your future mobility will look like after proper gait training.

   **Please note, while I have the utmost respect for my Prosthetists, they are not the experts in mobility goals and the gait training process.  This is firmly within the territory of physical therapy.  This includes determining what home and car modifications may be needed as well as which walking aide (walker, crutches, etc) will be best for you to use (if any at all).

5. Once you have your goals written down (that you have discussed with your PT 😉), then it’s time to take a trip to ye ole Prosthetist clinic. Bring your Cheat Sheets with you for quick reference as well as your list of goals and activities.  I cannot stress enough how much this “homework” will allow your prosthetist to get a great picture of what you will need to get back to life!

6. The next step will be to determine which classification of feet will best suit your needs based on the goals and activities you have provided. Once you have narrowed this down, the fun begins.

   For example, if you and your Prosthetist decide you are in the market for a Dynamic Response foot, you will then want to trial feet from at least 2 different manufacturers that are classified as Dynamic Response feet.

   Now, that being said, you and your prosthetist may find that there is more than one classification of foot that could potentially be a winner.  Many folks who like the appeal of a Dynamic Response foot also find the Multi Axial interesting.  And some who gravitate towards the benefits of the Hydraulic foot find the Multi Axial foot enticing as well.  Despite the fact that these are very different feet, you might find characteristics that apply to your lifestyle in more than one category.

   The important thing to remember is that by knowing and understanding these classifications, you have already put yourself ahead of the game!

   Fair warning!

   When you are exploring different manufacturers, you WON’T find a handy dandy list on their websites listing their prosthetic feet by these classifications (sounds like they should give me a call 😉). I have visited pretty much every website with prosthetic feet and they all have their way of displaying their enticing wares with equally enticing (but ultimately not very helpful) names…

   But do not be turned away from your quest (Monty Python moment)!

   This is where your prosthetist can help you sift through all the cool names of prosthetic feet and find the descriptions and specs section that will ultimately tell you which foot is Dynamic Response vs Multi Axial vs Hydraulic etc.

   Chances are, your prosthetist will already be familiar with many of these feet and can make recommendations based on his or her experience with patients.

   However, you may need to expand your search a bit which brings us to step number…

7. If you and prosthetist feel you need more options to explore and you really want a peek behind the curtain, ask to speak to your local sales representatives! Each company will have sales reps that are assigned to the area where you live or where your prosthetist has his or her clinic. And they are experts in all these feet! These sales reps are usually my go to when I am on the prowl for the perfect foot for one of my viewers or patients.

   Another fair warning!

   Sometimes sales reps will be hesitant to “label” one of their prosthetic feet into a classification. There has even been the occasional eye roll when I really push them to pick a classification 😉

   Do we care…nope.

   If they can help identify the classification of a particular prosthetic foot, it will help you get a better understanding of what this foot can do for you. Remember, you are the center of this decision and understanding is key!

   Now why would the sales rep be reluctant to categorize their prosthetic feet to one of these simplistic classifications? Well folks, that’s another topic for another blog…

8. Ok, so you’ve picked out 2 or maybe even 3 feet from different 1-2 manufacturers-now what? Allow me to introduce the trial programs. All the big dogs out in the O&P industry have foot trial programs. They might be a little different in the criteria, but the basic idea is to allow you to take their foot home and trial it out in your daily life.

   Makes total sense right?!

   Folks, I cannot tell you how many times people tell me they never got the chance to trial a foot. Ever. They went to their prosthetist appointment and were assigned a foot. That’s it. Story over.

   This happens. A lot. Please don’t let this happen to you. If you are reading this article (and are still here), it really means you are vested in your care. And this might be the part where you have to advocate most for yourself.

   A good prosthetist won’t bat an eyelash at doing this for you—they will want you to trial the foot and make sure you are getting the best fit possible even if it requires extra visits to swap out the trial feet and ordering/shipping wait time with manufacturers.

   A prosthetist who perhaps is not…up to parr, will hem and haw at allowing you to trial different feet. This is a red flag and may mean you need to find another prosthetist. This sounds harsh I know, but this is your foot. And please understand, I hold myself and my physical therapy colleagues to a very high standard of practice too! But in this particular part of the process, your prosthetist should be encouraging you to trial AT LEAST 2 feet. I stand firm by this and I have had the support of many prosthetists in the community (who also happen to be the best ones).

   Think about it. Would you buy a car that you have never seen or driven? Or would you insist on taking it for a test drive? (Please tell me you test drove your car before buying!)

   Then why would your foot and main mode of transportation be given any less consideration?

Cosi Talks Soapbox Rant over (told you there were a lot of these!).

9. Once you have a trial foot, go forth and trial! I love it when my patients come to me with their trial feet (and their check sockets too). This is again where the Physical Therapist is an important part of this process. We will put your feet through the gauntlet (safely of course) and really test it out. I don’t want my patients to ride the first gear and burn out the clutch, I want to put this puppy through all the gears! (my husband is rolling his eyes at my lame attempt at car analogies) There is so much valuable information you can gain from taking the foot home and testing it out in your daily environment as well as having your PT’s expert eyes watching how you maneuver at the clinic.

10. The time has come. You did your due diligence by learning, goal writing, communicating with your team, trialing You have your objective criteria with the input you’ve received from your Prosthetist and Physical Therapist during this whole time. You have your experience on how you felt when using the feet.

    And now it is time for the final rose.

    I do not envy your decision because let’s face it, it’s part science and part “feels.” Maybe you had an ”aha love at first step” moment or maybe it took you some time to warm up to a particular foot. I’ve heard everything across the board. Here is my unsolicited advice (which in reading this blog you technically asked for it!).

    If you absolutely love the first foot you try on, awesome. Please still take the time to try a second foot. This will either reinforce that the first foot is in fact your solemate (sorry, I’ve been sitting on that one for awhile), OR you might discover another foot even more suited for you! If you don’t get the butterflies in your stomach (the good kind, not the bad seafood kind) right off the bat with the first foot, this is your sign to either give it some more time (hence the trial period) or to keep looking.

    Last part (good grief Cosi!).

    Once you have your foot and have signed on the dotted line, familiarize yourself with the return policy. While it would be unusual for you to have buyer’s remorse after doing all your homework and research, it can happen. And you will want to know what the policy is for returns for the particular manufacturer.