Amputees stand to benefit from new “game-changing” equipment which will make casting a socket for a residual limb “as close to perfect as possible”.

After lobbying for the machinery for three years, a jubilant Amy Camilleri Zahra, meningitis survivor, transplantee and co-founder of Amputees4Amputees, believes others like her will benefit greatly.

“Having used it abroad, I fought tooth and nail for the Ottobock casting equipment to be available here too,” she said.

“I kept up the fight because I know how important it is to have this machinery in Malta.”

Steward Health Care Malta said the new casting stand is now being used for a diagnostic socket fitting by the Orthotics and Prosthetics Unit within the St Luke’s Hospital complex to provide a “well-fitting prosthesis in a faster, more efficient manner”.

It saves time, allowing for a more accurate replication of what happens when a patient is standing and walking, and avoiding the need for extensive modifications – common among patients with complicated limbs, a Steward Health Care spokesperson explained.

“Without it, people like me would not be able to have a comfortable pair of legs to get on with their lives,” Camilleri Zahra emphasised.

“Not being mobile also leads to other health issues and that should not be the case, especially when we know there is a solution.”

Now, the majority of both above- and particularly below-knee amputees stand to benefit from the device, although patients who are deconditioned or have other health conditions and weakness would still require what is known as a hand cast.

Amputees can still get a cast without this machinery, but in the case of those with non-textbook residual limbs, this is a game changer, Camilleri Zahra stressed.

The frequency of casting for a new socket varies, and it is not the same for everyone, she said.

How does casting work?

Just after amputation, the residual limb goes through many changes due to a reduction in swelling, among other things, so at the beginning, amputees would need to be cast several times until the shape stabilises.

Without it, people like me would not be able to have a comfortable pair of legs to get on with their lives

Eventually, it gets to a point where this happens less often – on average, once every two to three years. However, it all depends on many factors – the residual limb may change if the person loses or gains weight, in which case a new socket would be required.

Prosthetic legs also go through normal wear and tear, “so if you need a new pair, you usually need to be cast a new socket too,” Camilleri Zahra added.

The new equipment allows the prosthetist to take a cast of the residual limb while the person is standing up and putting weight on it, which makes all the difference.

“When you have a lot of scarring on the residual limb, the shape changes drastically between sitting down and being upright with weight on it,” Camilleri Zahra said.

“Like this, the prosthetist can get a more accurate cast, which, in turn, will help with the socket being as bespoke as possible and allowing for more mobility and less pain.”

When Steward took over the management of the Orthotics and Prosthetics Unit in the first quarter of 2018, a comprehensive needs analysis was carried out and the priority was infrastructural upgrades, it said.

Then the coronavirus pandemic delayed the procurement of the casting stand due to worldwide supply chain logistics.

How are prosthetics currently cast?

Prior to its arrival, the prosthetist had to hand-cast all patients – a physically taxing task for practitioner and patient alike, said Steward Health Care, which uses US-based company, MCOP Prosthetics, to run the OPU at the rehabilitation hospital.

When hand casting above-knee amputees, they stand holding on to a walking frame for up to 10 minutes, with most of their body weight resting on a single leg – “incredibly difficult” particularly for older patients.

The practitioner and assistant had to physically support the patient while shaping the cast, which is hard when working with heavier patients, the spokesperson said.

“Before the unit was permanently set up here, we had to rely on a service from the United Kingdom, which only came to Malta every six weeks,” Camilleri Zahra said.

“If anything happened in between that time – and things do happen – you are basically in trouble and left stranded without legs!

“Practicality is everything. So, having this done here is also very important for family life and work-life balance,” she pointed out.

The activist and academic had been lobbying with Steward Health Care, spending years sending e-mails and advocating for its management to acquire the Ottobock equipment.

Instrumental in the arrival of the casting machine was Amputees4Amputees’ advocacy – an organisation run by a committee of amputees that aims to offer awareness, education and peer support.

One of its recent projects was, in fact, training amputees to support others in their same shoes.