A New Design and Construction For

a Swimming Prosthesis
Carlo Marano, C.P.
Eugene DeMarco, C.P.
This article, which concerns an innovation in ambulation for the active amputee,
may be read in conjunction with the article by Kenneth P. LaBlanc, B.S., C.P.O., in
Orthotics a n d Prosthetics, Vol. 37, No. 3, pp. 42-49, "Fabrication of the Water
Resistant B/K Prosthesis." T h e Editors

T h e a b i l i t y o f t h e l o w e r l i m b a m p u t e e to It w a s o u r g o a l to d e s i g n a s w i m m i n g
p a r t i c i p a t e in r e c r e a t i o n a l a c t i v i t i e s is prosthesis that w a s practical, c o s m e t i c ,
s o m e t i m e s n e c e s s a r y i n o r d e r to i m p r o v e safe, a n d d i s p l a y e d a m i n i m a l a m o u n t o f
t h e q u a l i t y o f h i s o r h e r life. S w i m m i n g , i n buoyancy. W e have achieved this end b y
p a r t i c u l a r , c a n b e an e n j o y a b l e m e t h o d o f c o n s t r u c t i n g a p r o s t h e s i s w i t h a large c e n ­
e x e r c i s e for t h e a m p u t e e . tral c h a m b e r t h r o u g h w h i c h w a t e r c a n
P r o s t h e t i c d e v i c e s for s w i m m i n g are e n t e r a n d exit q u i c k l y .
n e c e s s a r y , n o t o n l y to i m p r o v e o n e ' s a b i l i t y T h i s c h a m b e r has a distal o p e n i n g lo­
to s w i m , b u t to p r o v i d e : c a t e d i n t h e b a s e o f t h e w a t e r r e p e l l e n t foot,
• a safe m e a n s for a m b u l a t i o n i n a n d a n d a p r o x i m a l o p e n i n g in t h e p o s t e r i o r
out of water shelf of the socket (Figure 1).
• p r o t e c t i o n a g a i n s t t r a u m a to t h e r e ­
sidual l i m b
• constancy of residual limb v o l u m e
during s w i m m i n g activities
• safety i n t h e s h o w e r .
C o n t e m p o r a r y p r o s t h e t i c d e v i c e s for
s w i m m i n g satisfy t h e latter o b j e c t i v e s , b u t
fall s h o r t o f p r o v i d i n g m a x i m u m safety.
Especially w h e n ambulating in water,
p r o b l e m s h a v e b e e n e n c o u n t e r e d d u e to
the buoyancy of these devices. A prosthe­
s i s t h a t is fully b u o y a n t m a y b e h a z a r d o u s
to t h e w e a r e r . A g r e a t a m o u n t o f effort
m u s t b e e x e r t e d to k e e p t h e p r o s t h e s i s
submerged. A reduction in buoyancy gives
the patient a greater degree of control over
t h e p r o s t h e s i s . H e c a n affect its p o s i t i o n
with a degree of coordination and muscle
p o w e r that m o r e c l o s e l y a p p r o x i m a t e s
out-of-water ambulation.
W h e n a b o d y i s i m m e r s e d i n a fluid, it is
b u o y e d u p w i t h a force e q u a l to t h e w e i g h t
o f t h e fluid d i s p l a c e d b y t h e b o d y . T h e r e ­
fore, i n o r d e r to r e d u c e t h e b u o y a n c y o f a Figure 1. Schematic drawing of swimming prosthe­
s w i m m i n g prosthesis, o n e must reduce the sis: (1) central chamber, (2) proximal opening, (3)
a m o u n t o f w a t e r that it d i s p l a c e s . distal opening, and (4) distal socket drain.
 As the amputee enters the water with the s i z e a n d fitted to a flat r u b b e r s w i m m i n g
p r o s t h e s i s , w a t e r e n t e r s t h e distal o p e n i n g s n e a k e r . T h e k e e l is s h a p e d to fit t h e s e
a n d b e g i n s to fill t h e c h a m b e r . A i r is components.
simultaneously expelled through the Fiberglass cloth, impregnated with
p r o x i m a l o p e n i n g . T h e w a t e r level i n t h e p o l y e s t e r r e s i n , is s a n d w i c h e d b e t w e e n t h e
c h a m b e r will equilibrate with the water base of the keel and the plantar c o m p o ­
level o u t s i d e t h e p r o s t h e s i s u n t i l t h e p r o s ­ n e n t s o f t h e foot. T h i s l a y e r i n s u r e s a s t r o n g
t h e s i s is c o m p l e t e l y s u b m e r g e d . A s t h e keel b a s e a n d an i n t i m a t e fit w i t h t h e sole
p r o s t h e s i s is r e m o v e d from t h e w a t e r , a i r of t h e foot.
e n t e r s the p r o x i m a l o p e n i n g a n d forces
w a t e r o u t distally. W i t h o u t t h i s p r o x i m a l
o p e n i n g , t h e a m p u t e e w o u l d feel a d o w n ­ THE BELOW KNEE SOCKET
w a r d pull o n t h e p r o s t h e s i s d u e to t h e force
All b e l o w t h e k n e e s w i m m i n g p r o s t h e ­
o f the e x i t i n g w a t e r .
s e s f a b r i c a t e d in o u r l a b o r a t o r y u t i l i z e
PTB sockets with Supracondylar or Supra­
THE WATER REPELLENT condylar/Suprapatellar suspension sys­
t e m s . T h e s e h a v e p r o v e n to b e t h e s u s p e n ­
FOOT sion types of choice. Auxiliary suspensions
T h e distal o p e n i n g o f t h e c e n t r a l c h a m ­ should b e avoided whenever possible, be­
b e r is a 1.25 i n c h d i a m e t e r h o l e i n t h e b a s e cause i m m e r s i o n in water increases their
o f a s p e c i a l l y p r e p a r e d foot. E x p e r i e n c e h a s rate o f d e t e r i o r a t i o n a n d t h u s affects s a f e t y
d e m o n s t r a t e d that w a t e r , e s p e c i a l l y salt and frequency of repair.
w a t e r , r e a d i l y d e t e r i o r a t e s t h e foot p o r t i o n As previously stated, the water emission
of a s w i m m i n g p r o s t h e s i s as w e l l as its rate from t h e c e n t r a l c h a m b e r c a n b e i n ­
a t t a c h m e n t to the s h a n k . Efforts to r e d u c e creased b y providing a proximal opening
m a i n t e n a n c e and facilitate fabrication, in the posterior b r i m of the socket (Figure
w i t h o u t r e d u c i n g f u n c t i o n , h a v e l e d to t h e 3 ) . T h i s o p e n i n g is c r e a t e d d u r i n g t h e
d e s i g n o f a w a t e r r e p e l l e n t foot for s w i m ­ s o c k e t l a m i n a t i o n . A 1.5 i n c h w i d e , s l i g h t l y
ming prostheses. tapered, piece of .125 inch thick polyethyl­
T h e k e e l o f t h e foot is f a b r i c a t e d f r o m 3 5 0 e n e is i n s e r t e d b e t w e e n t h e l a y e r s o f s t o c k ­
g r a m s o f P e d i l e n f o a m ( t h r e e p a r t s h a r d to i n e t t e p r i o r to l a m i n a t i o n . T h e p o l y e t h y l ­
o n e p a r t soft) p o u r e d i n t o a n e u t e r b l a n k e n e w e d g e e x t e n d s to t h e d i s t a l e n d o f t h e
m o l d . T h i s b l a n k c a n b e s h a p e d to a c c o m ­ s o c k e t b u t is e a s i l y r e m o v e d b y h e a t i n g t h e
m o d a t e all foot s i z e s , left a n d r i g h t ( F i g ­ posterior aspect of the socket. W h e n the
ure 2). t a p e r e d w e d g e is r e m o v e d , it w i l l l e a v e a
O t t o B o c k P e d i l e n toe a n d s o l e p a r t s are c h a n n e l that will u l t i m a t e l y d r a i n i n t o t h e
c h o s e n t o c o r r e s p o n d to t h e p a t i e n t ' s foot central c h a m b e r of the shank.

Figure 2. Components of "water repellent" foot: (left to right) neuter blank mold for urethane keel;
shaped keel attached to Pedilen foot parts; swim sneaker.
Figure 3 . Posterior socket channel in proximal Figure 4. Distal socket drain leads to the central
brim—air passes through this opening to facilitate chamber of the shank and allows water to enter the
equilibration of water level. socket.

A d d i t i o n a l o p e n i n g s to t h e c h a m b e r are
p r o d u c e d b y d r i l l i n g .125 i n c h d i a m e t e r
h o l e s t h r o u g h t h e distal e n d o f t h e s o c k e t
( F i g u r e 4 ) . T h e final result is a s o c k e t in
w h i c h t h e p o s t e r i o r c h a n n e l a n d distal
o p e n i n g s e m p t y into the central c h a m b e r
of t h e s h a n k . A i r p r e s s u r e t h r o u g h t h e s e
o p e n i n g s i n c r e a s e s the rate o f w a t e r flow i n
a n d out o f the p r o s t h e s i s .

ALIGNMENT AND
FITTINGS
T h e s o c k e t is e m b e d d e d i n u r e t h a n e
f o a m a n d is a t t a c h e d to an a d j u s t a b l e
p y l o n . T h e foot is a t t a c h e d to t h e p y l o n
u s i n g a w o o d e n b l o c k as a b a s e for t h e foot
p l u g ( F i g u r e 5 ) . All a l i g n m e n t p r o c e d u r e s
are p e r f o r m e d a c c o r d i n g to e s t a b l i s h e d
techniques.
S i n c e t h e s w i m m i n g foot h a s n o c o m ­
pressible S A C H component, the patient
m a y e x p e r i e n c e i n c r e a s e d f l e x i o n at h e e l
s t r i k e . It m a y b e n e c e s s a r y to b e v e l t h e
p o s t e r i o r a s p e c t o f t h e h e e l , to a 4 5 d e g r e e
a n g l e , to h e l p r e d u c e t h i s m o m e n t . T h e
p a t i e n t w i l l adjust to t h i s s l i g h t i n c r e a s e i n
flexion at h e e l s t r i k e w h i l e w a l k i n g o n s o l i d Figure 5. The swimming socket and foot attached to
ground. W h e n ambulating on sand, or the adjustable pylon are ready for fitting.
o t h e r soft t e r r a i n , the c o m p r e s s i o n of t h e
s a n d w i l l p r o v i d e an e v e n s m o o t h e r gait
pattern.
A l i g n m e n t d u p l i c a t i o n is p e r f o r m e d
u s i n g u r e t h a n e f o a m as a s h a n k filler. S u b ­
s e q u e n t to a s e c o n d d y n a m i c a l i g n m e n t ,
t h e p r o s t h e s i s is s h a p e d a n d p r e p a r e d for
the f i n i s h i n g p r o c e s s .

FINISHING PROCESS
(BELOW KNEE)
After c o s m e t i c s h a p i n g , the toe a n d sole
p a r t s are r e m o v e d a n d t h e p r o s t h e s i s is
l a m i n a t e d w i t h p o l y e s t e r r e s i n in t w o lay­
ers o f f i b e r g l a s s s t o c k i n e t t e . T h e p r o s t h e s i s
Figure 6. Distal opening of the central chamber lo­
is t h e n r e f e r e n c e m a r k e d a n d c u t in a t r a n s ­
cated in the base of the foot, allows free flow of water
v e r s e p l a n e at t h e s h a n k . All t h e u r e t h a n e in and out of the chamber.
foam w i t h i n t h e s h a n k is r e m o v e d , t h u s
creating the central c h a m b e r . T h e two hol­
l o w e d s e c t i o n s are g l u e d t o g e t h e r a n d
s m o o t h e d for final l a m i n a t i o n . T h e final
lamination consists of three layers of nylon
stockinette saturated with polyester resin
and the appropriate pigment.
After final t r i m m i n g , the P e d i l e n foot
p a r t s are a d h e r e d to t h e b a s e o f t h e k e e l
with epoxy and covered with a swim
s n e a k e r . T h e s n e a k e r is g l u e d to t h e keel
a n d a 1.25 i n c h d i a m e t e r h o l e is drilled
t h r o u g h t h e s n e a k e r a n d foot p a r t s ( F i g u r e
6 ) . It is t h i s h o l e that b e c o m e s t h e distal
o p e n i n g of the central c h a m b e r . T h e
f i n i s h e d p r o s t h e s i s is s h o w n i n F i g u r e 7.

ABOVE KNEE PROSTHESES

T h e aforementioned techniques can b e
i n c o r p o r a t e d i n t o t h e f a b r i c a t i o n of a b o v e
knee prostheses.
T h e k n e e u n i t o f c h o i c e is t h e O t t o B o c k
3 K 5 u n i t . It is p l a s t i c , l i g h t w e i g h t , a n d
ideal for i m m e r s i o n in w a t e r w h e n t h e
m e t a l e x t e n s i o n s p r i n g is r e m o v e d . T h e
o p e n i n g s in t h e k n e e e l i m i n a t e t h e n e e d for
a posterior socket channel.
T h e foamed socket, k n e e , and water re­
p e l l e n t foot are set in b e n c h a l i g n m e n t a n d
g l u e d . T h e p r o s t h e s i s is t h e n fit a c c o r d i n g
to e s t a b l i s h e d p r a c t i c e ; h o w e v e r , t h e p a ­ Figure 7. The finished below knee swimming pros­
tient m u s t a m b u l a t e w i t h the k n e e l o c k e d . thesis.
 T h e foot p a r t s are a t t a c h e d as i n t h e
below knee. The swim sneaker is g l u e d to
t h e foot a n d t h e distal h o l e is drilled
t h r o u g h t h e s n e a k e r a n d foot parts (Fig­
ure 8 ) .

DISCUSSION
W e have used the t e c h n i q u e s outlined
for m o r e t h a n t w e l v e y e a r s . T o d a t e , w e
have followed the progress of 34 patients
wearing s w i m m i n g prostheses fabricated
as d e s c r i b e d . All t h e p a t i e n t s w e r e a b l e to
a c h i e v e t h e i r f u n c t i o n a l g o a l s , from par­
t i c i p a t i n g i n w a t e r s p o r t s to t a k i n g daily
s h o w e r s . T h e o n l y r o u t i n e s e r v i c e is a n a n ­
n u a l c h e c k u p to i n s u r e t h e i n t e g r i t y o f t h e
components.
The patients experience no significant
l i m i t a t i o n s o t h e r t h a n a s l i g h t d e c r e a s e in
simulated plantar-flexion, but they easily
a c c o m m o d a t e to it. A b o v e k n e e p a t i e n t s
are l i m i t e d to w a l k i n g w i t h t h e k n e e
locked. Long above knee residual limbs
p r e s e n t a c o s m e t i c p r o b l e m d u e to t h e d i ­
m e n s i o n s o f the 3 K 5 u n i t a n d t h e r e s u l t a n t
p r o t r u s i o n o f the k n e e .
T h e r e are great l i m i t a t i o n s o n t h e t y p e s
of c o m p o n e n t s that c a n b e i n c o r p o r a t e d
into a s w i m m i n g prosthesis. Development
of a v a r i e t y o f c o m p o n e n t s , s p e c i f i c a l l y for
r e c r e a t i o n a l p r o s t h e s e s , is n e c e s s a r y if w e
are to h e l p i n the r e h a b i l i t a t i o n o f o u r p a ­
Figure 8. The finished above knee swimming pros­ tients.
thesis.
BIBLIOGRAPHY
Kegel, B., "Prostheses and Assistive Devices for Special Activities,"
Atlas of Lower Limb Prosthetics, TheC.V.Mosby Co., St Louis
Missouri, 1981
FINISHING PROCESS Kegel, B., Webster, J.C., Burgess, E.M., "Recreational Activities of
Lower Extremity Amputees: A Survey,"Arch.Phys.Med.Rehabil.,
(ABOVE KNEE) 61(6): 258-264, 1980
Smith, J.P., "In what sports can patients with amputations and other
handicaps successfully and actively participate?" Physical Therapy,
After t h e fitting, t h e p r o s t h e s i s is s h a p e d 50(1):121- 126, 1970
a n d d i s a s s e m b l e d . T h e s h a n k p o r t i o n is
t r e a t e d as d e s c r i b e d u n d e r t h e b e l o w k n e e AUTHORS
f i n i s h i n g p r o c e s s . It is l a m i n a t e d , c u t , h o l ­ The authors may be contacted at the Orthopedic Studio, Inc., 81
lowed, and relaminated with pigment. T h e Atlantic Avenue, Brooklyn Heights, New York 11201
t h i g h s e c t i o n is h o l l o w e d to t h e distal e n d
of t h e s o c k e t .
Water enters the thigh via the o p e n i n g s
in the u p p e r portion of the k n e e . T h e
openings in the lower portion o f the knee
are t h e p r o x i m a l e n t r y to t h e distal c h a m b e r
that is c r e a t e d i n t h e s h a n k .