An orthosis designed at San Antonio's Brooke Army Medical Center provides a spring-like motion
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The practice of limb salvage isn't confined to military hospitals. Because of greater use of seat belts and air bags, more people are surviving car wrecks with more-severe limb trauma, says Dr. Andrew Pollak, president of the Orthopaedic Trauma Association. Typically, he says, if a patient makes it through the first night without needing an amputation, he or she gets to choose whether to try to salvage the limb. "You begin a very difficult series of conversations with the patient and the family about what those two paths look like," says Pollak, who is also an orthopedics professor at the University of Maryland Medical Center. "Someone who works as an accountant in a chair in an office has dramatically different demands than someone who was in construction before and will be up on his feet all day long walking around. The accountant may be able to tolerate ongoing operations--and an inability to walk--and still do his job. The guy in construction may say, 'I simply can't put food on the table that way. I need an amputation so I can get a prosthesis and get back to work.'"
It sounds counterintuitive: cut off a leg to increase mobility. But it speaks to the advances in prosthetics technology over the past two decades. Many troops requested amputations so they could get a prosthesis nicknamed a cheetah leg, a curved carbon-fiber blade invented in 1984 and made famous in recent years by Oscar Pistorius, the South African double amputee who is one race away from qualifying to compete in the London Olympics.
For wounded troops, a severe injury can be a ticket out of the military. But for some limb-salvage patients who want to return to service, cheetah legs start to look pretty attractive as the months of rehab drag on.
"The reason why we had all these guys who wanted their legs cut off was that they wanted to run," says Johnny Owens, a physical therapist who is the director of limb-salvage rehab at BAMC. For high-performing troops, running separates those who can do their jobs from those who can't. On any given day at BAMC, dozens of amputees can be seen jogging on cheetah legs along the palm-tree-lined streets. As part of their recovery, many are training for triathlons and other endurance races.
In 2009, Owens and other specialists at BAMC noticed that an alarming number of patients were coming to the center asking for a "late" amputation--i.e., one performed months or even years after the injury. Most had conditions such as fused ankles and severe nerve and muscle damage that made it hard to walk, let alone jog. Their requests led Ryan Blanck, a prosthetist at BAMC, to design the IDEO. It fits into a patient's shoe and runs a carbon-fiber strut up the calf to a cuff that attaches just below the knee, acting as a cheetah-like springboard for an ankle that can't flex and muscles that no longer exist.
Once a patient gets this custom-made orthosis, he--almost all of the limb-salvage patients at BAMC are men--walks over to the rehab gym, where Owens mixes sports-medicine techniques into the regimen, teaching guys to run by landing midfoot instead of on their heels, using the same barefoot running style that's becoming popular even among noninjured runners. The result: patients who were in such pain that they could barely walk 10 ft. are, within a week of starting special training, jumping and sprinting.