# Lower Limb Amputee



## HobbesChoice (12 Aug 2009)

Hi there!
My Dad recently lost his lower leg just below the knee due to having diabetes and breaking his ankle in a fall  He now has a brand new prosthesis though and is anxious to get back on the bike. His physio and prostheic fitter have both told him to fit a smaller pedal crank to his bike as the prosthesis prevents his leg coming all the way up (it digs too far into the back of his knee).
I've googled various terms for amputee pedals and cranks etc but the only thing I can find is they say to attach the false foot to the pedal in some way (ie. velcro, toe clips etc). Nothing about changing the pedal crank. But he really can't raise his knee high enough for the upward pedalling action, so would any of you know anything about this by any chance please?
Many thanks!


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## PK99 (12 Aug 2009)

Not the answer you are looking for, but there is a guy who cycles in Richmond park regularly (at a good pace!) who has a lower leg stainless steel prosthesis - may be an alternative falsie is the route?


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## Bigtwin (12 Aug 2009)

Not specificially, but. Which side are we talking? If non-drive, just fit a shorter crank.

If drive side, then a flattish crank arm should be capable of being shortened by drilling a new hole and tapping the thread - any engineering shop will do that no problem if you don't fancy it yourself. So you may need to buy a new spider depending on what shape he currently has.

See here too: http://mnhpva.org/Meetings/July_02/Short.html

http://bikesmithdesign.com/Short_Cranks/m440.html

and: http://www.bentrideronline.com/messageboard/showthread.php?p=422149


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## ACS (12 Aug 2009)

Again not a direct answer but I met up with a rider over the weekend who had stainless steel prosthesis (drive side). By his turn of speed on the hills his set up certainly worked for him. 

Try this link


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## Chrisz (12 Aug 2009)

Not a clue but you could try getting in touch with Hadley Court - I know there are several guys there who have similar problems (I've cycled with them) and someone may be able to provide some advice.


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## HobbesChoice (12 Aug 2009)

You've all been really helpful. Thank you so much.

Bigtwin - he was told that the short crank was the way to go but I couldn't find any information so thank you for the links. 

I think I'll also contact Hadley Court - thanks Chrisz because this is completely new to him so any advice would be very well received.


He has his prothesis on his non-drive size by the way.


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## Will1985 (12 Aug 2009)

Alex Simmons is the person to talk to about this - he's on TTF and BR. He's an Australian cyclist and coach who uses a lower leg prosthesis following a freak cycling accident a few years ago. His blog might be helpful - it is for power training!.

Btw, it's DMRC Headley Court, not Hadley.


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## Paul_iow (12 Aug 2009)

Can your dad raise his sadle at all? By having it higher his leg would bend at a lesser angle so the prosthesis would not dig in as much.

Also is there any possibility of your dad having another limb made with a clipless pedal attachment (cleat? not sure what the right bit is) in it? This could then be clipped into the pedal as "normal".


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## palinurus (12 Aug 2009)

I've seen a crank arrangement designed for riders with limited leg movement recently. Can't find the particular site where I saw it but I did find these (which are similar)

MTB Mods for Leg Amputees

Hinged Crankarm

http://www.oandp.org/jpo/library/2005_01_035.asp


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## MichaelM (12 Aug 2009)

Headley


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## HobbesChoice (13 Aug 2009)

Hi Paul iow - Thanks for the idea, but if he raises his saddle for his bad leg then the good leg will be a bit out of synch for pedalling. We can get a cleat shoe for his false foot, that's not much of a problem and we'll be doing this once he's got the balance right on the bike, but to start with he needs to feel he can get his false foot off quickly and easily. I think we'll just do a velcro patch up to keep the foot stable on the pedal initially as it won't take him long to gain enough confidence I shouldn't think.

Those links are helpful, thanks Paulinurus.


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## HobbesChoice (13 Aug 2009)

MichaelM said:


> Headley



Thank you MichaelM. I'll contact them.


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## peanut (13 Aug 2009)

sounds to me like the prothesis needs to be adapted for cycling. post operative exercise is very important and if the prothesis prevents cycling it cannot have been made with exercise in mind. 

I have to say though I wouldn't have thought that the thigh would come anywhere near horizontal if the saddle is set up correctly. 

I would suggest your Dad asks to be referred to a Physio specialist . Can't believe this problem hasn't been solved before


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## HobbesChoice (14 Aug 2009)

Thanks Peanut. My Dad sees a physio twice a week and apparently it's normal for a lower limb prosthesis to have cycle issues as the NHS have provided a "standard" lower limb which, although can be used for cycling it's primarily focus is on walking and will need some adjustments on the bike too. I've spoken to quite a few sources now and most aren't surprised that a short crank needs to be fitted to the bike to allow for the minimised movement. 

I believe he also has to have a few adjustments made on the prosthesis over a period of time to ensure it's a perfect fit for him which is quite normal and I do think one of the adjustments will be because it touches/rubs the back of the knee just on walking!

You've noted on your weight loss list that you'll have to cut something off after your last weigh in? - just the lower leg itself is about half a stone if that helps???


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## peanut (14 Aug 2009)

HobbesChoice said:


> Thanks Peanut. My Dad sees a physio twice a week and apparently it's normal for a lower limb prosthesis to have cycle issues as the NHS have provided a "standard" lower limb which, although can be used for cycling it's primarily focus is on walking and will need some adjustments on the bike too. I've spoken to quite a few sources now and most aren't surprised that a short crank needs to be fitted to the bike to allow for the minimised movement.
> 
> I believe he also has to have a few adjustments made on the prosthesis over a period of time to ensure it's a perfect fit for him which is quite normal and I do think one of the adjustments will be because it touches/rubs the back of the knee just on walking!
> 
> You've noted on your weight loss list that you'll have to cut something off after your last weigh in? - just the lower leg itself is about half a stone if that helps??? B)



sounds like the prosthesis is going to require some surgery  I can see the problem. If you make the prosthesis suitable for walking and carrying weight it won't be suitable for cycling and visa versa.
Sounds like it really needs a different attachment or adjustment that will allow a fuller movement of the joint.

I think putting a smaller crank on is a real poor option to be avoided if possible. Your Dad is going to be lop sided in the pedalling motion and forever stuck with only one bike he can use.

Far better if possible to use a standard set of cranks and change the pedals. Then your Dad can simply transfer the pedals to use any bike he wants to.

By the way you cannot drill and thread cranks there isn't enough metal on the arm of any crank and it would fail. It would need to be specially made


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## peanut (14 Aug 2009)

I've just thought of something. Surely there will need to be an adjustable lock on the prosthesis for when your Dad sits down ? otherwise his leg will be stuck out straight. 
If the unlocking feature could be made to stay in that position on the bike it might be easier to cycle. 

If the saddle is set at the right height your Dads knee shouldn't come up very high anyway


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## HobbesChoice (14 Aug 2009)

When he sits down at the moment he does generally rest the leg straight out, but as it's new he takes it off whenever he can but you're right, it's not comfortable at all when he's sitting in his wheelchair and can't straighten his leg out. Ideally he wants to be wearing it when he's out in the chair as so many people stare and children make very innocent, sometimes funny but often embarrassing observations at the lack of shin and foot. Wearing the leg in the chair will prevent that hopefully.

To be honest, the more I think about it the more I think his leg is too long for him, but you do hope they know what they're doing as this is our first experience but hopefully not theirs.

Comparing cycling to sitting I would hope sitting would be a fair bit easier though as it would remain in one place most of the time other than the normal comfort movements at times. But cycling will be more of a grinding action? I say this but haven't really got a decent idea of the whole logistic thing. I'm seeing him again tomorrow so I'll have a better look at what's going on with normal wear and sitting.


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## peanut (14 Aug 2009)

what part of his leg was amputated ? is it below or above the knee ?

you might want to look at this site 
http://www.amputee-online.com/amputee/onyerbike.html

and this
http://www.onelegtim.com/bicycle.html


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## kyuss (18 Aug 2009)

peanut said:


> By the way you cannot drill and thread cranks there isn't enough metal on the arm of any crank and it would fail. It would need to be specially made



Really? Highpath Engineering amongst others would beg to differ. Crank shortening services have been offered for years.

HobbesChoice, you might want to take a look at this which seems to offer shorter pedal position without wrecking a good crank, though it would affect the Q factor.

Personally I agree with Peanut that this should really be sorted with a prosthesis that at least fits properly, if not one specifically designed for the job. I'm guessing it's early days but don't let them fob you off with a plastic peg leg, keep pushing for something fit for purpose. If cycling is such a big part of your fathers life it needs to be taken seriously when considering the best prosthesis for his needs.


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## HobbesChoice (19 Aug 2009)

That's a great link for the shorter pedal, thanks Kyuss!

He had a below the knee amputation in June and got his own leg the beginning of last week so it is early days but I think he needs the prosthesis to go up quite high for balancing him better when he walks, although that is just my speculation.

I think I'll go to the next appointment with him to find out more from the physio and prosthesis maker because he doesn't really know what to ask and doesn't like to "be a nuisance". Thanks again.


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## Jonathan M (19 Aug 2009)

HobbesChoice said:


> Hi Paul iow - Thanks for the idea, but if he raises his saddle for his bad leg then the good leg will be a bit out of synch for pedalling. *We can get a cleat shoe for his false foot*, that's not much of a problem and we'll be doing this once he's got the balance right on the bike, but to start with he needs to feel he can get his false foot off quickly and easily. I think we'll just do a velcro patch up to keep the foot stable on the pedal initially as it won't take him long to gain enough confidence I shouldn't think.
> 
> Those links are helpful, thanks Paulinurus.



Could a spacer between the cleat & shoe sole be an acceptable way forward? 

Only thinking of this becuase then he could fine tune the thickess of the spacer to suit, rather than being stuck with a 165 mm crank as example.


Forget this, I've thouight about it and using a spacer between cleat & shoe and when the crank is vertical this would most likely worsen the problem by causing your dad's knee to be more bent.


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## amrushton (20 Aug 2009)

Longstaff Cycles in Staffs used or may still do specialist help in regarding cranks for people who have difficulties like this.


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## allen-uk (16 Sep 2009)

Have a look at this thread

http://amputees.proboards.com/index.cgi?board=ars&action=display&thread=41

on the amputee board I use. It is a discussion of all you need to do to bikes to make them rideable by amputees, including where to get the bits. I'm a bka myself.


Allen.


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## Jonathan M (16 Sep 2009)

allen-uk said:


> Have a look at this thread
> 
> http://amputees.proboards.com/index.cgi?board=ars&action=display&thread=41
> 
> ...



Good link Allen, hopefully the OP will get the assistance that he is after from that forum.


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