The Prosthetics & Orthotics Service located within the Foot Care & Limb Design Centre provides orthotic and prosthetic services to patients. Our specialised Workshop enables on-site fabrication and fitting of customised prostheses and orthoses.
We attend primarily to both inpatients and outpatients at TTSH. We also provide inpatient services at TTSH Rehabilitation Centre @ THKH and outpatient paediatric services at KK Women’s and Children’s Hospital. Outpatients at TTSH are seen at the Foot Care & Limb Design Centre and in the Orthopaedic Clinic located at Clinic B1B. Services provided by our department include the assessment, prescription, measurement, fabrication and fitting of orthoses, prostheses, and custom-made shoes.
Our Prosthetists/Orthotists are all certified Category 1 International Society of Prosthetic & Orthotics (ISPO) status. They are supported by a highly specialized team of Technicians who perform the fabrication work for customised prostheses and orthoses. Foot Care & Limb Design Centre is certified with “Good Distribution Practice for Medical Devices (GDPMDS) – Import, Storage, Distribution, Installation and Servicing of Technical Aids for the Disabled Persons” This ensures that the prosthetics and orthotics we manufacture complies with mandatory quality standards.
How is Amputee Clinic run?
Amputee Clinic occurs every Wednesday morning at the Foot Care & Limb Design Centre (FLC). The clinic is run by a Rehabilitation Physician, Prosthetist/Orthotist, Podiatrist, Physiotherapist and Medical Social Worker. Consultation is strictly by appointment only. For first visit patients, you would need a referral letter from your doctor.
Who is seen at Amputee Clinic?
Both first-time and follow-up patients are seen at our clinic. Patients here for the first time are assessed to determine their medical, functional, social and financial abilities to warrant the prescription of a prosthesis. Follow-up cases are reviewed by the rehabilitation team in order to check the fit, function and maintenance of the prosthesis.
Once the multi-disciplinary team has assessed you, they will discuss a suitable level of prostheses for your needs. Our Medical Social Worker will conduct a means-testing screening if you have any financial difficulties in paying for your prosthetic limb.
Once funding is secure, your Prosthetist/Orthotist will take a cast of your stump. You will then return on a different day to be test-fitted with a socket. Depending on the fit, you may need to return again for another test-fit session before our Prosthetist / Orthotist and our Technician starts to fabricate your final prosthesis.
During this period, you would begin your physiotherapy sessions at FLC. For lower limb amputation, the session includes walking activity using a Pneumatic Post-Amputation Mobility Aid (PPAM). This device is designed for partial weight-bearing during rehabilitation. It will help to reduce the swelling in your residual limb, prepare your residual limb to eventually take on the hard socket of your prostheses and re-educate postural corrections during walking and standing.
Once your prosthesis has been fabricated, you will be fitted by your Prosthetist / Orthotist. Your Prosthetist/Orthotist will work closely with your Physiotherapists to make any necessary adjustments to your prosthesis during the next stage of your rehabilitation which is walking with your new prosthetic limb.
Your entire rehabilitation journey may take as long as 6 to 12 months depending on each individual functional abilities as well as goals.
Binedell T (2016): Prosthetic use and user satisfaction following lower extremity amputation in Singapore, proceedings from ISPO European Congress on Prosthetics & Orthotics, Oct 6-8, Rotterdam, Netherlands and proceedings from Asian Prosthetic & Orthotic Scientific Meeting, Nov 4-6, Seoul,Korea.
Lai SE, Anuar K (2016): Economic cost of transfemoral and transtibial amputee patients in Singapore requiring outpatient prosthetic care and rehabilitation: A retrospective study one year post-amputation, Ann Acad Med, Sept 45 Suppl(9): S368.
Wong XQ, Tan ZY (2014): Multi-disciplinary collaboration to facilitate early delivery of prosthesis for high level below knee amputation patients in Foot Care & Limb Design Centre: A Quality Improvement Project. Proceedings from Singapore International Physiotherapy Congress, 3-4 May, Singapore.
What is an orthosis?
An orthosis (brace) is a supportive device that helps to:
- control biomechanical alignment
- prevent injury
- provides support following injury
- assist in rehabilitation
- reduce pain
- increase mobility and independence
Orthoses can be either pre-fabricated or custom-made to suit the patient’s requirements.
What kind of orthoses do you offer?
We specialise in the custom measuring and fitting of:
- foot orthoses
- ankle foot orthoses (AFO)
- knee orthoses
- knee-ankle-foot orthoses (KAFO)
- fracture orthoses
- spinal orthoses
- cranial helmets
- sports orthoses
Who needs an orthosis?
Common problems prescribed where patients may need an orthoses include:
- drop foot following a stroke
- for management of polio
- fracture management
- muscle weakness
- scoliosis of the spine
- deformities of the head eg. Plagiocephaly in babies
- sports related ankle and knee injuries
- chronic wounds and deformities of the diabetic foot
How are the customized orthotics made?
Your Prosthetist/Orthotist will first take a cast, a scan or a measurement of your affected body part depending on the type of orthosis required. You will then be scheduled to come back another day while the cast, scanned image or measurement are brought back to our Workshop to fabricate your orthotics.
For cast, the mould will first be modified by hand and file by your Prosthetist/Orthotist according to your anatomical landmarks, requirements and specially identified areas. This modification process is done on our Computer Aided Design (CAD) software for the scanned image or measurements for specific orthotics. Our Computer Assisted Manufacture (CAM) machine will carve out the mould. The moulds are used as a reference whereby Additive Manufacturing is performed through a series of vacuum draping of plastic materials, grinding, adding of buckles, straps etc.
How long must I wear my orthotics?
Your Prosthetist/Orthotist will advise you on the frequency, duration and length of time you would need to use your orthotics. You will also be taught on how to don on and don off the orthotics correctly, how to check for pressure spots and care of your orthotics.
Murakami T, Cheung B, Ho MWM, Sani F, Anuar K (2016): Development of an algorithm to aid clinical decisions for offloading of plantar forefoot ulcers and Charcot deformities, Ann Acad Med, Sept 45 Suppl(9): S99.
Murakami T, Nagai R (2015): Cranial outcomes in the orthotic management of deformational plagiocephaly. Ann Acad Med, Oct 44 Suppl(10): S77.
Murakami T, Nagai R, Anuar K (2016): How effective is cranial orthotics in the management of deformational plagiocephaly and is visual screening sufficient in determining its need? Proceedings from 5th Singapore Paediatric and Perinatal Annual Congress, 21-23 Oct, Singapore.
Quake T (2016): Effectiveness of customized scoliosis bracing in improving in-brace corrections for adolescents with idiopathic scoliosis, Ann Acad Med, Sept 45 Suppl(9): S107.
What does “prosthetics” mean?
The term prosthetics refers to the design, fabrication and fitting of custom-made artificial limbs.
Prosthetic needs arise from amputation due to:
- Disease (diabetes, Peripheral Vascular Disease, tumours)
- Traumatic injury
- Congenital deformity
What is a prosthetic limb?
Prosthetic limbs restore, as completely as possible, the function and appearance of a full or partially missing limb.
Fabricating prostheses is an intricate procedure requiring a high degree of skill and technology.
The prosthetic design is determined by our Prosthetist/Orthotist after considering the patient’s physical condition, activity level and functional needs.
How often do I need to change my prosthesis?
Amputees generally require a new prosthesis every 3 years. Children, due to rapid growth rates, need replacement on a more regular basis. Prosthetic adjustments, repairs, re-alignment, and componentry upgrading are also aspects of ongoing care that are carried out at our department.
For a first time lower limb amputee, it is expected for your socket to be replaced after 6 to 18 months. During this time, your residual limb will change in shape and size causing the socket to become loose and uncomfortable. This is a natural part of your healing process. It is unpredictable and will occur differently for all amputees. Depending on the condition, the socket can be replaced while re-using the remaining parts of the prosthesis.
What kind of prostheses do you make?
We specialise in fabricating prostheses for:
- Below knee amputations
- Above knee amputations
- Through knee amputations
- Hip disarticulations
- Upper limb amputations and myo-electrics