The Importance of OOST

This blog is in response to a question I got about out of socket time (OOST) from my friend Emily, who is a fellow amputee:When I was a kid, I would put my leg on in the morning and often not take it off until shortly before bedtime. It was fairly common for me to take it off while watching tv in the evening, then hop to bed (which I don’t recommend for any amputees now that I know better), wake up the next morning & the first thing anyone heard from me was, “MOM, WHERE’S MY LEG??” My mom would usually reply with, “You left it under the couch, Emily.” I’ve always taken my leg off to sleep, and as I’ve gotten older I have grown to really appreciate more out of socket time, or OOST as Zach and I call it.

It’s probably no surprise to anyone that I’m pretty hard on my residual limb, and I always have been – from riding horses and walking around the barn for 10-12 hours a day to waiting tables and working on my “feet” for 12+ hours a day to training for triathlons, I put my residual limb though a lot. Because of this, I have to be very aware of any aches, pains, or changes to my residual limb and try not to ignore any signs of distress because I could end up at a point where I can’t wear my prosthesis and have to get back on crutches for a little while if I ignore the early signs. This is equally important whether you are an extremely active amputee or not because ignoring signs always carries the potential to lead to bigger issues with sores getting infected or nerves getting very angry, among other issues.

Unfortunately, I learned this lesson the hard way. When I was in my teens, I could ignore this stuff and bounce back from it fairly quickly. I remember one year after the annual horse show I helped organize and run when my residual limb was a total wreck following the event, and I had to stay out of my leg to give it time to heal. But, 3 or so days later I was back to normal and so I didn’t learn my lesson back then…

Fast forward to late 2010/early 2011 when I was in my 20’s and started having some pain on the lateral side of my residual limb. It started out as a nagging pain I hadn’t had before, then I would randomly feel like I was getting volts of electricity up my leg, and eventually these were so painful that I would have to stop and sit down for a while if it happened while I was walking. I finally saw a doctor (actually I had to go through a few doctors because many have never seen someone with fibular hemimelia before and just wanted me to teach them about it rather than actually helping me), and it was determined that I had a neuroma towards the bottom of my residual limb on the lateral side that was causing the shooting electric pain up my entire body. In March of 2011, I went in for a revision surgery to have the neuroma removed and some bone shaved down. I was out of my leg and on crutches for a good 2 months or so, and then had to walk with crutches or a cane for a few more months after that. It feels like it took a couple years after that to get back to where I was before the surgery as far as comfort goes, so it was a pretty long haul.

Following that experience, I have been way more cognizant of any differences I feel in my limb, and I also try to get a few hours of OOST every day before going to bed. This, to me, feels like a preventative measure so I can avoid major issues like I went through 7 years ago. I don’t always get as much OOST as I’d like because of events that throw off my schedule, but my standard practice is to take my leg off after I’m finished with any after-work choses that are easier to accomplish with my leg on (like making dinner). I also make sure to give my leg a few extra hours of OOST on the weekends when it’s possible.

The exact amount of time you can healthily stand in your leg is going to be different for everyone, so what it really comes down to is listening to your body and not ignoring the beginning signs of distress. However, just because you do this doesn’t mean your body is going to cooperate, so you may still have to deal with injuries or sores or other issues. That said, I still think it’s smart to do all you can to avoid major setbacks. A proactive measure like OOST is at least a step you can take to try to improve your overall health and wellness.

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