Frequently Asked Questions
The are many questions you undoubtedly have about prosthetic and orthotic services. And we're happy to answer them. Some of the questions that are most commonly asked of our team are provided here.
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How do I make an appointment?
Call our office at (707) 765-1122, (707) 499-1122 or (866) 294-LEGS (5347). Our office staff will review our schedule at each of our locations with you. We are available for consultations in Petaluma, Santa Rosa and Kentfield on different days of the week.
Will you come to my home for an appointment?
We prefer to see our patients in one of our three offices, in Petaluma, Santa Rosa or Kentfield, where we have the proper tools and machinery for casting and the adjustment of your device. However, we will do in home consultations for patients who are homebound and do not have the ability to come to our office. In these circumstances, an additional travel fee will be incurred.
Who will I see at my appointment?
You will be seen by Drew Hittenberger. Drew is highly qualified and certified in the areas of orthotic and prosthetic design and care.
What do I need to bring with me to an appointment?
Please bring all insurance information, x-rays, shoes, past orthotic and prosthetic devices and other medical correspondence that may pertain to your condition so that we can determine the best possible treatment and device for your needs.
Do I need to see a doctor before an orthotic and prosthetic consultation?
No, you do not have to see a doctor, however, it is highly recommended. During your initial visit with Drew, you will be evaluated, your goals will be established and the type of device will be recommended. Drew prefers to consult with your physician before, during and after working with you to ensure the best possible care.
Do I need a prescription to see you?
You do not need a prescription to see us for an initial evaluation. However, your health insurance plan does require a prescription from the referring provider before they will cover a particular device. In certain circumstances, we may need to consult with you in order to determine how your physician writes your prescription.
Does insurance cover orthotic and prosthetic services?
Most insurance companies do cover orthotic and prosthetic services. The types of services they cover and the amount depends on your insurance coverage. We recommend that you contact your insurance company prior to your appointment with us and ask them to explain your orthotic and prosthetic coverage and benefits.
We also will contact your insurance company with our notes along with your prescription to determine your coverage and make you aware of the charges up front. 50% of the amount not covered by the insurance company will be requested during your initial visit and the remaining 50% will be due at your delivery appointment.
What insurances do you accept?
For a specific listing of our contacted insurance companies, please refer to the “Patients – Insurance” section of this website.
How long does it take to make a particular device?
The type of device needed and its design dictates the number of appointments needed. A minimum of three appointments are generally needed for a custom device, for evaluation, casting, fitting, delivery and follow up. Your practitioner can provide you with a more accurate time frame during your initial consultation.
What are Drew Hittenberger’s qualifications?
Drew Hittenberger is certified in orthotics and prosthetics. He has been in the profession in 1974 and established his office in Sonoma County in1989. He is a fourth generation orthotist and prosthetist. His great-grandfather started a practice in 1902 in San Francisco, and his grandfather and father followed in the tradition. For a Drew's full credentials, click here.
How common are amputations?
Amputations are more common than most people realize. According to the National Limb Loss Coalition, there are approximately 1.7 million people with limb loss in the United States.
Further, it is estimated that one out of 200 people in the U.S. has had an amputation. Between 1988 and 1996 an average of 134,000 patients were discharged from hospitals due to amputation. Dysvascular amputations, or problems associated with blood vessels, accounted for 82% of the amputation. However, due to advancements in prosthetic treatment, most prostheses are undetectable.
Do I wear it to sleep?
Prosthetics are designed to be worn during the day and removed while sleeping. We recommend that you wear a “shrinker” on your residual limb at night to maintain the shape and configuration and help reduce edema and swelling of the residual limb. We also recommend that you apply creams to the skin during the evening.
Can I wear my prosthesis with different shoes?
Your prosthesis is aligned for a particular type of shoe and heel height. The alignment of the prosthesis affects its stability and the ease of taking steps. We can incorporate a special foot, with an adjustment mechanism, for patients who would like to wear different heel heights.
How often should my prosthesis be checked?
We recommend having your prosthesis checked at least once a week following the initial delivery. As your skin becomes used to the pressure and you are more comfortable wearing it, you can have it checked less frequently.
We also recommend that you initially check your skin several times a day for redness and pressure, and contact us immediately if you experience any changes in your skin condition and/or discomfort. Once you are comfortable with your prosthesis, we recommend check-ups every six months, to make sure the liners, alignment and socket materials are fitting well and the prosthesis is performing to the maximum level.
How are they made?
Before we make your prosthesis, we will evaluate you and cast your residual limb, taking a mold of your extremity. We use the mold to fabricate a check socket, which is a clear socket that we fit to you so that we can see the fit. When you stand on the check socket we can also see the pressure points. Once we know that the socket fits well, we transfer that shape into a laminated or plastic type socket that will be incorporated into your prosthesis. We then add that socket to particular components to design your prosthesis.
How heavy are prostheses?
Below-the-knee prostheses will weigh between 2 – 5 pounds, depending on the type of components and liners used. An above-the-knee prosthesis can weigh up to 15 pounds depending on the type of components that are used.
Does this correlate with the amount of weight that was removed during the amputation?
No, it does not. We attempt to make the prosthesis as light as possible so that it is more comfortable to wear and require less energy to use.
What types of activities can I perform with my prosthesis?
Different prostheses are designed for different types of activities. For the most part, people sit, stand and walk with their prosthesis, and your initial prosthesis will be designed for those purposes. Special prostheses can also be designed for specific activities. Different components can be used in prostheses for patients who want to run, participate in water sports, ski or most other activities a patient with an active lifestyle would like to participate in.
How are prostheses applied?
Most prostheses are applied by hand. They incorporate a sock that goes next to your skin with a liner over the top that is slid into the prosthesis. Either a sleeve is added to the outside or a suction flexible silicone liner is rolled over the skin and incorporates a lock or pin along the very bottom of the skin that slides into the socket and mechanically attaches and holds it in place. Various types of other mechanical straps, sleeves or suction mechanisms can be added to the prosthesis to hold it in place. The better the prosthesis is held to your skin, the less pistoning and skin irritation you will experience.
How will I know if it is fitting correctly?
We spend considerable time making sure that the prosthesis fits well. It is important that the socket is comfortable and applies consistent pressure over the entire residual limb. We also try to align the prosthesis so that as you take a step, it lands smoothly and you roll over the prosthesis with minimal effort. The fit of the prosthesis may change over the time as your residual limb increases and decreases in size. Thus, the fit and performance of your prosthesis is largely dictated by the stability of your residual limb and your activity level. Like a pair of shoes, you will know how tight it should be, when it is causing irritation and when it is performing well. We also recommend that you regularly inspect your skin for redness and irritation.
Can the prosthesis be used in the shower or water?
Most prostheses cannot be used in the shower because they contain metal components that will rust. However, we can design prostheses that are made out of fiberglass and/or plastic components if you need to use them to be waterproof.
Will I need physical therapy?
Although physical therapy is not required, we do recommend it after you receive your initial prosthesis. A physical therapist can help you learn to walk efficiently with your new limb and expedite the rehabilitation. The physical therapist will work with you on maintaining your balance, strengthening your limb and improving your gait pattern. We also recommend physical therapy if your condition changes and/or you obtain a new prosthesis.
How long will my prosthesis last?
Your final prosthesis usually lasts an average of five years depending on your age and activity level. Typically, the younger and more active you are, shorter the life span of your prosthesis. Medicare generally allows a prosthetic replacement every five years. However, if the patient’s condition changes their activities or there are changes in the physical condition of an amputee, the prostheses can be replaced sooner.
How soon after an amputation can I expect to be fit with a prosthesis?
Your residual limb must be completely healed prior to prior to being fit with your prosthesis. We suggest that you be fit with a “shrinker” as soon as it can be tolerated. A prosthetic shrinker is an elastic sock that fits around your residual limb and helps decrease the edema or swelling of your leg in preparation of prosthetic fitting. Once we can fit you with the prosthesis, it will take between 2 and 6 weeks to fabricate.
How much does a prosthesis cost?
Below-the-knee prostheses range in price between $5,000 and $20,000, and above-the-knee prostheses range between $10,000 and $60,000, depending on the types of components that are used. The cost of your prosthesis will depend heavily on the type of socket, liner materials, configuration of your residual limb and the components. We will work with you on these items during the design phase in order to provide you with a better estimate.
Can I drive while wearing my prosthesis?
Although some amputees drive with a prosthesis, it requires considerable caution. The ankle of your prosthesis will not flex up and down like it normally does, so the movement of your foot will need to be controlled by motion of your entire leg rather than your ankle. You will also have a hard time determining how hard either an accelerator or brake pedal is being depressed and moving your foot from one pedal to another. We recommend that you contact the DMV if in question and/or physician for particular details.
What will my prosthesis look like?
Prostheses can either look like an anatomical leg or it can be designed as an expression of your personality. We often design prostheses with cosmetic covers or soft covers that go over the socket, mid-calf, knee, thigh area and foot so they look anatomically correct or alternatively with a design of our patient’s choosing. Here are a few examples of specially designed prostheses.
Where can I get information regarding prosthetics?
We will answer all of your questions about prosthetics while working with you on your specific device. During the design phase, we will discuss the various sockets, liners, knees and feet available. We can also have you talk to different patients about their prosthetics. We also have links to organizations that may be of interest in the Resources section of this website.
How long will it take for me to learn to use my prosthesis?
Most people who go to physical therapy, will become proficient with their prosthesis within about two months.
Do prostheses have toes?
Yes. Prostheses usually have toes. Recently there have been a number of advances in prosthetic components that allow the incorporation of toes and/or split toes between the great toe and other toes so that sandals can be worn.
Do prostheses move at the ankle?
No, most prostheses do not move at the ankle. They incorporate a keel or a special foot mechanism that deflects as you step forward on the prosthesis so that it does not move as much as a real foot. However, as you step over the prosthesis it provides you with more stability which makes it easier to walk on, thus improving your walking stability.
How do I clean the prosthesis?
Hygiene is very important in prosthetic care, particularly against the skin. We suggest that you wash your skin daily with soap and water. Depending on your skin sensitivity, we also suggest that you use rubbing alcohol to decrease any bacteria formation. You should wash the liner and suspension sleeve of your prosthesis daily to decrease accumulation of bacteria, which can cause infections.