[AMP-L] Questions related to transtibial bursas
t-barr at t-barr.com
Wed Aug 17 10:46:19 PDT 2005
Over the last six months I have seen three patients who have developed what
has been diagnosed as a bursa on their anterior distal tibia. None of the
patients complained of any pain or discomfort while developing the the
bursa. All three patients are relatively new moderately active patients.
Two are wearing PTB sockets with Iceross comfort plus liners, the third is
wearing a PTB suction socket with an Alps cushion liner. It is particularly
odd to me that I haven't seen this ever in ten years and suddenly I have
seen it three times. Thanks for ideas or suggestions.
Todd Norton, CP, LP
Amputee list serve subscribers maybe interested in reading another patients
problems with bursas and Dr.William Ertl's explanation and possible
surgical remedies to correcting them that often times, create challenges to
a providing a proper fiting prosthesis.
As Todd eludes to in his post this is not as a rare of a problem for
amputees that some people think.
The below was taken from the "Ask The Ertls" link at
>From Kim :
Hey Dan and everyone else, I have yet another question to throw out there at
all of you experts. I had my BKA in May 2004, I am up and walking, running
and other things that I probably shouldn't do... However, I have been seeing
my ortho doc, I guess that I have developed a bursa sack at the tip of my
Tibia, at the amputation site. My doc says that I am the only person he has
ever seen that has had this happen, through thousands of amputations. Well I
guess these sacks should go away over time but mine seems to like me and
has, over time, increased to the size of a golf ball and getting bigger. So,
when you look at my leg, it looks fine , till you hit the end of the stump,
then there is this HUGE lump at the end, that is fluid filled, sounds
attractive doesn't it? Anyways, they are going to go in this Friday, 10-01,
and remove it and re sew up the muscles that have loosened because of this.
I guess what I really want to know, am I just the freak of nature that I
think I am, or has anyone else experienced this? Any help would be
A: From Dr. W.Ertl:
Kim, I am William Ertl MD, Tony Barr had forwarded you inquiry from Dan to
Jan Ertl and myself. I hope I can provide some insight into your
question(s)and others that anyone can adress to the "Ask The Ertls" link.
A bursa sac can develop over the end of a prominent object after it gets
irritated. This can occur in natural, uninjured, non-amputated joints. In
amputees, sometimes the distal end of the tibia gets very prominent,
irritated and the bodies response can be to form something, anything, to
protect that area. At times, a bursal sac will develop. This is essentially
a fluid filled area are inflammatory fluid from chronic irritation of that
area. The exact mechanism, to my knowledge, is not entirely understood. But
the end result is a frustrating situation for the patient.
A possibility of why this occurs is the chronic movement between the tibia
and fibula when these are not stabilized. Bridging the tibia and fibula can
prevent this chronic movement and hopefully diminish or remove a source of
irritation. Further, the end of the limb can now become end-bearing allowing
the amputee bear weight on the end of their limb and utilize the remainder
of their residual limb to support the prosthesis. Essentially, the
prosthesis can then become an extension of the residual limb instead of some
place to put a prosthesis.
When there are no complications, the recovery from the Ertl procedure can be
about 6-7 weeks until you get into your first socket and most likely a
prepatory prosthesis. Of course, pain can be multi-factorial, such as in
decreased bone density, neuromas, poor soft tissue balancing, etc. So the
surgeon has to be sure of all causes of pain.
I hope that this has been helpful or at least a start of answering some
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