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Technical Note: An Economical Cosmetic Covering for Preparatory Prostheses

Kuiken, Todd A. MD, PhD; Soltys, Nicole T. CP

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JPO Journal of Prosthetics and Orthotics: April 2007 - Volume 19 - Issue 2 - p 37-39
doi: 10.1097/JPO.0b013e3180421318
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A person with lower-limb loss is usually first fit with an endoskeletal preparatory prosthesis. This prosthesis is intended to be a simple, adjustable, and functional limb that the amputee can use for a few months as the residual limb shrinks and matures. Because preparatory prostheses are intended to be temporary, low-cost devices, most third party payers do not reimburse for cosmetic coverings. Even with definitive prostheses, prosthetists often delay applying a custom covering until all adjustments are completed. Therefore, the preparatory prosthesis and its successor, for a brief time, consist of a socket connected to a foot by a pipe (Figure 1). The endoskeletal pylon is thin and will not accommodate a sock. When the amputee walks, long pants sway and fold around the distal pylon, revealing the top of the prosthetic foot and the absence of an anatomical leg. When the amputee sits, more components are exposed. Preparatory prostheses, by definition, look artificial and can be visually unappealing.

Figure 1.
Figure 1.:
A preparatory transtibial prosthesis with no cosmetic covering.

The fitting of a preparatory prosthesis occurs early after the amputation when the patient is still coping with the loss of his or her natural limb and struggling with body image issues.1 The artificial, unappealing look of the preparatory prosthesis is a disappointment for many and may significantly impede the amputee’s adjustment to the loss of a limb. Correlations between body image and psychological well-being have been documented.1–3 Williamson4 found that older amputees who were self-conscious in public situations were significantly less active. Breakey5 and Rybarczyk et al.6 describe the concept of stigma, an attribute that makes a person different from others and therefore less desirable. Others’ reactions to a newly disabled individual may influence how the individual perceives him- or herself. When amputees interpret reactions by others as negative, they may view themselves as deformed, incompetent, and inferior. Passero and Doolan7 suggest that a patient may adjust more rapidly if initially provided with a prosthesis that mimics the appearance of the lost limb. Poor cosmesis may increase self-consciousness and thus impede an amputee’s functional recovery.

Limb loss patients frequently indicate that the poor cosmesis of preparatory prostheses is a significant problem. A simple and inexpensive solution to this problem is readily available.

We recommend using polyethylene foam tubing as an economical, lightweight cosmetic covering for preparatory prostheses. The tubing may also be used as a temporary covering on definitive lower-limb prostheses before the custom- shaped foam cover is fabricated. Polyethylene foam tubing is inexpensive, lightweight (generally weighing less than 100 grams per meter or 1 ounce per foot), and comes in a variety of sizes. It is categorized by inner diameter and wall thickness (Figure 2). We recommend using 35-mm (1 3/8-inch) inside diameter, which allows the tubing to fit nicely over the endoskeletal pylon fittings. For average size limbs, 13-mm (1/2-inch) foam tubing works best to match the size of the ankle. For larger limbs, 20-mm (3/4-inch) tubing can be used. Polyethylene foam tubing is readily available in white or dark gray; the color is not particularly important because the tubing can easily be covered with a cosmetic prosthetic sock, regular socks or a few layers of nylons. The foam has a slightly irregular surface, which provides sufficient friction to hold socks in place. The foam is held in place around the endoskeletal pylon with a piece of tape at either end. This foam tubing can be sanded or ground to customize the shape of the covering. Polyethylene foam tubing is most commonly used as pipe insulation. It is readily available at most plumbing supply stores and many home improvement centers. Self-sealing foam tubing is available at a slightly higher cost.

Figure 2.
Figure 2.:
Polyethylene foam tubing. Left to Right: 35-mm (1 3/8-inch) ID, 13-mm (1/2-inch) wall thickness, white; 35-mm (1 3/8-inch) ID, 20-mm (1/2-inch) wall thickness, gray; 35-mm (1 3/8-inch), 13-mm (3/4-inch) wall thickness, gray; 35-mm (1 3/8-inch) ID, 13-mm (1/2-inch) wall thickness, beige.

The application of this foam tubing can significantly improve the appearance of an endoskeletal transtibial prosthesis (Figure 3). Foam tubing can also be used on transfemoral prostheses (Figure 4), with one piece between the foot and knee and a second piece between the socket and knee. The tubing is applied quickly and easily and can be removed and replaced for prosthetic adjustments. Our patients have been very receptive of this technique and have appreciated the improvement in the appearance of their artificial limbs. There have been no complications from the use of the foam tubing, and it has not interfered with any component.

Figure 3.
Figure 3.:
A preparatory transtibial prosthesis with polyethylene foam tubing placed around the endoskeletal pylon as a cosmetic covering.
Figure 4.
Figure 4.:
A preparatory transfemoral prosthesis with polyethylene foam tubing placed around the endoskeletal pylon above and below the knee unit.

The use of polyethylene foam tubing to improve cosmesis is a simple and elegant solution to a common prosthetic challenge. Our experience is that few prosthetists take the time to implement any type of temporary covering. As professionals in the field, we get used to the appearance of uncovered prostheses. Coverings can be considered a nuisance to making prosthetic adjustments. We must remember that the endoskeletal pylon is conspicuous to the general public. Many patients are self-conscious about the appearance of the prosthesis, and some patients have considerable difficulty adjusting to their new body image.1–3,5 The foam tubing and a sock clearly improve the appearance of the prosthesis. The improved appearance may also improve patients’ acceptance of prostheses and may help patients adjust to their amputations at an important time in their recovery process. These benefits are clearly worth the extra effort and expense involved in applying this simple technique. We recommend that polyethylene foam tubing be applied around the pylon of all preparatory prostheses and all definitive limbs until a custom covering is fabricated.


1. Breakey JW. Body image: the lower-limb amputee. J Prosthet Orthot 1997;9(2):58–66.
2. Murray CD, Fox J. Body image and prosthesis satisfaction in the lower limb amputee. Disabil Rehabil 2002;24(17):925–931.
3. Donovan-Hall MK, Yardley L, Watts RJ. Engagement in activities revealing the body and psychosocial adjustment in adults with a trans-tibial prosthesis. Prosthet Orthot Int 2002;26(1):15–22.
4. Williamson GM. Restriction of normal activities among older adult amputees: the role of public self-consciousness. J Clin Geropsychol 1995;1(3):229–242.
5. Breakey JW. Body image: the inner mirror. J Prosthet Orthot 1997;9(3):107–112.
6. Rybarczyk BD, Nyenhuis DL, Nicholas JJ, et al. Social discomfort and depression in a sample of adults with leg amputations. Arch Phys Med Rehabil 1992;73(12):1169–1173.
7. Passero T, Doolan K. Aesthetic prostheses. In: Smith DG, Michael JW, Bowker JH, eds. Atlas of Amputations and Limb Deficiencies. Surgical, Prosthetic, and Rehabilitation Principles. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2004:303–310.

artificial limb; cosmesis; covering; prosthesis

© 2007 American Academy of Orthotists & Prosthetists