音声ブラウザご使用の方向け： SKIP NAVI ／ GOTO NAVI

Nothing About Us Without Us
Developing Innovative Technologies
For , By and With Disabled Persons

Part Two
CREATIVE SOLUTIONS FOR WALKING
AND FOR LEG AND FOOT PROBLEMS

119

CHAPTER 19

The Mukti Limb:

Fast, Cheap Legs from Plastic Pipe

CULTURALLY-ADAPTED LIMBS IN INDIA

Dr. P.K. Sethi talks with a double amputee who has been fitted with Jaipur limbs at the Center in Jaipur, India. Many ideas for improving the limbs come from the users.

The Jaipur Foot

India is the home of some remarkable innovations for and by disabled persons. The Jaipur Foot, now world famous, was developed by an orthopedic surgeon, Dr. P.K. Sethi, in response to a disturbing realization. A kind-hearted person, he had gone to great efforts to provide the best, most modern fiberglass-and-resin Western prosthetics to the neediest of amputees. Weeks or months later, he would see these same amputees hobbling on crutches, without their limbs. Humbly, he asked them why. Apologetically, they told him. He began to realize that limbs well-suited to a Northern city are completely out of place in rural India. Indian villagers need a leg with which they can go barefoot into homes and temples, squat at their toilet, sit cross-legged on the floor while eating, and work knee-deep in the mud of rice paddies.

The Jaipur foot squatting

Through a process of trial and error, with a lot of feed-back from village amputees, Dr. Sethi developed a design that was more suited to the traditions, poverty, and environment of rural India. The Jaipur foot-piece is heat-molded in iron forms in which pieces of wood are covered with vulcanized rubber. It is very flexible, water-proof, and looks real (with toes, veins, and skin color). The foot is fixed to a lightweight aluminum shank crafted by traditional tinsmiths. The above-the-knee limb has a swivel knee joint that permits comfortable squatting and cross-legged sitting.

Many of the limb-makers at the Jaipur Center are amputees, like this young man, or they are local, traditional craftspersons. The Jaipur limb has a rubber foot and aluminum shank.

The Jaipur foot is so practical and low-cost, that it is now produced in many countries of Asia, Africa and Latin America. At many community centers that make these limbs - including a large center in Colombo, Sri Lanka - most of the limb-makers are themselves amputees.

Because the Jaipur technology is already widely known, here we will limit our description to only a few photos. The limb was developed working closely with local disabled persons and with local craftspersons. Much can be learned from this cooperative learning process.

120

STEPS IN MAKING A JAIPUR LIMB FOR GOPI, WHO LOST HIS LEG JUMPING A TRAIN

A local limb maker measures Gopi's stump. He draws measurements on a sheet of aluminum and cuts them out. He welds the aluminum sheet into a tube.
He hammers the tube to took like a leg and to correctly fit the stump. After attaching the foot to the tube, he adds padding and a strap, and tries it on Gopi's leg. Gopi walks on the new limb the same day it was begun.
A double amputee with Jaipur limbs. Here, the man in the right picture runs carrying a man on his shoulders. More folks waiting for limbs.

121

A Mukti Limb - Made from Plastic Pipe

MUKTI logo.

The Jaipur foot is not the only user-centered breakthrough in prosthetic limbs from India. In 1986, Meena Dadha, a remarkable woman from Madras, became concerned that there were hundreds of thousands of amputees in India who needed a limb and could lead more fruitful, happier lives if they had one. A method of leg-making was needed where limb-making teams could "go to the people," even in remote villages, and make good quality legs quickly at low cost.

Mukti is the name of a limb-making program that has its main base in Madras, and runs a mobile outreach program to rural areas. The limb-making equipment is transported in a van to small towns that invite Mukti's service and agree to bring together amputees from nearby villages. A 5 or 6 day workshop is organized in a temple, meeting hall, or school.

As part of a United Nations training program, I (the author) had the privilege of observing a Mukti workshop in a remote village. To my amazement, a team of 5 craftspersons produced 60 limbs in 5 days. I watched as they made a limb for a poor farm worker. He began to walk on his new limb just 2 hours after the first measurements were taken! (He, of course, stayed longer for gait training and adjustments.)

Plastic pipe is converted into prosthetic legs, as shown here.

The key to this fast, low-cost technology is the use of plastic water pipe for the socket and the shank of the limb. The pipe is 3 inch diameter "HDPE" (high density polyethylene) irrigation pipe, with a melting point of 134 to 137 degrees C. It is produced by Polylefins Industries, which makes skin-colored pipe especially for Mukti. (The pipe is somewhat different from PVC pipe, and easier to mold.)

The hot pipe is stretched over the cast of the leg.

To make the limb, a plaster mold of the stump is made. To the bottom of this mold, plaster of Paris is added to form a mold of the entire shank. To do this, a cardboard cone is attached to the bottom of the stump mold, and filled with plaster-of-Paris (see drawings on next pages). A measured section of plastic pipe is put over a stout wooden stick, and is heated in an oven until it begins to droop.

The elderly farm worker was able to walk surprisingly well with his new, light-weight leg.

Then, the hot pipe is stretched over the cast of the leg.

On cooling, the plaster is removed from the inside of the mold. A pre-made rubber foot, similar to a Jaipur foot (produced in different sizes in Mukti's center in Madras), is fixed to the bottom of the shank. Straps are attached to the top of the limb to hold it firmly on the stump.

The results are impressive. The elderly farm worker whom I saw fitted was able to walk surprisingly well with his new, light-weight leg on that same afternoon. He was overjoyed.

A series of drawings on how to make the limb, from a booklet by Mukti, are reproduced on the next 3 pages.

122-124

STEPS TO MAKE A MUKTI LIMB

adapted from a booklet by Mukti, titled A Limb of Utility Is a Joy Forever

Figure 1. Putting the plaster of paris(POP) on a cotton bandage. Figure 2. A woman lose her one leg (below knee).
Figure 3. Making a mould by wrapping the wet plaster bandage around the stump. Figure 4. When you take the mould, watch out the patellar press.
Figure 5. Liquid plaster of paris filled in negative mould. Figure 6. After the mould hardens, cut the negative mould.
Figure 7. When the mould is ready, we need a socket as the same length of her sound leg. Figure 8. Filling up of socket should be kept on the positive mould and then again filled with plastic plaster of paris.
Figure 9. When the plaster is hard, remove the cardboard. Figure 10. Finish with iron net and chisel.
Figure 11. Now we require a scissors, wooden stick, HDPE pipe and cloth net or stockinette Figure 12. Wrap the stockinette around one side of the HDPE pipe with the wooden stick inside.
Figure 13. Put in the oven the item in Figure number 12. Figure 14. After vice the item, stretch the soft, hot HDPE pipe over the mould.
Figure 15. Moulding of plastic completed. Figure 16. Plaster of paris removed after hitting the mould by hammer.
Figure 17. The rubber foot being fitted to the mould. Figure 18. We finished making the Mukti limb.

More information on Mukti Limbs can be obtained from Mukti, (address on page 342). Many other groups are also experimenting with limbs and braces made from plastic pipe, including Handicap International (address on page 341).

Go back to the CONTENTS

Nothing About Us Without Us
Developing Innovative Technologies
For, By and With Disabled Persons
by David Werner

Published by
HealthWrights
Workgroup for People's Health and Rights
Post Office Box 1344
Palo Alto, CA 94302, USA

Go to the top of this page. | Go to the upper category.