A common question I get as a Prosthetist is whether or not a prosthesis can be worn in the water. Many prosthetic components, such as feet and knees, are water-resistant, meaning that it’s okay to be caught in a rain storm or splash water on them without causing damage. Some components are entirely waterproof, meaning it’s okay to completely submerge them in water. A prosthetist can help in selecting appropriate components for a person whose lifestyle is such that he or she is going to be exposed to water. If a certain component is not water-resistant or waterproof, a protective cover and skin could be another option to assure the components will not be damaged. Protective covers and skins can not only help to extend the overall life of components, they also help to restore the shape and skin tone of the prosthesis so it’s visible appearance is more similar to a person’s biological limb.
Showering with a prosthesis is a possibility, although most people do not choose to do this because it’s necessary to clean the residual limb anyway. Equipping the shower with grab bars and a shower chair is important to reduce the chance of falls. Alternatively, a shower leg can be made from an older foot and socket, and may make sense in situations such as showering in an unfamiliar environment where an accessible bathroom is not available.
Swimming with a prosthesis is a possibility, although most people take it off because it is easier to swim without a prosthesis. The prosthesis can be taken off at the edge of the pool and covered up with a towel to prevent it from getting wet. For those swimming for the first time after losing a limb, balance in the water is going to be different and it may take some time to adapt. Persons with upper extremity limb loss may benefit from a specialized prosthesis or paddle-type device with straps around the residual limb, such as in the picture below. As a general rule, the prosthesis should be rinsed with fresh water anytime it’s exposed to chlorine or salt water.
Swimming in the ocean adds the challenges of sand getting in and on the prosthesis, and also getting from the shore into deep enough water to start swimming. Sand is the enemy when it comes to prosthetic feet. Sand inside the footshell will act just like sandpaper and rub holes through the spectra sock. This eventually exposes the carbon fiber (or similar) foot to rubbing on the rubber footshell, and causes the carbon to wear prematurely. The solutions to this are to prevent as much sand from getting into the footshell as possible by using a high sock or grocery bag, and then to remove the footshell shortly after exposure to sand and to rinse off the foot, sock, and footshell. It’s important to ask your prosthetist how to remove and put the footshell back on properly. In addition to the sand issue, getting into the water can be challenging. It would certainly be disappointing, to say the least, if an incoming tide were to sweep away a leg at water’s edge. A waterproof prosthesis is ideal for walking into deep enough water to start swimming. In order to ensure it doesn’t end up on the end of a fisherman’s line someday, a secondary form of suspension, such as a sleeve or belt, is highly advised. Rinsing off the prosthesis with fresh water will reduce rust and corrosion of any metal parts from the salt water. For avid beach-goers, a prosthesis that is completely corrosive-resistant and that has a solid footshell or a footshell filled with expandable foam will make life easier.
Triathlon is a race involving swimming, cycling, and running (in that order). Most races will allow a “handler” to provide assistance for getting out of the water and in transitions. Talking to the race director ahead of time can help ensure that the handler can set up the participant’s towel, leg, etc., ideally at water’s edge. Since wearing a prosthesis during the swim is not allowed ( at least in ITU or USAT races), getting to and from the water’s edge can be a challenge. Many race directors will allow an in-water start for amputees. Alternatively, crutches may be an option for some to get from the start line to the water. Crutches would then be left with the handler. Upon finishing the swim, a handler can help when getting out of the water, stripping the wetsuit, and donning prosthesis. Crutches are generally not helpful when exiting the water because wet skin slides around easily on the armpit pads of the crutches and can be dangerous.
Snorkeling and scuba diving are possible without the use of a prosthesis. However, it may be easier to climb the ladder on the boat while wearing a prosthesis. Specialized feet that lock out in 90* or in full extended position are also available and may be beneficial. This is conductive for the use of fins, which help give better propulsion and symmetry in the water. Neutral buoyancy is a necessary concept in scuba diving and since the prosthesis tends to want to float to the surface, that will need to be taken into account. Ankle weights are a good option for novice divers and a prosthesis with a hollow shell that fills with water is a good option for avid divers.
Wakeboarding and waterskiing can be done with or without the use of a prosthesis. One option for waterskiing is to use only one ski and no prosthesis. If a prosthesis is worn, wetting the prosthetic foot makes it easier to get into the binding. The tow rope can be held onto with the elbow for a person with a below elbow amputation or with only the sound arm. A number of adaptive devices are available for non-upright waterskiing. At a novice level, specialized knees are available with shock units to offer a more athletic stance. Certain waterproof microprocessor knees can be programmed by a prosthetist to lock in a certain amount of flexion as well.
Kayaking and stand up paddle boarding are possible for those with arm and/or leg amputations and can be done with or without a prosthesis. Adaptive equipment may be necessary, especially for those with arm amputations. Specialized prosthetic devices are available to help a person hold onto a paddle. Safety is paramount and one consideration is to ensure that the terminal device can release from the paddle with a strong force. For kayaking, another safety consideration is ensuring that the prosthetic leg does not become entrapped in the event that the kayak is overturned. For this reason, it is advised that a full prosthesis not be worn inside a kayak. The use of a gel liner and old socket without a foot attached can prevent injury to the residual limb and can facilitate balance by pushing against the side of the kayak without risking entrapment. Stand up paddle boarding is easier to learn while kneeling than standing, so that might be a good place to start. Non-slip shoes, such as aqua socks, may help prevent the footshell from sliding on the paddle board when an individual does stand up.
In conclusion, water sports are possible for people who have sustained almost any level(s) of amputation with the right equipment and instruction. Preventing damage to components is simple and requires only rinsing the prosthesis with fresh water following exposure to chlorine, salt water, and sand. Safety in the water is of utmost importance and participation in skilled adaptive programs is strongly advised.