Kogan Prosthetics Inc.

02/15/2026

As an American Amputee, your primary insurance often only covers 80% of the cost of a prosthesis. It is much cheaper to get a supplementary/secondary insurance to pick up the last 20%!!

01/20/2026

Being an amputee doesn't mean you're not capable. It means you have a different way of doing things. https://www.facebook.com/share/r/1CEdpvtU4g/

01/17/2026

There is no easy fix at this time. Do the work!

01/17/2026

Balance is very important for all amputees to work on. Don't be embarrassed to use a walker until your balance improves. You'll be more embarrassed with a black eye!

01/05/2026

I did not make this one, but it goes to show you how popular it is.

Also, the gray ball in the pylon is called a torsion adapter. It acts as both shock absorption and twisting motions for the prosthesis.

01/04/2026

Humor is an important part of anyone's recovery!

12/31/2025

Using a toe-filler prosthesis (sometimes called a partial foot toe spacer or toes prosthetic insert) is important for several biomechanical, safety, and long-term health reasons. In clinical practice, the rationale centers on preserving gait mechanics, preventing deformity, and protecting the integrity of the residual limb.

Below is a comprehensive explanation framed in Medicare-style clinical language.

1. Maintains Normal Foot Biomechanics
A toe-filler restores the forefoot’s contour when one or more toes are missing. Without it, the shoe collapses around the void, altering weight distribution. This causes:

Excessive pressure on the remaining metatarsal heads

Abnormal pronation or supination

Increased shear forces during toe-off

These deviations significantly elevate risk for skin breakdown and ulcer formation, especially in patients with diabetes or peripheral neuropathy.

2. Enhances Stability and Balance
Missing toes reduce the forefoot’s contact area and destabilize push-off. A toe-filler helps:

Prevent excessive forward foot migration inside the shoe

Improve stance stability

Reduce risk of trips and falls

3. Prevents Shoe Deformation and Improves Fit
Shoes tend to collapse into empty toe spaces. A toe-filler preserves the internal shape of the shoe, ensuring:

Proper heel seating

Controlled foot motion

Consistent fit across both limbs

4. Reduces Long-Term Musculoskeletal Strain
Improper gait mechanics caused by partial toe loss can create compensatory patterns up the kinetic chain. Over time, this may contribute to:

Knee, hip, and low-back pain

Asymmetric stride length

Muscular fatigue and overuse syndromes

A toe-filler supports a more normalized gait, reducing the need for harmful compensation.

5. Protects the Residual Limb
The void left by missing toes becomes an area where the forefoot can deform or collapse. A toe-filler supports the soft tissues and prevents:

Contracture development

Skin shear and friction

Callus buildup and ulcer formation

6. Essential for Medicare Compliance and Prosthetic Coding
For beneficiaries with partial foot amputations (e.g., PFA, transmetatarsal, or toe amputation), use of a toe-filler is standard of care. It supports compliance with:

Proper therapeutic shoe fit (A5500 series)

Multi-density insert requirements

Documentation demonstrating off-loading necessity

Medicare auditors routinely expect to see toe-filler use documented for partial foot amputees when shoes/inserts are billed.

In short:
A toe-filler prosthesis is not cosmetic. It is a medically necessary device to maintain foot alignment, protect the residual limb, normalize gait, and prevent ulceration—especially in neuropathic or vascular-compromised populations.

12/31/2025

The image below covers the basic and most common levels of amputation.

12/31/2025

Remember, you may be an amputee, but that doesn't mean you can't have fun with it. Don't worry about the children. That's what therapy is for! 🤣

12/30/2025

12/30/2025

I often see posts asking about options for irritating or painful Phantom Sensations. Below is a good list of options for amputees to research and try. Remember that what works for one person doesn't necessarily work for another. Hope this helps....

Top 10 remedies for phantom sensations / phantom limb pain

Mirror therapy / visual-movement feedback
What: use a mirror (or mirror-box) so the intact limb’s reflection appears like the missing limb while the patient moves it; re-trains sensory/motor maps.
Evidence: many randomized trials and meta-analyses show clinically meaningful short-to-medium term pain reductions for some patients, though results are mixed and protocol-dependent. Often used as first-line noninvasive therapy.

Graded Motor Imagery (GMI) / motor imagery training
What: staged program (laterality training → imagined movements → mirror/movement) to gradually restore normal brain representation of the missing limb.
Evidence: several randomized trials and systematic reviews report moderate benefit for PLP; commonly used when mirror therapy alone is insufficient.

Medications (neuropathic agents, short-term opioids, ketamine in refractory cases)
What: drugs commonly used include gabapentin/pregabalin (antiepileptics for neuropathic pain), some antidepressants (tricyclics) in selected patients, short courses of opioids or NMDA-antagonists (ketamine) for severe/refractory pain.
Evidence: systematic reviews show some short-term benefit for morphine, gabapentin and ketamine; evidence is mixed for amitriptyline/memantine. Medications are often adjuncts, not curative, and must be chosen with attention to side effects and addiction risk.

Transcutaneous electrical nerve stimulation (TENS) / noninvasive peripheral stimulation
What: surface electrical stimulation over the stump or peripheral nerves to reduce PLP by interfering with pain signaling or providing sensory input.
Evidence: small trials and case series show benefit for some patients; inexpensive and low-risk so commonly tried early.

Peripheral nerve stimulation (PNS) & sensory-feedback prostheses
What: implanted or percutaneous electrodes stimulate peripheral nerves (or provide sensory feedback via a prosthesis) to restore somatosensory input and reduce PLP.
Evidence: growing positive case series and pilot studies (including restored sensation + pain reduction); promising especially for limb amputees using advanced prostheses. More controlled data are emerging.

Spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation
What: implanted epidural leads (SCS) or DRG stimulators deliver electrical neuromodulation to modulate pain pathways. Used for chronic, refractory PLP.
Evidence: systematic and scoping reviews show that a meaningful subset of patients obtain large pain reductions; outcomes vary and device selection/placement matters. Considered when conservative therapy fails.

Virtual reality (VR) / augmented reality (AR) therapies (including virtual mirror therapy)
What: immersive or non-immersive virtual environments that recreate the missing limb and allow the patient to “use” it (visual + motor feedback).
Evidence: growing trials show VR can reduce PLP similar to or sometimes better than traditional mirror therapy; promising adjunct especially for patients who don’t respond to simple mirror therapy.

Noninvasive brain stimulation (rTMS, tDCS) and other neuromodulatory techniques
What: repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) aimed at motor/sensory cortex to alter cortical excitability and pain perception.
Evidence: multiple small RCTs and reviews show short-term analgesic effects for some patients; often used as a trial or bridge to longer therapies.

Psychological therapies and multidisciplinary rehabilitation (CBT, pain-coping, physical therapy, desensitization, prosthetic training)
What: cognitive-behavioral therapy, acceptance strategies, pain education, combined with targeted PT and desensitization of the residual limb and optimized prosthetic fitting.
Evidence: psychological/rehabilitation approaches improve coping, reduce disability and often reduce pain intensity when combined with other modalities—recommended as part of multidisciplinary care.

Interventional/surgical options (nerve blocks, neuroma surgery, dorsal root entry zone procedures) — last resort
What: targeted nerve blocks, neuroma excision with careful technique, dorsal root entry zone (DREZ) lesioning or other destructive procedures, and revision/amputation site surgery in selected cases. These carry risks and are considered when other therapies fail.
Evidence: variable and often limited to case series; some patients achieve long-term relief but surgical approaches are individualized and risky—used when benefits outweigh the risks.

12/30/2025

Superman seems to be a popular theme from some of my patient's. A few years ago, I made a leather calf corset for a patient's orthosis