PRETORIA, South Africa — Muhammed Saib grins excitedly. In two hours he became taller by an inch, his shoe size went from 4 to 5 and he is wearing new, cool black sneakers.
“Look at my feet, they are bigger, bouncier, lighter!” he chortles, each step wider and steadier.
Saib, 13, just got new prosthetic feet and legs. Born with a rare bone disease, his legs end high on the thigh and he lacks a hip connection.
His new feet are state-of-the-art carbon fiber blades, a mini-version of those popularized by his fellow South African, paralympic sprinter Oscar Pistorius. The blades fit into flesh-colored polyurethane feet and are screwed into a titanium leg that looks like an erector set.
Saib chose the colors for his legs — blue, yellow and red — and fire-engine red for the sockets. Next he wants a Ferrari and a Lamborghini spray-painted on each socket. “That will be so cool,” he says.
Conventional prosthetics, a laborious process where a mold is made from a plaster cast of the stump, take much longer — two to four months above the knee and two to four weeks below the knee. Meanwhile, the stump changes, requiring adjustments.
“The muscle deteriorates and you have to start from scratch,” said physiotherapist Tarina Coetzee.
Six months is the average wait for a prosthesis in South Africa. In Pretoria, where Mohammed lives, the waiting list at Steve Biko Academic hospital numbers 300.
Some 1,000 children need artificial limbs in South Africa, estimates ICExpress prosthetics expert Johan Snyders. In its Jumping Kids program, the company aims to fit 25 high school-age amputees with blades for free every year.
The ICExpress technique involves four steps, eight components and two hours.
First, a silicone sleeve that fits snugly is rolled onto the stump to protect its soft tissue from the hard prosthesis, preventing lesions.
The stump is covered with six layers of fiberglass and one of silicone. A resin is injected and pressurized with a hydrostatic balloon and a hand-pump. The resin sets in 15 minutes, resulting in a well-fitting and durable socket. A lock joins the prosthesis to the stump.
The ready-made components — metal leg and foot — are assembled and adapted to the person’s height and weight. For amputees, it means instant mobility.
“Africans often start dancing,” Snyders said. “They are far more open than Europeans to explore the prosthesis and to talk about their amputation.”
One reason is age: The average age of an amputee in Europe is 78 (81 in Sweden) and the cause of the amputation is cancer or diabetes. In Africa, the average amputee's age is mid-30s and the limb was lost to landmines, grenades, crocodiles, hippos or in a car accident.
Said's new limbs don’t come cheap: $4,000 for the blades and $10,000 for the legs. But ICExpress has developed a cheaper alternative using the same technology.
Its “African foot” is designed for the needs of African amputees: walking on gravel, sandy or muddy roads, farming, and cooking on an open fire — heat that conventional orthopaedic plastic legs cannot withstand. The polyurethane foot has a carbon fiber energy-returning plate and provides a steady grip on rough surfaces.
The cost for a below-the-knee prosthesis, including the socket, metal leg and foot, fitting and training, costs about $2,000. The more, the cheaper: an order for 100 would bring the price down to $1,000, Snyders said.
In comparison, the basic Indian-made Jaipur foot costs $40. In the U.S. a lower limb prosthetic ranges from $5,000 to $50,000 for a state-of-the-art bionic limb.
The comparative advantage is the savings in time, fittings, trips to the clinic and physiotherapy. The technology can be applied anywhere. It does not require a dedicated workshop or electricity. The tools fit in a travel bag. Snyders has fitted legs on the streets of Islamabad.
“Aid organisations give Africans the cheapest prostheses made of wood or rubber,” Snyders said. “It makes me sad to see African amputees receiving inferior prostheses.”
With funding from the Icelandic government and the Rotary Club, the ICExpress team have traveled to Pakistan, Mozambique and the Gaza strip to fit amputees with new limbs and train local technicians, sponsored by donors.
They returned two weeks ago from Botswana, where they fitted 31 amputees with prosthetics in three days. The oldest patient was 91; the youngest, 8.
Ndozi Xhaudi, 71, was out of her wheelchair and running on the same day.
The needs in Africa are huge. Civil wars leave a legacy of landmines and cluster bombs. Mozambique has some 7,000 amputees. Angola has 80,000 — one out of 470 people. In Angola, the Red Cross manufactured 32,000 limbs since 1979 until July 1, when it handed over its three orthopaedic centers to the Angolan government.
The U.S. Department of State estimates that fewer than one in four amputees in the world is fitted with a proper prostheses. Thousands of amputees still use old, damaged, heavy, wooden limbs, more painful than helpful.
Back in Pretoria, Saib is taking longer and firmer strides. His mother, Fahida, and grandmother Sarah look on proudly.
Since birth, Saib has had 20 surgeries, including painful bone extensions last year. His grandmother home schooled him and this year he joined his classmates in grade seven. His next goal is to leave the crutches and run, like his role model, Oscar Pistorius.
Johan Kirsten, 11, had his feet amputated in February due to a spinal disease. Today he is trying lower limbs in bright blue for the first time.
“Trust me, it’s a wonderful feeling,” Said tells him. “At home, you will get the hang of it. Like me: I can do whatever I want.”