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Metro

Marathon victims take 1st steps down uncertain path

Many bombing victims are now being fitted with artificial legs. It is a time of reckoning, pain, and hope.

Ever since the terror on Marathon Monday, Celeste Corcoran has hungered for the moment she would step out of her wheelchair and walk on new legs. And she had an idea what those legs should look like.

When a glamorous amputee strode into her hospital room for a morale-boosting visit in April, Corcoran admired the polished toenails and high-heeled sandals on her custom-crafted limb. She imagined that, once her wounds healed, her own artificial legs would seem just as lifelike.

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Then the morning of her fitting finally arrived; the 47-year-old hairdresser “was off-the-charts excited,’’ said her sister, Carmen Acabbo. But as the prosthetist tugged on the aluminum legs for the first time, the normally expansive Corcoran grew quiet. As her loved ones looked on, she gripped a walker, fixed her eyes on the floor, and determinedly took steps. The legs felt clunky and uncomfortable. They looked to her like silver stilts.

Back in the front seat of her sister’s car, she cried softly during the drive home to Lowell. Her real legs, always her most-complimented feature, were not coming back. “When reality slaps you in the face it’s really a slap,’’ she said later.

There are 16 people whose legs were blown off in the Boston Marathon bombings. Corcoran is one of two who lost both legs. Sixteen people have taken — or are likely to in the coming months — their first halting baby steps on prosthetic legs, leaning on walkers or parallel bars. It’s a long-anticipated moment that has produced surprising emotions. They have been hit hard by the finality of their injuries, and by the arduous work and enormous expense involved in getting back on their feet.

Celeste Corcoran walked on her new prostheses with her daughter Sydney and physical therapist Alyson Jodoin.

John Tlumacki/Globe Staff

Celeste Corcoran walked on her new prostheses with her daughter Sydney and physical therapist Alyson Jodoin.

Some of the women are particularly anxious. More than half of those who lost legs are female, a rarity in a country where men make up the vast majority of amputees, losing limbs in car and motorcycle crashes, construction accidents, or combat.

Men tend to wear their metal prostheses bare and exposed, sometimes proudly so. But some of the women want realistic-looking “skins’’ and adjustable heels like the ones television star Aviva Drescher wore when she visited them in the hospital. These are extras, along with special legs adapted for running and swimming, that many find crucial to feeling like their old selves but that health insurers typically do not cover.

Even with the One Fund and individual charities set up by the survivors’ families, the money may fall short of what they will need for prostheses and other expenses for decades to come.

“If I want my legs to look like real legs . . . that is very expensive,’’ said Corcoran, who last Friday wore stocking-like covers over her prostheses. “With Aviva’s leg you can barely tell. Mine look nothing like hers.’’

At Spaulding Rehabilitation Hospital, Dr. David Crandell, who has treated many of the amputees, said that controlling expectations has been especially challenging with the Marathon bombing victims.

“They have been exposed to highly successful amputees, people on TV, elite athletes,’’ he said. “Expectations are built up. ‘If I can just get my leg everything will be OK.’ A prosthetic leg does function, but it’s not your leg.’’

Last week, Corcoran and Roseann Sdoia, a Boston development executive who lost her right leg above the knee, were admitted to Spaulding to learn how to walk on their new prostheses. Mery Daniel, a 31-year-old Haitian immigrant, and Heather Abbott, 38, a human resources executive from Rhode Island, started mastering their artificial limbs as outpatients. Paul Norden, a construction worker from Stoneham, picked up his prosthesis last Thursday.

The women said that the metal limbs feel more comfortable with practice. But prosthetists said it will take months, or even a year, of physical therapy for the amputees to trust their limbs enough to walk normally unaided.

Other bombing victims, including Erika Brannock, 29, of Maryland, youngster Jane Martin of Dorchester, and Norden’s older brother J.P., are not ready for prostheses because they are still healing from their injuries, according to relatives and friends.

Several of those who have been fitted said it is unclear what their insurance companies will cover, and for how long they will cover the items. “What happens five years from now?’’ Sdoia asked.

Crandell said the concern about cost is well-founded.

Above-the-knee amputees in their 20s can expect the lifetime cost of a computerized prosthesis, which must be replaced every three to five years, and related care, to easily reach $1.5 million, he said. Insurance companies are required by state law to cover prostheses; some pay for modern computerized models, while others cover only more basic ones.

Crandell has had patients who had insurance that covered computerized legs for years, and then found themselves without coverage for the most advanced prostheses when their employer switched to a new health plan. And his estimate does not include customized cosmetic covers, which go for $15,000 to $20,000, adjustable heels, a special blade leg for running, or a waterproof one for swimming.

Unlike elderly people who lose their limbs to diabetes, the Marathon amputees are younger, healthier, and used to being physically active, so they want legs with greater capabilities. “They will need more higher-end prostheses,’’ said Greig Martino of United Prosthetics in Boston.

Because Sdoia exercised regularly before the bombing, as well as ran and skied, her insurer, Blue Cross Blue Shield of Massachusetts, agreed to cover the most expensive computerized leg on the market. Insurers, including Blue Cross, said they consider these requests on a case-by-case basis.

Sdoia’s prosthesis, the Genium, includes a microprocessor-controlled knee that can climb stairs and step over objects, mimicking the movement of the person’s other knee. It takes less effort to operate than a less-costly mechanical leg or hydraulic leg, which means the person wearing it can walk farther and faster.

Still, Sdoia’s first fitting was bittersweet. “It was just the harsh reality that it’s forever,’’ she said. And even with an $80,000 prosthetic limb, there were reminders that it isn’t her own: Because of how the leg fits, the foot does not lie flat on the floor when she sits.

On a recent Monday, Sdoia was back at Next Step Orthotics & Prosthetics in Newton, where prosthetist Arthur Graham adjusted her gait with his computer as she walked, grabbing onto parallel bars. Her leg was sore, she said. Graham told her it was probably swollen from a salty meal the previous night. Sdoia said the prosthesis reminds her of wearing a ski boot — they don’t hurt but “you know you have them on.’’

Sdoia is determined to progress quickly. Normally, Graham said, he would not introduce an adjustable heel to an amputee so early in the process, but she insisted.

“Once we get this settled, then we’re going to talk about the running leg, right Arthur?’’ she prodded him.

Sdoia asked Blue Cross to pay for a customized cover. The company said it is evaluating her request. But she is not waiting. A specialist from Dorset Orthopaedic in England recently began crafting the cover during a four-hour sitting. He counted the freckles on her remaining leg and recorded the various colors on her toenails.

Sdoia recalls that all of the male amputees who visited her at Massachusetts General Hospital and Spaulding wore their metal legs without covers. Nationally, 80 percent of amputees who lose limbs to trauma are men. “It’s almost a badge of honor for them,’’ she said, noting that a number of those visitors were soldiers who had served their country. “Not for me.’’

Abbott’s prosthetist is doubtful that her insurer will pay for a customized cover, she said. “This is a common concern among the young women,’’ she said. “Insurance companies mostly cover men, so we don’t have as much of a voice.’’

Like Sdoia, Abbott wants running and swimming legs. She picked up her prosthesis at Next Step’s office in Warwick, R.I., on June 6. Her fitting had been delayed, after she fell and bruised the skin and bone where her left leg ends below her knee. She had been talking on the telephone when her doorbell rang. She forgot she was missing a leg and got up from her bed and fell. (Now she places one slipper by her bed to remind herself.)

The day she brought home the leg, she felt discouraged.

“I looked at the leg sitting there and I thought, ‘OK, this is real. I am not getting my leg back.’ I didn’t expect [walking on it] would be this hard.’’

One day last week, Corcoran was back at Spaulding, practicing standing on her prostheses. Her daughter, Sydney, who also was injured in the bombing, tapped a balloon through the air to her mother, who hit it back.

A teenage girl and her mom having fun . . . it was a step toward normalcy. Still, a therapist stood nearby to spot Corcoran, in case she lost balance.

Liz Kowalczyk can be reached at kowalczyk@globe.com.

Correction: An earlier version of this story misstated the status of insurance coverage for Heather Abbott’s customized cover for her prosthetic leg. Abbott has been told that insurers usually don’t pay for customized covers, but her insurer said it considers requests on a case-by-case basis. Abbott’s left leg was amputated several inches below the knee.

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