Hundreds of people in Estonia lose limbs each year, facing life-altering changes. Hand amputations most often result from workplace accidents, while leg amputations are usually linked to diabetes and vascular disease. Men are more likely to lose fingers, particularly in the fall, Lilienthal noted.

"If wounds don't heal and sepsis develops, the limb must be removed to prevent the infection from spreading," she explained.

Longer lifespans also mean more people end up with prosthetics, and are using them for longer. "Statistically, prosthetic use is rising," Lilienthal said.

The vibrant world of prosthetics

Prostheses come in a wide range of designs, attachment systems and price points. The newest or most expensive isn't always the best, however; the right fit depends on the patient's needs and comfort.

Carbon fiber legs are becoming popular for their light weight and energy return, which makes walking easier for younger users. Older patients, however, often prioritize stability over springy movement, and a classic wooden prosthesis may suit them better.

High-tech solutions carry risks, too. Prosthetics with 3D-printed elements can warp in the heat, and while AI can help robotic hands and arms learn their users' movements, they also grow heavier and harder to control with each added function.

"At the end of the day, people mostly use hands to grasp things," Lilienthal said.

Sockets, which attach prostheses to the limb, are typically custom-molded. Some advanced designs attach directly to the bone, eliminating the need for a heavy socket, though these aren't yet available in Estonia.

Cosmetic prostheses can improve both self-esteem and body balance, Lilienthal said, noting their importance even for hand amputations.

"With hand amputations, a prosthesis isn't just about function — it also helps keep the body balanced," she explained. "Cosmetic prostheses can be a big help."

Access ensured for those in need

Several Estonian companies manufacture prosthetics and partner with the public sector.

Lilienthal, who earned her degree and trained in Sweden, is the country's first woman prosthetist — and the only university-trained one.

She has praised Estonia's organization of prosthetic care: the Social Insurance Board (SKA) listens, offers guidance and ensures access for those who need it.

Depending on a person's income, the state covers 90–95 percent of prosthetic costs. Lilienthal said that although even just a 5 percent co-pay for expensive prostheses can still be significant, no one in Estonia is ever denied a prosthesis for financial reasons.

Patients typically meet with a prosthetist before surgery to discuss the outlook. After recovery, the prosthetist molds a socket, orders specialized components such as liners, knees, robotic hands or prosthetic feet, and, if desired, adds cosmetic finishes to make the limb look natural.

Lilienthal supports patients through rehabilitation, teaching proper use and accompanying them in physical therapy sessions.

Prostheses require ongoing adjustment as stumps change and devices wear down. Although prostheses are designed to last seven years, she has never seen one last that long. How much wear and tear occurs depends chiefly on how active the user is, she said, adding that users typically come in for repairs once every couple of years.

Lilienthal encourages young people to consider the prosthetics field, calling it an "ideal blend of medicine and engineering."

It isn't currently possible to train as a prosthetist in Estonia, but opportunities exist in neighboring countries and beyond. Prosthetists in Estonia, however, enjoy more freedom and greater opportunities than elsewhere.

"In other countries, you often have to start out making foot braces and orthoses before you might eventually work with prosthetics," she explained. "In Estonia, you can begin practicing as a prosthetist right away."

Challenges beyond technology

Even so, Lilienthal admits Estonia's prosthetics field has its own drawbacks. For example, it still lacks a strong scientific foundation, and as most prosthetists gain much of their knowledge through prosthetics companies, they tend to approach things from the company or product perspective instead — when in reality, it should be the other way around.

"First, we need to determine what functionality we want to achieve, and then choose the right product and company accordingly," Lilienthal emphasized, adding that a relevant university education gives prosthetists the necessary skills for this approach.

Communication between surgeons and prosthetists is also inconsistent. Misaligned stumps can limit functionality, forcing additional surgeries. Patient health must be considered as well — for example, severe heart disease can make prosthetics too physically demanding for their users.

Lilienthal stressed that surgeons, attending physicians, physiotherapists, prosthetists, peer counselors and mental health support providers should be continuously working together.

"Every patient should have a case review to determine the available options," she said, adding that right now, major consultations are held only in complex cases. The entire process, including preparatory training, should also begin even before the amputation occurs.

Lilienthal has made it her mission to foster interdisciplinary collaboration, improve public awareness and build support networks for amputees.

Urban design and social attitudes add further hurdles. Uneven sidewalks, stairs, and inaccessible bathrooms make movement risky, especially for elderly or disabled residents, Lilienthal explained, adding that these issues are present even in healthcare facilities.

Public and workplace acceptance of prosthetics, including users publicly removing them when needed, is crucial for social inclusion as well.

"It even benefits the state when prosthesis users can leave home and get back to their everyday lives," she added.

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