Byline: Tim Christie The Register-Guard

SPRINGFIELD - Nathan Keepers is a busy man, routinely working 12-hour days building artificial limbs and bracing systems as well as managing his small but busy business, Barnhart Prosthetic and Orthotic Services.

He recently moved the practice

"I'm pretty tired," Keepers said. "The move has got me pretty run down."

Keepers can expect his practice to remain busy. A big chunk of his business comes from people with diabetes, which has become epidemic in the United States, driven by an explosion of obesity. About 23.6 million Americans have diabetes, or 7.8 percent of the population, according to the Centers for Disease Control and Prevention.

Diabetics often suffer from poor circulation in their feet, so Keepers fits them with special shoes to keep pressure off sensitive areas. That poor circulation can lead to amputation of feet and legs, so Keepers fits those people with prosthetic limbs.

Keepers estimates that about 60 percent of his prosthetic practice involves helping people with diabetes who have lost a limb. Nationally, an estimated 71,000 diabetics have a lower limb amputated each year, according to the CDC.

A wave of aging baby boomers also will need prosthetics and orthotics "and their bodies give out in various ways," he said.

Business has been so busy that Keepers moved the practice and its 10 employees to a new building he built at 1881 Second St. in Springfield, providing some desperately needed elbow room.

The old Eugene clinic covered about 2,100 square feet.The new clinic covers about 3,800 square feet, occupying the first floor of the two-story building, and has specially designed fitting rooms and a more spacious workshop. Keepers said he'd like to lease out the top floor to another business, or perhaps start a durable medical equipment business.

Keepers said he enjoys his work, particularly the reward of restoring mobility to someone who has lost a limb to disease or accident.

"You get to help people and it's your job," he said.

Keepers, 31, bought the business six years ago from its founders, David and Linda Barnhart, who helped him get his start in the business.

Keepers grew up in Pleasant Hill and he earned a biology degree at Oregon State University. He said his interest in prosthetics stems from a National Geographic special he watched when he was in high school about a man who was building his own prosthetic feet for rock climbing.

"I thought I wanted to be an engineer and design components," he said. "But I got bored with formulas and math. I wanted to do something more hands-on and personal."

He got his certification in orthotics and prosthetics from Northwestern University in Chicago, did a one-year residency in Southern California and a one-year residency under Barnhart in Eugene. Keepers stayed in contact with the Barnharts, even when he went to work briefly in Montana for Hanger Inc., a publicly traded prosthetic and orthotic company with 600 clinics in the United States.

When the Barnharts retired, Keepers bought the practice, keeping the name because "the Barnhart name has been around this area for a long time and it got a good reputation."

The job requires him to be both clinician and craftsman. One minute he's in a exam room, talking with a patient, checking the fit of a prosthetic. The next minute he's in his workshop, wielding a propane torch or cordless drill to fine-tune a prosthetic limb.

He recently spent several months working with a patient named Benjamin Bautista to craft a new prosthetic leg. Bautista, 47, lost his left leg on June 6, 2006, when it got caught in a machine at the dairy he works at in Coburg. His leg was amputated below the knee.

Bautista's first artificial leg was getting loose, and had grown uncomfortable. It's common among amputees for their stumps to atrophy and get smaller over time. Keepers took a cast of Bautista's stump so he could build a new socket, the beginning of a painstaking, sometimes trial-and-error process of fine-tuning a prosthesis so that it fits and works right.

It's inherently challenging, he said, trying to get a good, comfortable fit between a rigid device and a fleshy limb.

Over a period of weeks and repeat visits, Keepers tried different technologies and made adjustments to the socket on Bautista's artificial limb. He tried a battery-powered vacuum system intended to ensure a snug fit, but it proved too bulky. He tried a new type of artificial foot equipped with a microprocessor that anticipates the user's gait, moving in response to the type of terrain being traversed, but determined that it wasn't right for Bautista.

Bautista came back in for a checkup earlier this month, and Keepers asked him how he was doing with the new limb.

"It's hurting - this part," Bautista said, speaking through a Spanish-language interpreter, pointing to the area just below his kneecap.

Keepers marked the spots with a Sharpie pen, and took the prosthesis back to his shop, where he beveled out the areas on the inside of the plastic socket using a sanding cone mounted on a router. He used a propane torch to heat and soften the plastic, then used his fingers to push out the material and create more space.

"Sockets are the hardest part - getting the right amount of pressure where we want it and not where we don't," he said.

He returned to the fitting room and had Bautista try it out. He adjusted the foot hinge with an Allen wrench and asked him if it was better.

"It's fine," Bautista said. "It doesn't hurt."

Keepers said he expects he'll see Bautista again soon and continue fine-tuning the leg. A project such as Bautista's might cost $15,000, Keepers said. The work is covered by insurance.

Keepers also goes to the hospitals, working with patients who have suffered an injury and need help after surgery. For example, he might go into an operating room and fit a halo - a device intended to keep the neck and head from moving - on a patient recovering from spinal surgery, or fit a prosthesis on a logger or motor-cyclist who has lost a limb in an accident.

"Luckily, we're the positive side of it. We're part of recovery," he said. "It's pretty cool to get people up and walking."