Objectives: This study aims to assess the level of awareness of transtibial amputee patients on stump contractures and their compliance with efforts implemented to prevent the condition. Patients and methods: This study included 50 unilateral transtibial amputees (26 males, 24 females; mean age 55.4±14.7 years; range, 18 to 78 years) who met the respondent criteria of the study. The respondents were randomly selected and were issued with a questionnaire. Results: The majority of the transtibial amputees were aware of stump contracture complications. It was found that they also preferred methods of prevention which required less effort, was cost-effective, and were also practical. Conclusion: More focus should be placed on contracture prevention methods which were most complied with by the patients. This is because the effectiveness of a prevention method is highly influenced by patients' compliance with the method. Patients with a higher risk of developing stump contractures should be also given more attention in post-amputation care.

Abstract. Knee flexion contracture on a stump side is a phenomenon in which the stump cannot move in normal range of motion (ROM) or cannot be fully extended. This study has been carried out by using Biodex Stability System (BSS) in order to investigate the effect of stump flexion contracture towards the postural stability among the transtibial prosthesis users with the intervention of alignment accommodation. The BSS provides the reading of anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI). Higher reading of the index indicates lesser stability. Each of the subjects had been tested in three different sessions that were Visit 1 (before contracture improvement), Visit 2 (after contracture improvement without alignment readjustment), and Visit 3 (after contracture improvement with alignment readjustment). The APSI reading was significantly higher during Visit 2 compared to Visit 1 and Visit 3. The OSI during Visit 2 was also found significantly higher compared to Visit 3. In Visit 2, the degree of contracture was significantly improved with 44.1% less than Visit 1. The stability index in anterior-posterior aspect (APSI) was proven to be lower as the prosthetic alignment was adjusted according to the ROM of knee. This finding explained that the alignment set up based on the adaptation with the stump's ROM can contribute positively in maintaining postural stability. BackgroundKnee contracture or flexion contracture on the stump is one of the common problems occurred among the below knee amputees. It refers to the situation in which the patient cannot fully straighten the knee or in other words, the range of motion of the joint is limited from normal [1]. It is a result of the shortening and tightness of the muscles which might be associated with their structural changes due to the long period of bending position or inactivity due to the illness and lack of exercise [2]. The significant characteristics of contracture are limitation of joint mobility and increasing resistance of the joint to passive ROM which is the movement of joint applied by external power, either by someone or by exercise machine [3]. The mobility of joint is very important for a prosthetic candidate. This is because the limitation of joint motion which refers to joint contracture will significantly affect the fitting and function of the prosthesis [4].In overcoming the contracture, most of the efforts are focused on treating the contracture itself, decreasing the contracture angle or prevent it from becoming worse. For transtibial amputation cases, the amputees are advised to avoid placing pillow under the knee. An extension board is commonly used to be placed across the back of the knee joint to ensure the extension position [5]. Besides, stretching the soft tissues which can be done actively or passively is also very helpful to overcome the contracture.

Background Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. Objectives (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. Design In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the userʼs socket comfort. Setting Outpatient clinic in a tertiary hospital in Singapore. Participants People (N = 16) with unilateral transtibial lower limb amputation using a prosthesis. Interventions NA. Main Outcome Measures Peak pressure and socket comfort score (SCS). Results The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p = .001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t‐test results showed a mean increase between the first SCS and final SCS was 2.6 (p = .001). Conclusion The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.