Objectives To determine the perspectives of amputees and rehabilitation clinicians on the effect of socket fit and issues caused by ill-fitting sockets throughout lower limb prosthetic rehabilitation. Design A survey was developed to identify rehabilitation factors and issues for prosthesis wearers and rehabilitation clinicians. Participants opted to participate in a further telephone interview. Setting Online and across the United Kingdom. Participants Lower limb prosthetic wearers and clinicians who are part of a lower limb prosthetic rehabilitation team (N=94). Interventions Not applicable. Main Outcome Measures A survey and an interview to measure the perceived effect of socket fit on lower limb rehabilitation. Results Issues related to socket fit were identified as the biggest factor affecting rehabilitation by 48.0% of amputees and 65.7% of clinicians. Amputee interviewees focused on the effect of fit on quality of life and the ability to complete daily tasks, whereas clinicians focused on the lack of widespread ability to adjust the socket and gait re-education. Conclusions Socket fit has a large effect on and is a large source of frustration to amputees and their clinical teams throughout rehabilitation. From the interviews, it became clear that the interpretation of socket fit is different for each person; thus, “socket fit” does not mean the same for all patients.

Background:Successful rehabilitation is essential to improve the physical and mental outcomes of people with lower limb amputation(s). Individuals have different goals and expectations of successful rehabilitation and experience issues that affect their quality of life.Objectives:To determine factors affecting lower limb prosthetic rehabilitation from people with amputation(s), important for studies focusing on prosthetic and socket design and fitting because they provide context of need and user issues.Study design:Thematic analysis of semistructured interviews.Methods:Ten people with amputation(s) were self-selected from a survey identifying factors affecting lower limb prosthetic rehabilitation. The telephone interviews were semistructured exploring the biggest impactors on and frustrations with rehabilitation and the socket. A thematic analysis was completed by following the undermentioned steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and reporting.Results:Five distinct but interrelated themes were identified: External to Prosthesis, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Work and Social Impact. Those living with amputation(s) mentioned prosthetic-related issues affecting their work and social life, including difficulties wearing their prosthesis all day, the socket's rigidity, and the ability to participate in hobbies.Conclusions:The study provides new insights into the issues experienced during prosthetic rehabilitation, highlighting impacts beyond just physical health consequences. The study provides an evidence base for areas of the rehabilitation journey which could be improved to improve the quality of life of people with amputation(s).

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BackgroundIn the UK 55,000 people live with a major limb amputation. The prosthetic socket is problematic for users in relation to comfort and acceptance of the prosthesis; and is associated with the development of cysts and sores.ObjectivesWe have developed a prototype low-cost system combining low-profile pressure sensitive sensors with an inertial measurement unit to assess loading distribution within prosthetic sockets. The objective of this study was to determine the ability of this prototype to assess in-socket loading profiles of a person with an amputation during walking, with a view to understanding socket design and fit.MethodsThe device was evaluated on four transtibial participants of various age and activity levels. The pressure sensors were embedded in the subject's sockets and an inertial measurement unit was attached to the posterior side of the socket. Measurements were taken during level walking in a gait lab.ResultsThe sensors were able to dynamically collect data, informing loading profiles within the socket which were in line with expected distributions for patellar-tendon-bearing and total-surface-bearing sockets. The patellar tendon bearing subject displayed loading predominately at the patellar tendon, tibial and lateral gastrocnemius regions. The total-surface bearing subjects indicated even load distribution throughout the socket except in one participant who presented with a large socket-foot misalignment.ConclusionsThe sensors provided objective data showing the pressure distributions inside the prosthetic socket. The sensors were able to measure the pressure in the socket with sufficient accuracy to distinguish pressure regions that matched expected loading patterns. The information may be useful to aid fitting of complex residual limbs and for those with reduced sensation in their residual limb, alongside the subjective feedback from prosthesis users.

The majority of limb prostheses are socket mounted. For these devices, the socket is essential for adequate prosthetic suspension, comfort, and control. The socket is unique among prosthetic components as it is not usually mass-produced and must instead be custom-made for individual residual limbs by a prosthetist. The knowledge of what constitutes “good” socket fit is gained by expert prosthetists and technicians over years of experience, and rarely documented. The reliance on tacit knowledge makes it difficult to standardize the criteria for a well-fitting socket, leading to difficulties understanding the impact of socket fit. Despite its importance, the workflow for socket fitting is often overlooked in literature. Due to the customized nature of sockets, if information is provided in literature, generally only the type of socket and suspension mechanism is noted, with information regarding the fitting and manufacturing processes omitted. In this article, the concerns, issues and consequences arising from lack of upper and lower limb socket documentation are discussed from a researcher perspective, supported by healthcare professionals and socket fabrication specialists. Key changes are proposed to the way socket manufacturing and evaluation are documented to assist future research.