Developments in the transtibial prosthetic socket fitting process

Abstract

A revolution in trans-tibial prosthetic design began at the end of World War II with the development of new materials and a dramatic improvement in the understanding of biomechanics. Early research was based mainly on the improvement of existing prosthetic design practice. Today, research has been focused on providing a better understanding of stump/socket interface biomechanics and improving socket fit by attempting to quantify the normal/direct stresses at the interface. The purpose of this review paper is to question whether research and prosthetic education/training to date has significantly improved our understanding of what makes a good socket. Although there is no doubt that advances in socket fitting techniques have been made what is not clear is the actual extent to which these advances have improved the quality of sockets fitted. It is suggested that a new approach is needed which can overcome some of the inherent problems of designing and manufacturing a comfortable high quality socket. It is also suggested that current research and education/training in the fields of pressure/interfacial interaction measurement and Finite Element Analysis techniques have limited potential to address many of these problems. There is also little evidence that current computer aided design systems offer any significant advantages over more conventional techniques.

Systematic review of effects of current transtibial prosthetic socket designs—Part 2: Quantitative outcomes

“…For example, exploring extensive residual limb load thresholds under dynamic and static situations would allow for the development of accurate pressure maps, perhaps revealing patterns across different socket designs and liners in relation to various ADLs. Previous reviews highlighted that there is a lack of research to help the understanding of socket residual limb biomechanical interactions, which documents residual limb soft tissue pressure tolerance and discomfort thresholds and relates this information to age, sex, and pathologies [56][57]. Over a decade has passed since these conclusions have been published, yet the lack of knowledge and understanding of these fundamental factors continues.…”

Physically Based Modelling and Simulation to Innovate Socket Design

“…Finite element modeling and analysis have been already adopted to simulate the socket-stump interaction, and over the past two decades, several researches have been performed [9][10][11][12][13]. Most of them have considered transtibial socket, only few transfemoral one.…”

Predicting Interfacial Loads between the Prosthetic Socket and the Residual Limb for Below‐Knee Amputees – A Case Study

“…However, studies have not lead to any tools that could aid the prosthetist in determining the socket fit by quantifying the regions of high and low pressure acting at the interface during the course of a normal fitting assessment session with the patient. It has been reported in a review of the current fitting process/research that ideas for novel future research have not yet been documented [9].…”