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Unformatted text preview: CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 361, pp 76-84 0 1999 Lippincott Williams & Wilkins, Inc. Socket Considerations for the Patient With a Transtibial Amputation John Fergason, CPU+,.F,$,O; and Douglas G. Smith, MD** This paper reviews the theory of transtibial prosthetic socket designs from a historic per- spective to the present. The patella tendon bearing socket originated in 1959, and is the standard from which the new alternative socket designs have evolved. Although the patella tendon bearing socket is still the most commonly prescribed socket for a transtibial prosthesis, the total surface bearing and hy- drostatic sockets are becoming increasingly ac- cepted. The total surface bearing socket still may incorporate the weightbearing character- istics of the patella tendon bearing socket, but often will he accompanied by a shock absorb- ing gel liner. The hydrostatic socket does not incorporate the standard patella tendon bear- ing design characteristics, but instead depends on a method of pressure casting that in theory produces a socket with equally distributed pressure over all of the residual limb soft tis- sue. These three designs are reviewed as cur- rent options for the socket portion of the transtibial prosthesis. The socket portion of the transtibial prosthe- sis is of significant importance in the overall outcome in the rehabilitation of the patient From the *Division of Prosthetics and Orthotics, De- partments of **Rehabilitation Medicine and tor- thopaedic Surgery, University of Washington, Seattle, WA; and $Harborview Trauma Center, Seattle, WA; and $Prosthetic Research Study, Seattle, WA. Reprint requests to John Fergason, CPO, University of Washington, 1959 North East Pacific Street, Seattle, WA 98195-6490. with a transtibial amputation. The prosthetic socket is the primary interface between the patient with an amputated limb and the ground. Although the body weight is axially loaded in the skeletal structures in an indi- vidual with an intact limb, it now must be carried through the soft tissues of the resid- ual limb in the patient with an amputated limb. At midstance during the gait cycle, the prosthetic socket is expected to support and distribute the entire weight of the patient with an amputated limb. Although there are numerous causes of a poor overall functional result in rehabilitation of patients with an amputated limb, these often may be compli- cated by a poor fitting socket. Even the best surgical technique cannot compensate for a poorly fitting prosthesis simply because the residual limb does not have the same weight- bearing capability as the plantar surface of the foot. The skill and experience of the prosthetist in designing and fitting a com- fortable and biomechanically correct socket are often the determining factors in patient rehabilitation once a successful amputation has been performed. An exact mold of a residual limb does not make a good socket....
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This note was uploaded on 09/02/2010 for the course BME 314 taught by Professor Frey during the Spring '08 term at University of Texas at Austin.
- Spring '08