1200 - Adjustable Prosthetic Sockets Are a Solution to Skin Breakdown for Persons with Lower Limb Loss: A Case Study

Skin breakdown with conventional hard sockets is a frequent occurrence reported in over half of transtibial prosthesis users.  Adjustable sockets are now available that better accommodate residual limb shape and size and hold promise for reducing skin breakdown.  We present a 57-year-old male with transtibial amputation who entered a research study at the University of Pennsylvania. In the year prior to study entry, the patient suffered frequent, almost constant, skin breakdown on his distal residual limb and anterior tibia due to limb volume changes and excess pressures generated by his conventionally fabricated hard socket.

Case Description: The subject was fit with an adjustable, immediate fit, transtibial prosthesis made by iFIT Prosthetics^®. After completing a two-week home trial, he rated the adjustable prosthesis 62 out of 70 on the adapted Prosthetic  Evaluation Questionnaire, compared to a score of 20 for his conventional prosthesis.  He abandoned his conventional prosthesis in response to the improved comfort of the adjustable study prosthesis.  The subject was followed for over a year and continued to wear this adjustable prosthesis exclusively with no skin breakdown.

Discussions: With conventionally fabricated hard sockets, residual limb changes can result in a poorly fitting socket and skin irritation frequently occurs.  This can lead to overt skin breakdown.  In persons with diabetes, healing these residual limb wounds can be time consuming and functionally limiting.  Insurance limitations and fabrication timelines for conventional sockets often restrict the number of prostheses a person can obtain annually. In this study, a novel adjustable prosthesis effectively prevented skin breakdown in a subject who suffered from frequent skin lesions with his conventional device prior to the study.  

Conclusions:

Adjustable sockets can prevent skin breakdown in persons with transtibial limb loss. People who are expected to have limb volume changes are at particularly high risk for this preventable complication.