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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 86-88 |
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Design and fabrication of improved socket system, the triple-side wall expansion socket system for better comfort of transtibial amputees
Sahil Rasiklal Patel, Gouri Mahato
Department of Prosthetics and Orthotics, Sumandeep Vidyapeeth Deemed to be University, Village Piparia, Taluka Waghodia, Vadodara, Gujarat, India
| Date of Submission | 28-Dec-2022 |
| Date of Decision | 07-Jan-2023 |
| Date of Acceptance | 14-Jan-2023 |
| Date of Web Publication | 16-May-2023 |
Correspondence Address:
Dr. Sahil Rasiklal Patel
Department of Prosthetics and Orthotics, Sumandeep Vidyapeeth Deemed to be University, Village Piparia, Taluka Waghodia, Vadodara - 391 760, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_23_22
Background: Transtibial prosthesis is a device specifically replaces the part of the leg that is below the knee joint. Mostly the amputees are dependent on others and live a sedentary life when they cannot function effectively and efficiently with their prosthesis.[1] To wear a prosthesis whole day long requires better comfort as well as the function along with the other components. The prosthetic socket is the main connector between the residual and prosthesis. Poor socket fitting directly affects socket comfort, function, and workability of the user, making them more dependent and psychologically depressed and weaker and creating challenges for the user, family, and rehabilitation professionals.[2] Aims and Objective of the Study: The purpose of the research work is to design and fabricate a comfortable socket design which can be fitted to provide better comfort to the users. Methodology: The study is based on custom-made socket where modification needs to be done on the socket part and in the fabrication procedure. Results: During fitment, 70% of users found it significantly comfortable and improved in ambulation. Conclusions: For the triple-side wall expansion socket system, it can be concluded that change in socket for better function is also could be an alternative for troublesome residual limb amputees.
Keywords: Comfort, transtibial prosthesis, triple-side wall expansion socket system
How to cite this article:
Patel SR, Mahato G. Design and fabrication of improved socket system, the triple-side wall expansion socket system for better comfort of transtibial amputees. J Integr Health Sci 2022;10:86-8 |
How to cite this URL:
Patel SR, Mahato G. Design and fabrication of improved socket system, the triple-side wall expansion socket system for better comfort of transtibial amputees. J Integr Health Sci [serial online] 2022 [cited 2023 Jun 9];10:86-8. Available from: https://www.jihs.in/text.asp?2022/10/2/86/377149 |
| Introduction | |  |
Transtibial prosthesis substitutes the function of missing anatomical segment(s) from below the knee joint to the foot. The prosthetic socket is the connection between the residual limb and the prosthesis.[1] The socket distributes the forces and pressure through the residual limb. The more closely the socket the better the function and comfort of the prosthesis traditional patella tendon bearing (PTB)[2] and supracondylar PTB Socket designs consist of a soft insert and an unyielding hard laminated socket. A triple-side wall expansion socket system includes a thin walled, flexible shell as an inner insert, and areas of the flexible shell are cut away. These areas were made with relief chambers in the anterior-lateral and medial-posterior walls of the socket.[2],[3] New technology has been used in prostheses for below-knee amputees and the availability of new materials, can be used for a light weight more functional, but more expensive prostheses.[3] Flexible, lightweight total surface bearing socket type,[4],[6],[8] and atmospheric suspension systems had been introduced.
For now, however, a great majority of below-knee amputees can benefit by utilizing the new triple-side wall expansion socket system. Common tools, equipments and materials were used (used in conventional and new socket system) for this system.
This triple-side wall expansion socket system is indicated for active patients and patients who have poor pressure tolerance, invaginated scars, prominent bony structures, spurs, adhesion, located bursal enlargement, and short residual limb with limited pressure distribution.[5]
| Methodology | | |
For making of the socket, material and equipment were common, which also used for making conventional and other new socket system for below knee prostheses from workshop. The casting and measurements are made as PTB supracondylar (PTB SC) sockets.[2] The cast modification is done the same as the PTB SC socket and the model constitutes a faithful reproduction of the stump. It's done same to the model in such a way that, when a socket is fabricate over it, the shape of the socket will be enough to distribute the weight of the body over pressure tolerant areas. For best suited to weight-bearing while at the same time relieving pressure sensitive areas from responsibility for bearing more weight than will be comfortable. However, substantial plaster buildups for bony areas should be avoided. The distal end of the positive mold should be extended about 3/8 inches. This can minimize the possibility of end bearing for the active patient.
A soft distal end pad can be employed for the maintenance of total-contact socket fit. The expansion chambers are located over the apex of the medial condyle, and/or tibial crest, and/or fibula head. In those areas, pads were attached for making expansion chamber. Anterior expansion [Figure 1], throughout the tibial crest. The tibial crest cannot be a weight tolerant area because of the high unit pressures that would necessarily develop over the knife-like ridge. Lateral expansion [Figure 2], because the common peroneal nerve passes on the lateral side below the head of the fibula, only very low pressure can be tolerated in that area. Medial expansion [Figure 3] for the apex of the medial femoral condyle and hamstring tendon minimize the risk for hamstring injury. The bubble drape system is used here for molding, in which the bubble of softened polypropylene sheet is draped over the mold to get a strong socket. A thick sheet of polypropylene is required to obtain the same thickness all over the socket for check socket. Check socket is used for checking the volume contamination of soft tissues and amount of pressure created on the same.[7],[9]
After that the check socket can be used as inner socket or a laminated inner flexible socket can also be made with 3/4 layers of nyglass stockinette and resin. Moreover, final socket is laminated over the inner socket, with 5/7 layers of stockinette and carbon fibers and resin. In the inner flexible socket, expansion chambers should be cut carefully and smoothed it for comfort.
| Results | | |
Four patients were fitted with this socket system. The triple-side wall expansion socket system was preferred by 70% of patients who were already using with their existing transtibial socket. The socket comfort score is significantly improved in comfort, function, and with pain reduction and also helps in less energy expenditure, by the triple-side wall expansion socket system [Table 1]. | Table 1: Result of ambulation achieved with the triple-side wall expansion socket prosthesis and patient's existing socket
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| Discussion | | |
Designing and fabricating a functional triple-side wall expansion socket system that can take over the functions of an amputated body part without any limitation as compared to other socket systems, has been a challenge to the prosthetist.
The outer socket was laminated with layers of stockinette, acrylic resin. The socket is then attached to a pylon, foot adaptor, and solid ankle cushion heel foot.[10] All patients were fitted with both below-knee prosthesis socket system (their old socket) and below knee prosthesis, with triple-side wall expansion socket system, which they used at different times and were allowed to walk with each of them through a distance of 100 m and observations/evaluations the gait pattern achieved with each of the prostheses were made by observations the different gait phases at different instances. In the gait pattern with the research/improved prosthesis, two gait phases, stance and swing phases, were present and achieved with ease.[11] Patients attested to; no pain, minimal energy expenditure, and moderate comfort. The steps per minute is improved from 127 steps to 153 steps with more significant comfort [Table 1].
| Conclusions | | |
The triple-side wall expansion socket system is originally designed to progress the comfort level for below-knee amputee including active patients, aged patients, and those having trouble daily activities like traveling, fieldwork, and some athletic practices. However, the design also offers solutions for easy donning doffing and troublesome residual limbs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Green H Inc. Lower Limb Prosthetics, 1982 Revision. New York City: New York University; 1983.  |
| 2. | Radcliffe CW, Foort J. The Patellar-Tendon-Bearing Below-Knee Prosthesis. Berkeley: University of California; 1961. |
| 3. | Staats TB. Advanced prosthetics systems for below knee amputees. Orthopedics 1985;8:210-25. |
| 4. | Hachisuka K, Dozono K, Ogata H, Ohmine S, Shitama H, Shinkoda K. Total surface bearing below-knee prosthesis: Advantages, disadvantages, and clinical implications. Arch Phys Med Rehabil 1998;79:783-9. |
| 5. | Leonard JA Jr., Meier RH. Upper and lower extremity prosthetics. In: Delisa JA, editor. Rehabilitation Medicine Principle and Practice. 3 rd ed. Philadelphia: Lippincort Williams and Wilkins; 1998. p. 669-96. |
| 6. | Toshiko Takano, Koichiro Dozono, Kenji Hachisuka, Tetsuya Okazaki, Hajime Ogata. Total surface bearing prosthesis for a below-knee amputee with skin erosion.The Japanese Journal of Rehabilitation Medicine 31 (2), 126-129, 1994 |
| 7. | Schuch CM: Thermoplastic applications in lower extremity prosthetics. J Prosthet Orthot 1990;3:1-8. |
| 8. | Corell EB. Normal Pressure Distributions Applied by Total Contact Below Knee Prostheses. Technical Report No. 9, Orthotics Research Project, Department of Physical Medicine and Rehabilitation, University of Michigan; 1969. |
| 9. | Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs-Part 1: Qualitative outcomes. J Rehabil Res Dev 2015;52:491-508. |
| 10. | Childers WL, Wurdeman SR. Transtibial amputation: Prosthetic management. In: Krajbich JI, Pinzur MS, Potter BK, Stevens PM, editors. Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles. 4 th ed. Rosemont, IL: American Academy of Orthopedic Surgeons; 2015. p. 493-508. |
| 11. | Czerniecki JM. Rehabilitation in limb deficiency. 1. Gait and motion analysis. Arch Phys Med Rehabil 1996;77:S3-8 |
[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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