Welcome to this Fourroux presentation of advancements
in prosthetics. We've put together this special DVD for you, the case manager, to help you
understand the challenges faced by prosthetic patients, as well as the latest in prosthetic
care and technology. The socket has been described as the most
important part of a prosthesis. Learn the basics of lower extremity socket design, fitting,
socket basics liners, socks, and more in our presentation entitled "inside the socket." Finally, proper physical therapy is essential
to an amputee's recovery. We invite you to join our staff physical therapist and see
what our patients see in this excerpt from our home exercise program. Just one of the
many tools we provide to help our patients achieve the freedom and independence they
deserve. The socket is the part of a prosthesis that
joins the artificial components to an amputees residual limb. It's custom made to conform
to his or her anatomy. The socket is an environment made up of different parts that work together
to secure the prosthesis safely and comfortably. These parts include the carbon fiber and plastic
outer shell, a liner that makes direct contact with the skin, socks, and padding. As an amputee's
body changes, so too does the fit of a socket. Patients must learn to use the parts of the
socket environment properly in order to maintain correct fit of a prosthesis. Let's review some key socket design features. At Fourroux, we use the latest technology
to create a socket that matches the shape of a patient's limb. The shape of a socket
is important to minimizing unwanted movement while an amputee walks. The socket shape also
determines how weight is distributed. In a poorly fitted socket, a patient's weight
rests on just a few points that make contact with the socket wall. This isn't just uncomfortable,
it can also cause injury. But by creating a total contact socket, each part of the residual
limb within the socket shares some of an amputee's weight. As time passes, the residual limb
will change shape and size. This is normal, but it means that there will
be changes in the fit of even the best made sockets. When the residual limb shrinks, it's
referred to as losing volume. Volume is lost because of changes in diet,
muscle atrophy, and other factors. When it happens, padding is sometimes used to relieve
pressure points and restore the socket to a proper fit. Padding takes up space within
the socket, and helps to "make up the difference." placement of padding varies at different times,
and also varies from person to person. Fourroux Prosthetists analyze volume loss
and custom fit padding in patient's sockets as needed. For this reason, it is important
that patients report any changes in socket fit or comfort. Another custom socket feature
is the way it is cut at the top. The top edge of the socket is not flat, but rather trimmed
into a unique shape. These trim lines provide support where needed, while also allowing
a patient's muscles to work. The shape of both the socket and it's trim
lines are different between aboveknee and below-knee amputees. Sockets are held in place by utilizing one
of four primary methods: the pin lock, lanyard lock, suspension sleeve, or suspension belt.
Each prosthesis will utilize only one of these. Now let's discuss liners, socks, and skin
irritation. The liner is the covering for a residual limb
that serves as the "middle man" between patient and socket. Its purpose is to cushion the
amputee's limb from the forces that come from the socket while standing and walking. There are many different kinds of liners.
They can be made of several types of material. Three of the most common liner materials are
silicone, urethane, and thermoplastic elastomer, or TPE. Liners can be custom made, or prefabricated
in many different sizes. They vary in thickness and flexibility. Different liners are made
for above knee and below-knee amputees. In general, liners are used to protect the residual
limb. They are usually very soft, and move with an amputee's body while wearing a prosthesis. At Fourroux, we choose the most appropriate
liner for each patient based on his or her individual needs. Just like a socket, liners
are custom trimmed at Fourroux to best suit each patient's socket environment. It's crucial
for patients to immediately report any problems with the liner trim lines. Patients should
never attempt to trim anything off of a liner. To apply a liner, a patient should begin by
inverting it, or turning it inside out. The liner is then carefully rolled onto the residual
limb, starting at the end, working upward. Using this method is important. The goal is
to make sure no air remains trapped inside the liner. If the liner is pulled on like
a sock, air trapped inside can cause irritation and skin breakdown. For those prostheses that utilize a pin lock,
the pin will be attached to the bottom of the liner. It is extremely important for patients
to align the pin correctly when applying a liner. As you can see with this clear socket,
a misaligned pin can make it difficult for the pin to lock into the docking device. Trying
to compensate by angling the pin into the dock can cause soreness on an amputee's residual
limb. It may also cause the pin to become jammed in the dock, making it impossible to
remove the prosthesis. When applying a liner, a patient should always
check to make sure the pin is straight out from the bottom of the residual limb. If it
isn't, the liner must be removed and re-applied. In below knee or BK amputees, there are two
common liner difficulties to be aware of. While walking with a prosthesis, a patient
may feel like his or her residual limb is lifting in and out of the socket. This is
called pistoning, and it varies depending on the liner. We'll talk more about pistoning
in our segment on skin irritation. Also, a BK patient may feel that his or her
skin is being stretched inside the liner when weight is placed on the prosthesis. This varies
depending on the socket. Patients noticing either pistoning while walking, or stretching
of the skin, should contact us right away to discuss the cause and solution. Above knee or ak liners have distinct front
and back sides that have been custom trimmed for each patient's contour. The front may
be marked with a black line. AK patient's should always check the position of the liner
before rolling it on. Liners are an essential part of the socket
environment. As a patient's liner ages, keep these things in mind. If an amputee's residual
limb changes volume significantly over time, a liner may start to feel too tight, or too
loose. In order for the liner to work correctly, it must first fit correctly. Also, with use over time, a liner may begin
to tear or develop abrasions. Damaged liners can cause discomfort and problems with a prosthesis.
Patients noticing these things should be instructed to contact a Fourroux Prosthetist right away.
