2. Assessing the problem
Listen to patients complaint
Observe patient walking
Check stump – observe any redness/
abrasions caused by socket
Compare measurements of stump
with those on the measure chart
3. Common socket problems
Volume changes
Ischial seat
Medial wall and anterior corner
Trochanter area
Anterior wall
Distal end
Skin problems
6. Volume changes
If patient loses weight stump reduces in
volume
Solution ( temporary)
Add padding over anterior wall
Increase socks
Solution ( permanent)
Make new socket
7. Volume changes
Fluctuating volume
Some patients may have changing
volume throughout the day
Solution
Education on socket fit and how to
adjust with socks
( If more than 3 socks – need new
socket)
9. The ischial seat
Common complaint of new amputee
Pressure under ischial tuberosity
Normal for first few weeks
Patient should gradually adapt to
pressure
Particular problem if patient has little
muscle coverage
Add padding over seat?
10. The Ischial seat
Problem
Ischial tuberosity
falls inside socket
Prosthetic Reason
AP Diameter too big
Socket circumference
too large
Edge of seat too
round
15. The Ischial seat
Problem :
Ischium not in contact with the seat
Solution:
Check Volume – does patient have
oedema? Elevation / Bandaging
Make new socket
16. The ischial seat
Problem:
Seat is too wide
Prosthetic Reason:
Socket has not been
carefully trimmed- will
rub against other
buttock and cause
discomfort when
sitting
17. The Ischial seat
Problem :
Seat too wide
Solution:
Width of seat reduced by grinding
material away
19. The Ischial seat
Problem :
Pain –Burning sensation
Solution:
Heat and adjust – increase radius or
corner between ischial seat and
Posterior socket wall
20. Medial wall and Anterior Corner
Problem:
Pressure on pubic
ramus causing
pain
Prosthetic Reason:
Medial wall too
high
Anterior wall too
low
Seat incorrect
21. Medial wall and anterior corner
Problem :
Pressure on pubic ramus
Solution:
Lower and increase flare on medial brim
Heat and reshape
Make new socket
22. Medial wall and Anterior Corner
Problem:
Adductor roll
Prosthetic Reason:
ML dimension too
small
Medial wall too low
23. Medial wall and anterior corner
Problem:
Adductor roll
Solution:
Difficult to solve
New Socket but patient will be initially
uncomfortable
28. Distal end
Problem:
Pain/ discomfort on end of femur
Prosthetic Solution:
Increase no of socks
Adjust socket – add padding over
Scarpa’s triangle
If very big- make new socket
31. Distal end
Problem:
Distal end inflamed,
red, hot-
Congestion
Prosthetic Reason:
Lack of total contact
– socket too tight
proximally and
loose distally
33. Skin Problems
Hot climate – bacterial infections
Solution
Prevention! – wash stump , dry well ,
keep clean , wash socks frequently
If infection- refer to doctor: may need
antibiotics, rest
Do not wear prosthesis until wound
healed
34. Case study 1
Your patient, a young male aged 24 ,
attends for a 3 month review after he had
his first prosthesis fitting. He is an army
soldier.
He is wearing 2 thick socks .The ischial
tuberosity is a little far forward on the
ischial seat area. He complains of discomfort
on the medial brim
When you remove the socket there is some
discoloration both on the medial proximal
area of his stump but also a little bit of
redness over the distal end of the femur
which is quite prominent
35. Case study 2
Your patient attends the clinic for an
unscheduled adjustment.
He is an elderly man aged 67, who had his
transfemoral amputation 4 months earlier.
He was fitted with his first prosthesis 3
weeks earlier. He lives in Kibosho.
He has a short residual limb, poor muscle
tissue consistency, and his muscles are a
little weak. He weighs 65 kg.
36. Case study 2
He complains that he is unable to wear the
prosthesis as it causes him pain whenever
he stands on the leg. He asks you to cut
away the ischial shelf area as this is the
source of his pain.
Fit appears correct . The ischium is correctly
located on the ischial seat. Measurements
also correct . When observing him walking
however you can see he is in a lot of pain
when he bears weight.
37. Case study 3
A long standing prosthetic limb user attends
for her first fitting at the clinic. 53 yr,
mother , of 3 children
She has had a prosthesis for 15 years and
has a large adductor roll as a result of
previous uncorrect fitting sockets
You have correctly accommodated it in your
new socket. The ischial tuberosity is
correctly located on the ischial seat. The
volume appears to be correct.
38. Case study 3
However your patient complains of
discomfort on the ischial tuberosity and says
she does not like to put weight on it. She
says that unless you make it comfortable
she will go back to wearing her previous
prosthesis which is far more comfortable
although the proximal circumference is very
small .
39. Case study 4
A 48 year old man from Kiboriloni attends the clinic
for an adjustment.
He had a transfemoral amputation due to diabetes 3
years previously. He has had his prosthesis for 2
years
He complains the socket is loose, although when you
observe him walking there is minimum pistoning
When you observe the fit, there is a gap distally
where the pull hole is. The ischial tuberosity is
located above the ischial seat. When you check the
measurements the socket appears to be tight.
