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- PTB sockets:
- provide some weight bearing support in the area of patella tendon and medial tibial flare;
- city of granite city il Suspension:
- important design considerations for both sockets include
- support (pressure distribution)
- control (based on limb socket interface)
- suspension (socket and/or corsete)
- alignment (angular and linear)
- total contact socket contour suspension is commonly used & can be one of two designs: patella
tendon bearing (PTB) or patella tendon supporting (PTS);
- ineffective suspension will manifest as pistoning during swing phase of gait;
- PTS sockets
- cover the condyles of the femur and have a high anterior wall enclosing the the patella;
- provides more support anteriorly & add improved stability & suspension;
- PTB w/ supracondylar cuff:
- advantages include a kinesthetic hyperextension stop;
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- addition of a supracondylar wedge of a flexible material to a PTB socket gives more
stability by providing locking fit over the condyle (these may be fixed or removable);
- PTB w/ sleeve suspension:
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- may cause dermatologic problems;
- neoprene sleeves can also be used to provide additional skin protection (especially for diabetics);
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- Standard Prosthetic Alignment: (corsetless prosthesis)
- knee flexion moment (and posterior foot placement):
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- encourages knee flexion between strike and foot flat;
- reduces length of keel encouraging knee flexion from midstance to heel off;
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- encourages "roll over" between mid stance and heel off;
- limits recurvatum (hyperextension) forces during genotype chart for porphyria
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- tends to load more pressure tolerant areas of the proximal tibia;
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- excessive knee flexion (at heel strike) may result from:
- heel too firm (knee flexes when the heel is fully compressed);
- foot too posterior
- foot too dorsiflexed
- interface too flexed
- forward placement of socket
- causes increased knee entension
- patellar pain
- instability is not a problem;
- varus alignment:
- initial foot placement is 12 mm inset in relation to midpoint of interface;
- narrows the base of support
- smooths horizontal displacement of center of gravity
- makes for efficient gait;
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- excessive varus moment may be caused by:
- foot positioned too medially;
- M-L interface is too large;
- there is laxity of the lateral collateral ligament;
- insufficient varus moment may be exhibited by:
- foot positioned too laterally;
- loading of pressure sensitive areas (such as a load on the fibular head);
- in coronal plane fulcrum is about the patellar tendon;
- gait is excessivel widened;
- excessive medial shoe wear;
- translation of socket:
- lateral translation:
- excessive translation causes valgus knee strain;
- medial translation: (excessive translation causes:)
- varus strain on knee;
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- anterior translation:
- slight anterior translation may be useful to minimize the tendency for knee hyperextension at heel strike (instead encourages knee
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- knee but excesssive cause knee to buckle into flexion at heel strike;
- posterior translation:
- tends to keep knee in hyperextension during stance phase;
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- Skin Tolerance:
- pressure tolerant areas:
- patellar ligament
- anterior compartment
- medial flare of the tibia
- distal end
- shaft of the fibula
- popliteal fossa
- pressure sensitive areas:
- anterior distal tibia
- fibular head
- crest of tibia
- peroneal nerve
- distal cut fibula
- lateral tibial condyle
- Common Prosthetic Problems:
- pistoning during swing phase of gait is usually caused by ineffective suspension system;
- pistoning during the stance phase is due to poor socket fit or volume changes in stump (may require a change in stump sock
- pressure related pain or redness should be corrected w/ relief of the prosthesis in the affected area;
- foot related problems:
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- too much knee hyperextension: (at heel off);
- foot too anterior or plantar flexed;
- insufficient flexion of the socket or posterior displacement of the socket;
- too soft heel cushion (knee flexes when the heel is fully compressed);
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