Protecting Limb Health Through Optimal Socket Pressure Distribution
Abstract
The prosthetic socket provides the connection between the person with an amputated limb and the prosthetic limb. Since every residual limb is different, a prosthetist custom makes a prosthetic socket for every patient. Currently, the clinical practice of making a prosthetic socket is viewed as an art form because it is dominated by the clinician’s skill and experience and lacks objective measures to determine if they have achieved the best socket fit. The fit of the prosthetic socket has been identified as a primary concern for prosthesis users. Despite this concern for a comfortably fitting socket, there are still high levels of dissatisfaction with prosthesis comfort. Even more concerning is the high prevalence of skin injuries that occur, with socket fit reported as a contributing factor. Some groups have attempted to quantify interactions occurring at the interface such as pressure and motion to help aid clinical guidelines; however, they have failed to translate their findings out of the laboratory. One explanation is that these outcomes do not connect the findings to the impact on skin health. Our group has developed methods to quantify limb health using objective measurement techniques common in the wound healing space. Our group has also developed a tool to systematically approach socket design and fitting. The objective of this research is to investigate how the shape of the socket affects pressures placed on the limb and therefore affects residual limb health using a standardized approach for designing the socket. Data regarding the subject’s skin tissue will be collected and used to drive the design of the socket in a digital workspace. This process will control how the socket is formed so the effect of socket pressure, and therefore fit, on the health of the residual limb can be systematically studied. The study population will be divided into two groups, where each group will test one of the above methods of socket design after completing the standard of care. The outcomes used to assess differences include limb health and functional performance measures as well as subject-reported responses. This will be a randomized, longitudinal crossover study to compare objective tissue health and subjective user responses collected from transtibial amputee participants wearing definitive prosthetic sockets that differ in their design. Ultimately, this research can change the way prosthetic sockets are designed and fit. Not only can this work help validate new techniques for designing more comfortable sockets, it can also reveal critical socket fit parameters that can guide clinical care and decision making to create more standardized outcomes. The standardization of outcomes is needed to reduce the high levels of discomfort and skin injury currently being reported. This is particularly important for those patients with compromised sensation in their residual limbs since the current artisan-based approaches rely heavily on feedback from the patient to guide socket shape modifications. The research will also be vital to the development of new procedures and technologies that can collect and automatically adjust the shape of a socket design digitally. It is expected that future clinical trials will be based off the results of this award. These clinical trials will help refine and optimize the parameters that stem from this proposed work. The project is expected to last 3 years, with clinical research beginning early in the first year of the award. Improvements in protective armor and medical practices have increased combat injury survival rates. Thus, the number of Service personnel surviving with amputations has increased with current estimates exceeding 1700 surviving amputees, many of whom have sustained more than one limb amputation. While a primary goal of many military personnel having an amputation is to lead normal, productive lifestyles, an important secondary goal is the potential to return to active-duty sta
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210469
Entities
People
- Matthew Wernke
Organizations
- United States Army
- Willow Wood (United States)