Developments in the trans-tibial prosthetic socket fitting process: a review of past and present research

A revolution in trans-tibial prosthetic design began at the end of World War II with the development of new materials and a dramatic improvement in the understanding of biomechanics. Early research was based mainly on the improvement of existing prosthetic design practice. Today, research has been focused on providing a better understanding of stump/socket interface biomechanics and improving socket fit by attempting to quantify the normal/direct stresses at the interface. The purpose of this review paper is to question whether research and prosthetic education/training to date has significantly improved our understanding of what makes a good socket. Although there is no doubt that advances in socket fitting techniques have been made what is not clear is the actual extent to which these advances have improved the quality of sockets fitted. It is suggested that a new approach is needed which can overcome some of the inherent problems of designing and manufacturing a comfortable high quality socket. It is also suggested that current research and education/training in the fields of pressure/interfacial interaction measurement and Finite Element Analysis techniques have limited potential to address many of these problems. There is also little evidence that current computer aided design systems offer any significant advantages over more conventional techniques.