Temperature and moisture management and mitigation techniques in prosthetic sockets and liners: A rapid review

Many prosthesis users report skin discomfort and breakdown when wearing an artificial limb, often due to the accumulation of sweat and high temperatures inside the socket. In this review, we seek to identify the existing engineering solutions that have been developed for liner and socket thermal and moisture management. A total of 174 published articles were identified for review, and 16 manuscripts met our inclusion criteria for full review. We present a summary of the aims, methods, study populations, findings, and recommended future directions from each of these manuscripts. The approaches we identified generally fall into 1 or more of the following categories: liner material, socket material, socket structure modification or attachment, suspension and sealing techniques, or perforation. At least some solutions in each of these categories showed promise, as demonstrated by participant feedback or direct measurement of socket conditions. However, while most papers used standardized questionnaires or measurement instruments, the approaches, timelines, populations, and critical appraisal results varied greatly between studies. All studies focused on lower limb prostheses. Three studies were limited to only 1 participant, and the overall population was 86.9% male. While the approaches we found in the existing literature show promise, only half the studies included commercially available liners or manufacturing materials, and there is overall a clear need for additional studies. The number of studies in this domain has been growing steadily over the past decade, hopefully indicating that this gap will be filled.