Beyond shape capture: The dynamic transtibial prosthetic interface and the continuing role of clinical expertise

Despite major advances in prosthetic components, digital workflows, and manufacturing technologies, substantial variability continues to exist in prosthetic interface outcomes. Socket fit, tissue tolerance, user comfort, and long-term functional success remain difficult to predict and standardize across individuals and clinical settings. While contemporary technologies such as CAD/CAM, pressure scanning, additive manufacturing, and emerging artificial intelligence applications may improve manufacturing precision and reproducibility, they do not fully address the biological and biomechanical complexities that influence interface performance. Residual limb tissues, suspension systems, gait mechanics, skin adaptation, and individual user characteristics interact dynamically throughout prosthetic use, limiting the ability of shape capture and manufacturing processes alone to determine successful outcomes. This perspective paper argues that prosthetic interface management should be viewed as a dynamic biological and biomechanical process rather than primarily a manufacturing challenge. Building upon a systems-based understanding of the interface, the paper proposes that successful outcomes emerge from the interaction between socket design, liner characteristics, suspension mechanisms, tissue biology, gait dynamics, and clinical decision-making. The paper further highlights the unique role of the prosthetist in observing long-term outcomes and emphasizes the continued importance of clinical expertise in an increasingly digital environment. Future progress in prosthetic interface management will likely depend on integrating technological innovation with rehabilitation science, biomechanics, tissue biology, and outcome-focused clinical practice.