title: Comparison of Rectified and Unrectified Sockets for Transtibial Amputees.
abstract: The current method for fabricating prosthetic sockets is to modify a positive mold to account for the non-homogeneity of the residual limb to tolerate load (i.e., rectified socket). We tested unrectified sockets by retaining the shape of the residual limb, except for a distal end pad, using an alginate gel process instead of casting. This investigation compared rectified and unrectified sockets. Forty-three adults with unilateral transtibial amputations were tested after randomly wearing both rectified and unrectified sockets for at least 4 weeks. Testing included a gait analysis, energy expenditure and Prosthesis Evaluation Questionnaire (PEQ). Results indicated no differences between sockets for gait speed and timing, gait kinematics and kinetics, and gait energy expenditure. There were also no differences in the Prosthetic Evaluation Questionnaire and 16 subjects selected the rectified socket, 25 selected the unrectified socket, and 2 subjects selected to use both sockets as their exit socket. Results seemed to indicate that more than one paradigm exists for shaping prosthetic sockets, and this paradigm may be helpful in understanding the mechanisms of socket fit. The alginate gel fabrication method was simpler than the traditional method. The method could be helpful in other countries where prosthetic care is lacking, may be helpful with new amputees, and may be helpful in typical clinics to reduce costs and free the prosthetist to focus more time on patient needs.
authors.affiliation: Human Performance Laboratory, Department of Neurosurgery, Washington University Medical School, St. Louis, MO.
authors.forename: Jack R
authors.initials: JR
authors.lastname: Engsberg
authors.forename: S Wayne
authors.initials: SW
authors.lastname: Sprouse
authors.forename: Mary L
authors.initials: ML
authors.lastname: Uhrich
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Ziegler
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Luitjohan
references.citation: Eng Med. 1986 Jan;15(1):27-34
references.pmid: 3699235
references.citation: J Prosthet Orthot. 2008;18(1):1-7
references.pmid: 18776945
references.citation: J Orthop Res. 1988;6(2):215-22
references.pmid: 3343627
references.citation: South Med J. 2002 Aug;95(8):875-83
references.pmid: 12190225
references.citation: Am J Public Health. 1999 Aug;89(8):1222-7
references.pmid: 10432910
references.citation: Prosthet Orthot Int. 2002 Dec;26(3):243-50
references.pmid: 12562072
references.citation: J Pediatr Orthop. 1986 May-Jun;6(3):291-8
references.pmid: 3711320
references.citation: Arch Phys Med Rehabil. 1995 Jan;76(1):39-44
references.pmid: 7811172
references.citation: Prosthet Orthot Int. 1985 Apr;9(1):17-22
references.pmid: 4000906
references.citation: Arch Phys Med Rehabil. 1993 Nov;74(11):1225-31
references.pmid: 8239969
references.citation: Adv Data. 1997 Nov 13;(292):1-9
references.pmid: 10182811
references.citation: J Bone Joint Surg Am. 1964 Mar;46:335-60
references.pmid: 14129683
references.citation: J Rehabil Res Dev. 1995 May;32(2):111-9
references.pmid: 7562650
references.citation: J Appl Physiol. 1974 Apr;36(4):440-3
references.pmid: 4820326
references.citation: J Bone Joint Surg Am. 1976 Jan;58(1):42-6
references.pmid: 1249111
references.citation: Arch Phys Med Rehabil. 1991 Aug;72(9):657-61
references.pmid: 1859261
references.citation: Prosthet Orthot Int. 1992 Dec;16(3):183-8
references.pmid: 1491952
references.citation: Arch Phys Med Rehabil. 1974 Mar;55(3):111-9
references.pmid: 4817680
references.citation: Phys Ther. 1994 Oct;74(10):943-50
references.pmid: 8090845
references.citation: J Rehabil Res Dev. 1996 Jul;33(3):267-78
references.pmid: 8823674
references.citation: J Biomech. 1988;21(5):361-7
references.pmid: 3417688
references.citation: Arch Phys Med Rehabil. 1998 Aug;79(8):931-8
references.pmid: 9710165
references.citation: Arch Phys Med Rehabil. 1994 Dec;75(12):1335-41
references.pmid: 7993173
references.citation: Gait Posture. 2000 Oct;12(2):162-8
references.pmid: 10998614