A loose prosthetic socket can create a whole host of issues that affect the function and comfort of your prosthesis. Symptoms of a loose socket are not limited to feeling pressure along a bone or increased lower back pain, among others.
Prosthetic sockets are designed to fit snugly and comfortably, and you shouldn’t expect to have a super easy time sliding into your prosthesis. In fact, some resistance is expected, considering you're applying 2.5 times your body weight with each step. If you can easily apply your prosthetic leg by merely relying on hand strength, your residual limb is bound to bottom out in the socket.
So, how do you tighten a loose socket and regain security and comfort? We’ve compiled a few helpful techniques on snugging up your prosthetic socket.
Tighten with Gel
Not every amputation level loses volume in the same way. Some below-the-knee (BK) amputees tend to lose volume along the calf area while above-the-knee (AK) amputees tend to lose volume somewhat uniformly. But regardless of amputation level, there are a few gel products that can help tighten your prosthetic socket to improve suspension and comfort.
If you wear a prosthetic liner, you can tighten your socket by wearing a thicker gel liner. Most prosthetic liners are 6mm in the front and 3mm in the back. Therefore, upgrading to a 9mm thickness in the front can reduce your sock ply count by approximately 10-12 plies.
Simply swapping out your old liner for a thicker one has some disadvantages. Some people who've upgraded from a 6mm to a 9mm thickness report feeling like they are walking in a bowl of jello, and a thicker liner can shift your body weight line back 3-6 mm from what you’re used to. This alignment change can make it harder to walk up inclines until corrected by a prosthetist. And if you lead an active lifestyle, extra thick gel liners aren’t great for quick maneuvers; this is the result of a somewhat lessened proprioceptive feedback.
But, when you suddenly find yourself experiencing extreme discomfort caused by dropping into your socket too far, we think that the advantages of using a thicker gel liner far outweigh the disadvantages. And when you have lessened your sock ply by 10-12 plies, you will find that it’s easier to bend your knee, as a below-knee prosthetic user.
You can tighten your existing liner with either of these two products: Alps Skin Reliever Gel Sheath or Silipos Mineral Oil Gel Roll-On. They can most efficiently take up any slack within your socket. Choose the latter if you wear a BK prosthesis; merely add a gel roll-on underneath your current liner or socks to tighten the bottom portion of your socket, where most volume loss occurs.
The Alps Skin Reliever Gel Sheath is excellent for any level of amputation. It’s also compatible with other liners, socks, or foam liners. To use the gel sheath, merely swap out 5-10 socks plies with the Alps Skin Reliever.
If you’re an AK amputee and using a traditional suction socket, the gel products mentioned above will not work well since you need to use a donning aid to “pull” your limb into the socket. For traditional suction sockets, your prosthetist can carefully glue in padding. You can also use removable Amputee Essentials Calibrate Socket Adjustment Gel Pads or Össur Adjustment Pads, especially if you have an inner socket with outer frame design. You can add 4 calibrate long strips or the femoral Össur pad along the back area where the most suction loss will occur.
Tighten with Prosthetic Socks
If you wear a prosthesis that uses prosthetic socks, you should always apply enough to make your socket feel comfortably snug. The question of how many socks you should add is best answered only by yourself. You can figure this out by continuously adding sock plies until you can't apply any more socks and still comfortably don your prosthesis.
Sometimes after adding a 3-ply or 5-ply sock, you'll have to stand up and let yourself slowly sink into your socket. If you add a 3-ply prosthetic sock and you're able to step right into your socket, you may want to consider a thicker sock ply count.
When You Can’t Tighten Any Further
You might be in-between sockets and are currently awaiting a new socket to be fabricated. In the interim you need options. If you've tried the tips above, then you may want to consider a secondary suspension system to get you by. It's not uncommon to wear two forms of suspension.
If you wear a BK prosthesis, try adding a prosthetic leg sleeve for extra security. Meanwhile, AK prosthetic wearers can try low profile AK belts to mitigate suspension loss and any rotational issues.
Successfully managing a loose and uncomfortable socket with the techniques mentioned above is possible. Many options exist, from using gel products to prosthetic socks to help tighten your prosthetic socket. Loose sockets can cause greater perspiration and friction within your socket, and more sweat and friction can really wreak havoc on your skin in the form of blisters and rashes.
Please comment below if you tried any of the tips or techniques mentioned in this article. Feel free to comment below with any of your own methods.